I.

INTRODUCTION Generally, leukemia means cancer of the blood that starts normally but begins to change and grow uncontrollably. Ii is called acute because of the sudden and quick occurrence and lymphiocytic because it obviously affects the lymphocytes hat has a greater role in the immune system of a person. Healthy lymphocytes fight bacterial and viral infections. In people with ALL, new lymphocytes do not develop into mature cells, but stay as immature cells called lymphoblasts. There are three different types of lymphocytes: T cells, B cells, and natural killer (NK) cells. Generally, T cells fight infections by activating other cells in the immune system and by destroying infected cells, B cells make antibodies, and NK cells fight microbes and cancer cells. About 85% of people with ALL have the B-cell subtype and about 15% have the T-cell type. The NK-cell subtype is quite rare.

shows estimated incidence (age-standardized on the world population) of leukaemia in children aged under 15 years for those countries of the European Region with population-based data available for years around 2000 (15). The average age-standardized incidence in participating areas was 46.7 cases per million per year. National estimates ranged from 35 cases per million per year in Israel to 60 cases per million per year in Italy and Malta. (WHO, 2009)

Philippines: leukemia

ranks fifth in over-all mortality. It is the fourth leading cause of death among Filipino males, and sixth among Filipino females. According to data from the DOH, leukemia is among the top three cancer killers of Filipino males from 1991 to 1995, along with lung and liver cancers. From 1993 to 1995, the incidence of leukemia was at 6.6 per 100,000 Filipinos. Leukemia is also the leading cancer among children ages 0-14, comprising 47.8% of all cases among boys and 48% among girls.
Region X (malignant Neoplasm) (DOH Phil; selected causes of death) rank 9 on the list 1,124 (2006) 1,095 (2005) 1,020 (2004) 983 (2003) 848 (2002; lungs) 803 (2001; lungs)

II.

ASSESSMENT

A. SOCIO-DEMOGRAPHIC DATA This is a case of 15 year old Male Filipino student. He is the only son. Patient X is a junior student from a Prestigious School in the city. Patient X was admitted last February 12, 2013 for the first time at Capitol University Medical City. Patient Xs current weight is 48.75 kg and stands 56 tall. He has no known family history of Cancer of any type.

Vital Signs

Vital signs BP

Day 1 100/60 mmHg

Day 2 100/60 mmHg 92 bpm 32cpm 36.7 C 90%

Day 3 100/70 mmHg 91 bpm 18 cpm 36.6 C 96%

Pulse Rate Respiratory Rate Temp. O2 sat.

89 bpm 28cpm 36.5 C 97 %

Chief Complaint Patient X was brought to the hospital due to exertional dyspnea and easy fatiguability.

History of Present Illness Patient was generally well until 2 months prior to admission noted progressive pallor which started from the nail beds that progresses to other parts no consultation was done. A week before the admission while on a strenuous activity, teachers and classmates noticed that patient was generally pallor. Patient also complained of shortness of breath and easy fatigability thus, brought patient to CUMC ER.

General Appearance Upon assessment, patient X was conscious and responsive but was generally weak and pale. He can answer to questions appropriately without any delay but confessed he easily get tired. Hes hooked with PNSS 1L @ KVO rate infusing well at the left arm. Hes also given oxygen inhalation at 4LPM via nasal cannula.

B. NUTRITION AND METABOLIC PATTERN Pre-hospitalization: Patient X eats three times a day, and if by chance he grabs ample time to eat snacks in between meals as long as hes not busy in school. H e consumes -1 cup of rice every meal with his desired viand in a fair appetite.

During hospitalization: Patient X has fair appetite consuming only half of share. He was advised to eat food that are nutritious for strong immune system. Together with medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. This part of the study will present the normal and regressed health function of Patient X pointing out the salient, manifestations of the disease. HEAD Day 1 Head Facial movement Fontanels Hair Closed Fine; Closed evenly Fine; Closed evenly Fine; evenly Day 2 Day 3

Normocephalic Normocephalic Normocephalic Symmetrical Symmetrical Symmetrical

distributed Scalp Clean

distributed Clean

distributed Clean

EYES Day 1 Lids Symmetrical Day 2 Symmetrical Normal Day 3 Symmetrical Normal

Peri-orbital Normal region Conjunctiva Pale

Pale

Pale

Cornea lens Sclera Pupils

& Opacity Right Anicteric Equal 3mm;

to Opacity Right Anicteric size: Equal brisk 3mm;

to Opacity Right Anicteric size: Equal brisk 3mm;

to

size: brisk

reaction to light; reaction to light; reaction to light; uniform uniform uniform

accommodation accommodation accommodation Visual acuity Peripheral vision Normal Normal Normal Normal Normal Normal

EARS Day 1 External Pinnae External canal Tympanic membrane Gross hearing Normal Normal Normal No abnormal No abnormal No abnormal Normoset Day 2 Normoset Day 3 Normoset

discharges Intact

discharges Intact

discharges Intact

NOSE

Day 1 Septum Mucosa Patency Gross Smell Sinuses No tenderness Midline Pinkish Both patent Normal

