Case Study: A CHILD WITH ACUTE LYMPHOCYTIC LEUKEMIA M.R. is…
Case Study: A CHILD WITH ACUTE LYMPHOCYTIC LEUKEMIA M.R. is a 5-year-old seen in an ambulatory clinic for loss of weight. HISTORY: The child has had a series of upper respiratory infections with accompanying herpes simplex infections and otitis media since midwinter. They have lost 5 lb during spring months. The birthing parent has noticed “easy bleeding for the last 2 weeks.” The child has five ecchymotic areas on arms and seven on legs. Gums bleed easily as well. FAMILY PROFILE: The family is intact. The child is the youngest of four children (others are 19, 16, and 14 years). The nonbirthing parent works as self-employed landscaper. The birthing parent works part-time as a substitute language teacher. DAY HISTORY: Nutrition: The child likes all foods; appetite loss noticed during spring months. The child takes one multivitamin tablet daily. Sleep: Sleeps 8 hours per night; still sleepy in morning and difficult to awaken. Recreation/school: Enjoys playing soccer or with “Barbie dolls” after school but hasn’t played soccer for the last 2 weeks because of fatigue. The child attends kindergarten at local school; they have missed 32 days since start of second semester from illness or “tiredness.” HISTORY OF PAST ILLNESSES: Immunizations up to date. No hospitalizations. No allergies. PHYSICAL EXAMINATION: Height: 43 in. (75%); weight: 32 lb (3%); BMI: 13.4; BP: 102/60 mm Hg General appearance: Listless-appearing, pale 5-year-old White female; patch in place over right eye; four ecchymotic areas approximately 3 cm × 2 cm obvious on arms. Child appears tired; had been sleeping in waiting room; their nose is draining clear fluid and they were holding hand over left ear. M.R. is diagnosed as having acute lymphocytic leukemia (ALL). Question 4 of 4: Thinking of the QSEN competency of safety, an action you would ask M.R.’s parents to take if M.R. develops thrombocytopenia from chemotherapy is to which of the following?