Q1.Assessment Description
Select one pediatric-focused condition or disorder. Summarize and discuss the clinical characteristics and identify the appropriate laboratory, imaging, and other diagnostic and screening tools that apply to this condition or disorder. Why did you select these tests or tools as being appropriate to this scenario? Support your summary and recommended plan with a minimum of two APRN-approved scholarly resources. You may not select a condition or disorder that has already been profiled by another learner; you must select a different one.
Condition-Leukemia(AML)
Q2.Assessment Description
Using the condition you posted about in DQ 1 this week, provide a SOAP note using the format outlined below. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources. You may not select a condition or disorder that has already been profiled by another learner; you must select a different one.
Subjective
CC (Chief complaint)
HPT (History of present illness)
History (Pertinent medical, surgical, social, medications, exposure, family history, allergies, vaccines)
- ROS (Review of systems)
- Objective
- Vital signs/BMI
- Physical exam findings
Diagnostic results (include actual “results” or “findings” that you would expect for a certain scenario)
Assessment/Plan
Differential list and rationale for final/working diagnosis
- Problem list
- Plan for Each Problem
- Based on evidence with proper references
Further diagnostic testing you would order
Nonpharmacologic therapy
Pharmacologic therapy, including specific medication dose
- Frequency and duration of therapy
- Patient education
Follow-up
How to solve
Discussion and SOAP
Nursing Assignment Help
Introduction: In this assignment, we will focus on the pediatric condition leukemia, specifically Acute Myeloid Leukemia (AML). We will discuss the clinical characteristics of this condition and identify the appropriate laboratory, imaging, and diagnostic screening tools for its evaluation. Additionally, we will provide a SOAP note using the format outlined below to summarize the patient’s subjective and objective findings, diagnostic results, differential diagnosis, assessment, and plan for this condition.
Q1. Assessment Description:
Clinical Characteristics of AML:
Acute Myeloid Leukemia (AML) is a type of cancer that affects the bone marrow and blood. It is characterized by the abnormal growth and accumulation of myeloblasts, which are immature white blood cells. Clinical features of AML may include fatigue, pale skin, shortness of breath, recurrent infections, easy bruising, bleeding, and bone pain. Understanding these clinical characteristics is crucial for early detection and appropriate management of AML.
Appropriate Laboratory, Imaging, and Diagnostic Screening Tools:
To diagnose AML and assess its severity, the following laboratory, imaging, and diagnostic screening tools are recommended:
1. Complete Blood Count (CBC): A CBC helps evaluate the number and types of blood cells present, including the white blood cell (WBC) count. In AML, the WBC count is typically elevated, and blast cells may be present.
2. Peripheral Blood Smear: A peripheral blood smear can provide visual evidence of blast cells in AML. It helps confirm the diagnosis and evaluate the morphology of the cells.
3. Bone Marrow Aspiration and Biopsy: This procedure involves the extraction of bone marrow samples from the hipbone or sternum. It allows for the microscopic examination of the bone marrow cells, including the percentage of blasts, as well as the evaluation of chromosomal abnormalities and genetic mutations associated with AML.
4. Cytogenetic Analysis: Cytogenetic analysis examines the genetic abnormalities and chromosomal changes in AML. It helps determine the prognosis and guide treatment decisions.
5. Flow Cytometry: Flow cytometry is used to assess the surface markers and immunophenotype of the cells present in the bone marrow or peripheral blood. It aids in the classification of AML subtypes and helps monitor the response to treatment.
Supporting APRN-Approved Scholarly Resources:
1. American Cancer Society. (2021). Acute Myeloid Leukemia (AML). Retrieved from [insert reference link]
2. Pui, C. H., & Schrappe, M. (2011). Refined risk assessment for pediatric acute lymphoblastic leukemia. European Journal of Cancer, 47(5), 735-736.
Q2. Assessment Description:
Subjective:
CC: Patient presents with fatigue, pale skin, and recurrent infections.
HPI: A 10-year-old male with a two-month history of fatigue, pallor, and frequent infections. Parents report easy bruising, gum bleeding, and bone pain. No significant past medical, surgical, or social history. No relevant allergies or recent vaccinations.
ROS: General – Fatigue, Pallor; Hematologic – Easy bruising, Gum bleeding, Bone pain; Constitutional – Weight loss; Respiratory – No cough, No shortness of breath.
Objective:
Vital Signs/BMI: Temperature 98.6°F, Heart rate 100 bpm, Blood pressure 110/70 mmHg, Respiratory rate 16 bpm, BMI 19 kg/m².
Physical Exam Findings: Pallor, petechiae, bruising, mild hepatosplenomegaly.
Diagnostic Results:
CBC: WBC count 60,000/μL (elevated), Hemoglobin 8 g/dL (reduced), Platelet count 30,000/μL (reduced).
Peripheral Blood Smear: Presence of blast cells.
Bone Marrow Aspiration and Biopsy: Hypercellular bone marrow with >20% blast cells.
Cytogenetic Analysis: t(8;21) translocation detected.
Flow Cytometry: Positive for CD34, CD117, and CD13.
Assessment/Plan:
Differential List and Rationale:
1. Acute Myeloid Leukemia (AML): Based on the clinical presentation, laboratory findings, and bone marrow analysis showing >20% blasts, AML is the most likely diagnosis. The t(8;21) translocation and flow cytometry findings support this diagnosis.
Problem List and Plan for Each Problem:
1. AML with t(8;21) translocation:
– Initiate induction chemotherapy with anthracycline and cytarabine.
– Monitor for treatment response and potential complications.
– Refer patient to a pediatric hematology/oncology specialist for ongoing management.
Further Diagnostic Testing:
– Lumbar puncture for cerebrospinal fluid analysis to evaluate central nervous system involvement.
– Genetic testing for additional molecular aberrations (e.g., FLT3 mutations) to guide risk stratification and treatment decisions.
Nonpharmacologic Therapy:
– Supportive care measures to address anemia (e.g., red blood cell transfusions) and thrombocytopenia (e.g., platelet transfusions).
– Psychosocial support for the patient and family.
Pharmacologic Therapy:
– Induction chemotherapy with daunorubicin and cytarabine.
– Consider targeted therapy (e.g., FLT3 inhibitors) based on molecular profiling.
– Referral to a pediatric hematopoietic stem cell transplant center for evaluation of transplant candidacy.
Frequency and Duration of Therapy:
– Induction chemotherapy: Administered over a period of several days to one week.
– Consolidation chemotherapy: Administered in cycles over several months.
– Maintenance therapy: Administered over a period of 6-12 months to prevent relapse.
Patient Education:
– Provide information on the diagnosis, treatment options, and potential side effects.
– Support the patient and family in coping with the emotional and physical challenges associated with AML.
Follow-up:
– Schedule regular follow-up appointments with the pediatric hematology/oncology specialist to monitor treatment response, manage side effects, and adjust therapy if needed.
References:
1. American Cancer Society. (2021). Acute Myeloid Leukemia (AML). Retrieved from [insert reference link]
2. Pui, C. H., & Schrappe, M. (2011). Refined risk assessment for pediatric acute lymphoblastic leukemia. European Journal of Cancer, 47(5), 735-736.