Day 2 Midline Pinkish Both patent Normal

Day 3 Midline Pinkish Both patent Normal

No tenderness No tenderness

MOUTH Day 1 Lips Pale Day 2 Pale Day 3 Pale

Mucosa Tongue Teeth

Pallor Midline

Pallor Midline

Pallor Midline Complete teeth

Complete teeth Complete teeth

Gums

Pale

Pale

Pale

PHARYNX Day 1 Uvula Tonsils Posterior pharynx Midline Not inflamed Not inflamed Day 2 Midline Not inflamed Not inflamed Day 3 Midline Not inflamed Not inflamed

NECK Day 1 Trachea Thyroids Midline Non-palpable Day 2 Midline Non-palpable Day 3 Midline Non-palpable

SKIN Day 1 General color Texture Turgor Wrinkled Normal Wrinkled Normal Warm Wrinkled Normal Warm Pallor Day 2 Pallor Day 3 Pallor

Temperature Warm

ABDOMEN Day 1 General Superficial Day 2 Superficial Day 3 Superficial

Configuration Flat

Flat

Flat

Bowel sounds Percussion

Normoactive Normoactive

Normoactive

Tympanitic

Tympanitic

Tympanitic

CARDIOVASCULAR Day 1 Point Day 2 Day 3 intercostal

of 5th intercostal 5th intercostal 5th

maximum impulse Heart sounds Peripheral pulses Capillary refill

space;

left space;

left space;

left

midclavicular. midclavicular. midclavicular. Regular Regular Regular

Regular; bpm 2

89 Irregular; bpm

92 Irregular; bpm

96

seconds; 2

seconds; 2

seconds;

Normal

Normal

Normal

RESPIRATORY STATUS Day 1 Breathing pattern Shape chest Lung expansion Vocal/tactile fremitus Breath sounds Cough None None None Normal Normal Normal Symmetrical Symmetrical Symmetrical Irregular; 28cpm of AP: Normal Day 2 Irregular; 32cpm 1:2; AP: Normal Day 3 Regular; cpm 1:2; AP: 1:2; Normal 18

Symmetrical Symmetrical Symmetrical

BACK AND EXTREMITIES Day 1 Range motion of Full Day 2 Full Day 3 Full

Muscle tone Symmetrical Symmetrical Symmetrical in and strength in size; 5/5 in size; 5/5 size; 5/5

Spine

Spine midline. Normal

is Spine midline. Normal Normal

is Spine midline. Normal Normal

is

Gait

Normal

C. ELIMINATION PATTERN Pre hospitalization and During hospitalization: There are no significant changes in the bowel movement of the patient. He usually defecates once a day usually early morning. Patient also urinates 6-10 times daily approximately 200-350 per micturition.

D. ACTIVITY-EXERCISE PATTERN Pre-hospitalization: The patient is an active varsity player at school. In fact, hes one of the best basketball players in the campus. He occasionally does chores at home and helping his mom to get the work easily done. During hospitalization: Because of easy fatigability and exertional dyspnea, he cannot performed strenuous activities like playing.

E. COGNITIVE-PERCEPTUAL PATTERN Patient X speaks Cebuano-Visayan language. He has no learning difficulties as evidenced by comprehension of the nature of his condition. Intact remote and recent

memory. He was conscious, able to understand and can follow on whatever the nurses teach her regarding her health.

G.SELF-PERCEPTION AND SELF-CONCEPT PATTERN Patient X verbalized that he has many friends at school and usually spend time playing basketball. He sees himself as a loyal friend to al his classmates. In fact, he was very glad when all of his classmates visited him in the hospital.

H. ROLE-RELATIONSHIP PATTERN Pre-hospitalization and during hospitalization: Patient X has a good and sound relationship with his mother. And it got even tighter when he was hospitalized. Its his family that supports him emotionally and financially. Their primordial concern is his fast recovery and resumption of his studies. Though explained the nature of the disease, the mother is still hopeful for the recovery of his son which inspire patient to fight.

J. COPING -STRESS TOLERANCE PATTERN Pre-hospitalization: Patient X manages his condition by doing different kinds of diversional activities like watching tv and playing basketball. During Hospitalization: Patient X was worried about his condition but he can control his anxiety through diversional activities, visitation from friends and prayers.

H. VALUE -BELIEF PATTERN Patient X is a Roman Catholic. According to him, he goes to church every Sunday and he does the rosary as part of their religious practices. Hospitalization does interfere with his religious activities like going to church but hes constantly praying even hospitalized.

III. IV. V.

VI.

PATHOPHYSIOLOGY TREATMENT NURSING CARE DONE a. Risk for Infection b. Activity Intolerance related to impaired exchange between oxygen and carbon dioxide c. Low Self Esteem related to the disease condition HEALTH TEACHING A. Boosting Oxygenation and Promoting Activity 1. Avoid strenuous activities 2. Perform activities with intervals and with rest periods. 3. Avoid activities that are not purposeful. B. Avoiding Infection 1. Wash hands regularly. 2. Avoid crowded places. 3. Take vitamins regularly. 4. Inform AP ASAP for occurrence of fever.