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Childhood Leukemia And Evidence Based Nursing Practice

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Childhood Leukemia And Evidence Based Nursing Practice

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Childhood Leukemia And Evidence Based Nursing Practice

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Nursing care for pediatric nurse is very typical and complex. It requires appropriate skills and knowledge to provide quality care to children and to support their families. The purpose of this paper is identify the issues in nursing care based on the case study of a 9 years old Jenny. She is an active child and love playing and doing athletics. But, since last few days she is not finding interest in athletics and playing. She has pain in her legs and also feels lack of energy. Her parents are concerned about her, as she is becoming pale, lethargic and not eating well.  Her parents decide to visit the local GP.
GP examines Jenny and finds that she is facing problem in doing normal activities. She needs support of her mother, while doing simple work. Dr. Brown asks for following pathology, a mid-stream specimen of urine (MSSU), full blood examination (FBE), Haemoglobin (Hb), white blood cell count (WCC) & differential), urea, electrolytes and C-reactive protein (U & E). According to the pathological reports, Jenny is found to be suffering from acute lymphoblastic leukaemia (ALL), also known as acute lymphocytic leukaemia. The paper will further discuss the four main perspectives related to disease and patient care and will also Pathophysiology, family centred care, and importance of evidence based practice.
Pathophysiology and Anatomy of Acute Lymphoblastic Leukaemia (ALL)
Acute lymphoblastic leukaemia (ALL) is a kind of cancer, which is mainly found in children, but can also occur in individual of any age. This disease is also called as lymphocytic leukaemia (Bhojwani, Howard, & Pui, 2009). This kind of disease is characterized by over formation of the white blood cells. The bone marrow of the patient is crowded by these cells and formation of normal blood cells is prevented. Due to the overproduction of the white blood cells, these can also enter the blood stream and to other parts of the body. This is the malignant bone marrow disease, in which the malignant cells of the acute lymphoblastic leukemia (ALL) are considered as the lymphoid precursor cells (ie, lymphoblasts) (Bhojwani, Howard, & Pui, 2009). In the early stage of the disease, these cells are arrested. The arrest of these cells is caused due to the abnormal functioning of the genes. This abnormal functioning of the genes is resulted due to chromosomal translocations (Bhojwani, Howard, & Pui, 2009).
The normal elements of the bone marrow are replaced by lymphoblasts and the production of the normal blood cells is reduced. This situation also results in occurrence of anemia, thrombocytopenia, and neutropenia (Bhojwani, Howard, & Pui, 2009). These problems can occur at different degrees and levels.  The lymphoblasts can also multiply in various organs of the body such as liver, lymph nodes and spleen (Acute Lymphocytic Leukemia, 2016). Due to the changing physiological condition, patient suffers from acute pain in legs, reduced energy and becomes pale due to scarcity of the red blood cells (Acute lymphoblastic leukaemia (ALL), 2016). According to the subjective data, Jenny reported acute pain in legs, she also complain about feeling tired very soon, due to which she did not want to participate in athletics. According to the objective data, doctor examined Jenny needs support in normal activities, as she was independent and energetic kid. But, now she looks pale, mildly febrile, her respiratory rate is quite high and she seems quite lethargic. No other obvious symptoms could be found in the diagnosis, but according to mid-stream specimen of urine (MSSU), full blood examination (FBE), Haemoglobin (Hb)), white blood cell count (WCC) & differential), urea, electrolytes and C-reactive protein (U & E), it was found that she is suffering from acute lymphoblastic leukaemia (ALL).
