Leukemia Case Study
The nurse is caring for a child brought to the emergency department. Review the
electronic health record (EHR) before answering each question.
Recognizing Cues
02/02/20XX
07:00
A 15-year-old female is diagnosed with leukemia. For the past 3 months, she has been
receiving chemotherapy through a central venous access device (CVAD) being cared for
by her parents and herself. Amber has alopecia and has been hospitalized with a CVAD
infection, stomatitis and esophagitis, and bleeding requiring platelet replacement. The
adolescent is admitted to the pediatric unit of the local hospital with a temperature of
38.8° C (101.8° F) that did not respond to the acetaminophen that she has been taking
every 4 hours since yesterday. Her admission assessment indicated vital signs: BP
110/80, P 102, lung sounds are clear, heart sounds are strong and regular, bowel sounds
are normal in all four quadrants, and she is in no apparent distress, has alopecia, and
has evidence of white patches in her mouth. She has several school absences and
refuses to see her friends because of her diagnosis.
Select the 4 findings that require immediate attention.
The following items need immediate follow-up by the nurse:
 Client admitted due to a central venous access device (CVAD) line infection as
evidenced by a fever of 38.8 C (101.8 F). The nurse knows that blood work and
labs will need to be drawn so the nurse must assess the central venous access
device (CVAD) for patency, redness, swelling, purulent discharge, and pain.
 Treated for unknown bleeding.
 Has white patches in her mouth (stomatitis and esophagitis).
Alopecia is an expected finding of chemotherapy treatment and coping needs to be
addressed but it is not the priority requiring immediate attention at this time. Refusing to
see her friends is an expected psychosocial finding of adolescents concerned about their
appearance and is lower on Maslow’s hierarchy of needs. While this is important, it is not
the priority requiring immediate attention at this time.
Analyzing Cues
What are some potential issues or expected complications that the client
might be at risk for?
Common or expected findings of a client receiving chemotherapy include:
 myelosuppression
 most common complication of chemotherapy
 results from the non-differentiating effects of the agents on fast-multiplying
cells, both normal and abnormal
 risk for neutropenia and thrombocytopenia
 antineoplastics are most toxic to rapidly growing cells, hair follicle cells are
rapidly destroyed, creating a condition called alopecia.