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Noticing
A patient was admitted for acute myeloid leukemia, not having achieved remission. She
neutropenia, anemia, constipation, nausea, and vomiting secondary to treatment. She had
received countless blood and platelet transfusions but her blood counts were continuing
o The patients mother stated that the patient seemed to be improving. She reported
no recent nausea or vomiting. The patient had been tolerating drinking fluids and
eating meals. However, mom noticed the patients nose was very runny for the
o While doing the morning rounds, I noticed that the patient was irritable and
uncooperative. Mom told me that it was just a tantrum and not to feed into it. I
listened to mom and helped the patient go through her morning routine.
o I sat down with the patient and asked if anything was wrong, and she refused to
answer. So I took a mental note to ask how she was feeling around lunch time.
How did you know there was a problem? Abnormal patient presentation or your gut
feeling?
o I had a gut feeling that the patient was acting differently compared to our other
o I immediately alerted my preceptor of the temperature, and she paged the doctor
right away.
with AML can cause a prolonged period of neutropenia, which puts the patient at
risk for bacterial, fungal, or viral infections (Schiffer, 2014). After previously
reviewing the CBC, I knew the patients neutrophil count was <1.
Responding
drew blood from the patients mediport and did a nasal swab, and sent them to the
o Staff would then wait for the lab results to come back and watch if the fever
continued.
o I know we made the right decision because we were following hospital protocols.
o I would ask housekeeping to keep the patients room clean and change the
bedsheets daily.
Reflecting
o I believe that I made the right decision. The patient had contracted C. Difficile
earlier during this hospital stay, and she was put in isolation for 30 days. I would
much rather send labs and start prophylactic antibiotics than see her go through
o I have not been assigned to the patient since, so I do not know the cause of the
o I noticed the temperature and knew that a low grade fever is more significant with
o I could have practiced speaking with the patients mother about my concerns, but
o In the future, I will not be as hesitant to speak with family members and provide
teaching.
References
Schiffer, C.A. (2014). Overview of the complications of acute myeloid leukemia. In: T.W. Post,
https://www.uptodate.com/contents/overview-of-the-complications-of-acute-myeloid-
leukemia?source=search_result&search=AML%20fever&selectedTitle=3~150