Nursing Concerns
Risk of Infection: The care plan for the children suffering with ALL requires increasing comfort and reducing the problems of the patient. The risk of infection increases in the patient due to inadequate secondary defense. The number of immature lymphocytes increases and red blood cells reduces. The capability of the defense is also reduced due to traumatized tissues. The risk of infection also increases by malnutrition. The risk of infection cannot be diagnosed through signs and symptoms (Fraser et al, 2014). Till the time problem has not occurred, the nursing interventions must be focused towards preventing any kind of infection in future. For this purpose it is important that nurse must provide an infection free environment to the patient. The nurse, who takes care of patients with infection, must not come in contact with child. Hand washing protocol must be strictly followed by all professionals and nurse.
Rational: It is very important to save the patient from pathogens and infections. Since Jenny is very young she requires special care, during her initial treatment at hospital. Any kind of infection can have adverse effect on her health. The further treatment of ALL can put her on higher risk of infection. Washing hands before coming in contact with the patient reduces the chance of transfer of infection.
Risk of Fluid Deficiency: The risk of fluid is very high in the patient of ALL. Due to the treatment and chemotherapies there could be excessive loss of fluid because of vomits, diarrhea, and hemorrhage (Fraser et al, 2014). Since no signs and symptoms of the risk are yet diagnosed, so nursing intervention would focus on prevention of the problem. It is important that nurse should monitor the loss of fluid. It is important to measure urine pH and gravity. This intervention would also involve measurement of weight and promote nutritional balance.
Rational: For the proper functioning of the kidney, it is important that adequate fluid balance should be maintained. The continued intake of the fluid is important with regular output. If this process is hindered, it could lead to formation of stones in kidney. The adequate fluid intake also promotes urine flow and prevents precipitation of uric acid.
Development Issues: As Jenny is 9 years old, she is in the age of developing a sense of mastery over her environment. Children at this age are able to describe their pain and physical condition, but their description could not be considered as completely logical. Children at this developmental stage also have their own imaginations and thinking. They can also develop thoughts about their illness that it might have caused because they have done something wrong to anyone (Fraser et al, 2014). So the nursing concern would be support child and family in understanding the reason behind illness and to develop therapeutic relationships with them (Code of Professional Conduct for Nurses in Australia, 2010).
Rational: Children at the early childhood stage, they believe that there is some kind of magic in everything. These children love to try new things and have athletic abilities. This is the time, when children develop confidence in their activities, and get prepared for the future. Nursing concern would be to encourage confidence and problem solving skills in children (Koschel et al, 2012). It is important to inform child that she is not suffering because she has done anything wrong. She must be supported by her family members. It is because according to Family Centered Care (FCC) family is the most important part of a person’s life (Harrison, 2010). Children are dependent on their families and parents. They develop a sense of belonging towards their families. With support of parents, children improve their emotional contact and their health outcomes are also improved (Code of Professional Conduct for Nurses in Australia, 2010).
Coping and Adjustment with Illness: The chronic diseases may lead to impaired growth and retardation among children. The illness and treatment, both could be very traumatic and painful for children. As, in case of Jenny, she was an active child, but due to illness her energy is reduced and she do not feel normal. Such children may also suffer from anxiety, as they can sense that they are different from their peers. This could lead to further depressive condition (Fraser et al, 2014). Thus nursing concern would be related to adjustment and coping skills of Jenny. For the management of her illness, it is important to work in collaboration with her parents and develop and encourage coping skills in the patient. Her parent s can help her to develop coping skills and resilience (Understanding – Acute leukemia, 2014).
Rational: Due to long term illness and long term treatment, there could be psychological effect on children. Children might find their fault in illness and may not be able to cope with treatment. In the phase of chronic illness, parents a play a very important role in child’s life. They can help their kid to develop resilience (Harrison, 2010). Resilience is the ability to develop acceptance towards, trauma, illness, threats and tragedy (Understanding – Acute leukemia, 2014). Different stressors can affect the mental health of children and children may not be able manage stress. Thus, role of parents is very important, as children feel comfortable and secure only with their parents.
Importance of Evidence Based Practice (EBP) in Nursing
The importance of evidence based practice has been acknowledged across nursing practice and knowledge. For providing effective and safe nursing care it is essential to offer evidence based practice. Nursing care for children requires thorough understanding of evidence-based quality improvement (Koschel et al, 2012). It enhances the capabilities, knowledge and understanding of the nurses. EBP requires adoption of proper practice, education of the practice and understanding of the developmental theories in case of chronic illness in children (Fairbrother et al, 2014).  According to the cognitive and developmental theories, children go through different developmental stages; these stages define their cognitive and physical growth abilities. The new approach to provide family centered care and close support to young patients EBP has been found to be very successful.
EBP focuses on evaluating and reporting of the patient’s condition. It helps in enhancing the ability to plan care and improve the health outcomes of the patients. “Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population” (Fairbrother et al, 2014). This kind of approach also helps in exploring the nurse’s awareness towards the care and developing a positive attitude towards reporting evidences.
Long term physical illness and health issues can affect the mental health of the patients. As, in the case of Jenny, she was an active child, but due to her illness she could play and participate in her hobbies. She may find herself to be different from her peers and may have to go through acute pain. All these conditions require more evidence based nursing practice and quality in nursing care. This approach involves that nurses must monitor the effect of medicines on children, this would help to understand if any side effects are there. Thus EBP helps in developing the science of nursing and increase the confidence of nurses in decision making. Thus integrating EBP in nursing practice is important for offering high quality care (Fairbrother et al, 2014).
Every individual have their specific requirement in nursing care, according to their age, race and culture. Evidence based practice allow nurses to work in different environment through proper knowledge and research based evidence. This approach could be very easy for the nurses if they refer to already developed evidences and practice guidelines. With proper administrative support and knowledge sharing by mentors can help nurses to remove all barriers in providing quality care ().
The paper is based on the case study of a 9 years old girl, Jenny. She is a very active child and loves to take part in different physical activities. She lives with her parents and brother-sister. Her family has a nice living arrangement and adequate resources. In last few days her health deteriorated and she was taken to local GP. According to the objective and subjective data presented in the case study, she has been diagnosed with acute lymphoblastic leukaemia (ALL). She has been admitted to the hospital for 10 days, as she is also suffering from Bacterial Pneumonia.
The paper discussed the Pathophysiology of the disease that explained the occurrence of the disease. The paper also reviewed four nursing concern that could be vital in case of Jenny. The concerns are risk of infection, risk of fluid deficiency, developmental barriers and coping skills. All these could be serious concerns for Jenny. The paper also addresses the importance of family cantered care and evidence based practice in nursing. 
Acute Lymphocytic Leukemia. (2016). OMICS. Retrieved from:
Acute lymphoblastic leukaemia (ALL). (2016). Retrieved From:
Code of Professional Conduct for Nurses in Australia. (2010). Retrieved From:
Bhojwani, D., Howard, S. C., & Pui, C. H. (2009). High-risk childhood acute lymphoblastic
leukemia. Clinical Lymphoma and Myeloma, 9, S222-S230.
Fairbrother, G., Cashin, A., Conway, M. R., Symes, M. A., & Graham, I. (2014). Evidence based
nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills and barriers. Collegian.
Fraser, J., Waters, D., Forster, E., & Brown, N. (2014). Paediatric Nursing in Australia:
Principles for Practice. Cambridge University Press.
Harrison, T. M. (2010). Family-centered pediatric nursing care: State of the science. Journal of
Pediatric Nursing, 25(5), 335-343.
Koschel, A., Cross, M., Haines, H., Ervin, K., Skinner-Louis, D., & Carbone, D. (2012).
Research and evidence based practice in a rural Victorian cohort.Australian Journal of Advanced Nursing, The, 30(2), 13.
Understanding – Acute leukemia. (2014). A guide for people with cancer, their families and
friends. Retrieved From: https://www.cancercouncil.com.au/wp-content/uploads/2014/05/CAN720_AcuteLeukaemia_booklet.pdf

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