ACKNOWLEDGEMENT

"At times, our own light goes out and is rekindled by a spark from another
person. Each of us has cause to think with deep gratitude of those who have
lighted the flame within us." Albert Schweitzer
The success of this case study would have not been made possible if it
werent for these wonderful people who have assisted and prepared us
physically, emotionally, intellectually, and financially. Thus, as case presenters,
allow us to express and extend our heartfelt gratitude to the following people who
contributed and supported in making this case study ever possible:
To the Dean of the College of Nursing, Dr. Ramona C. Palad, RN, MAN,
MAEdwho made this clinical nursing exposure possible. We salute your effort in
molding us to become future registered nurses with competent skills,
comprehensive knowledge, and holistic attitude.
To the Faculty of the College of Nursing, for peppering us with the
appropriate knowledge and skills in preparation for our clinical exposures. You
have armed us with great knowledge and understanding with our duties and
responsibilities as student nurses.
To our clinical instructor Maam Ivy R. Go, RN MAN for her support,
continuous guidance, meticulous suggestions, and astute criticism during our first
day of duty and her inexhaustible patience in giving us ideas for the construction
of our case presentation.
To the healthcare professionals and staff of Maria Reyna Hospital, for
their cooperation and giving us the information we need to have a thorough
understanding of the nature of the disease and the complications that lie or
remain to be a threat in the patients health.
To our patient and his family, for their cooperation and consideration in
allowing us to perform our duties as student nurses and establish a

comprehensive assessment that will provide us with the significant information

needed to construct a firm foundation of our case study and presentation.
To Mr. and Mrs. Estandarte, for welcoming us in their abode where we
prepared and constructed our case study and presentation. If it werent for them,
life as case presenters would have not been easy.
To our families, whom we would like to express a deep sense of gratitude
for standing with us like a pillar in times of our needs and for their constant love,
encouragement, and for the moral and financial support. If it werent for them, we
wouldnt be in this field.
Finally and above all, our deepest gratitude and praises to God the
Almighty, to whom we dedicate our case study, for the cascading blessings that
He endowed upon us from the beginning to the end of our successful case study.

INTRODUCTION
This reflective case study will provide a written account of the care
delivered to a client by a group of level 2 nursing students. Its aim is to enhance
the readers knowledge of the importance of the nursing process and allow
discussion to take place at each stage. It will firstly give a pen picture of the
chosen client while offering a rationale for choice. The care delivered will then be
analyzed using elements of the nursing process as a structure while identifying
any ethical considerations. The case study will also provide theoretical
observations. It is hoped that the interrelation of each stage of the process will be
identified and by undertaking this study that knowledge, skills, and future practice
can be improved. Patient XYZ a 5 years old boy who was admitted at Maria
Reyna Hospital last November 30, 2015 and diagnosed with Acute Myeloid
Leukemia. Pneumoniae and Oral Bilateral Thursh. He has pallor and a visible
edema in his face and abdomen. He has lesions, fissures, and ulcers in his oral
mucosa. He is positioned at semi-fowlers position so as to alleviate airway
obstruction as a result from his abdominal edema. He had been admitted in
CUMC for 8 days due to infection and was discharged. 3 months prior to his
admission in Maria Reyna, he experienced fatigabilitis. And a month prior to
admission he experienced slight LDRR and Pallor. He had intermittent flues and
was given paracetamol for treatment. 3 weeks prior to admission he had fever
and cough. After having consulted Doctor Cordinez, he was diagnosed with acute
myeloid leukemia - is a cancer of the myeloid line of blood cells, characterized by
the rapid growth of abnormal white blood cells that accumulate in the bone
marrow and interfere with the production of normal blood cells, on November
2015. Due to the edema that developed on his abdomen, the apparent episodes
of tachycardia and tachypnea was recorded throughout the three-day
assessment. Thoroughly taking of vital signs is implemented and done every two
hours for keen observation. During the last day of follow-up assessment, the
child developed no significant improvement in his health and he has been
scheduled for a chemotherapy.The student nurse care unit incorporated several
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nursing theories in the duration of the patients stay and the care we have
rendered. First is the Nursing Care Plan which was created using the theoretical
framework of Ida Jean Orlandos Nursing Process. Second, is the Fourteen Basic
Needs of Virginia Henderson where it was used to look after the needs of the
client first and can be one of the basis in prioritizing in our intervention. Lastly, is
the human relationship model by Joyce Travelbee where the nursing care unit
are building rapport and trusting relationship to Patient XYZ to give an optimal
care with compassion, competent, commitment and conscience.

GENERAL OBJECTIVES
To further understand and gain extensive knowledge regarding Acute Myeloid
Leukemia, this output is accomplished for a comprehensive analysis concerning
the disease with the following objectives.
The primary concerns of this study are the following:

To further enhance our understanding about patients with Acute Myeloid

Leukemia in congruence with the learned concepts.

To raise the level of awareness of the general public about Acute Myeloid
Leukemia for them to become strengthened and empowered in becoming
actively involved in planning their lifestyle practices and health behaviors.

To establish a profound explanation of the disease process and its related

complications.
SPECIFIC OBJECTIVES

This case study specifically aims:

Skills:

To enhance the readers knowledge of the importance of the nursing

process and allow discussion to take place at each stage.

To formulate the most appropriate nursing diagnoses and nursing care

plans related to the patients medical condition.

To provide nursing interventions necessary for the patientscondition in

reference with the patients needs and action of the disease.

To provide holistic and therapeutic nursing care to the patient and his

family.
To guide patients and his family in taking indispensable actions to solve

and prevent complications at which the patient is at risk.

To render health education to the patient and his family.
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To effectively utilize the resources present so as to provide best nursing

management.
To encourage a modification in health behaviors and practices of the
patientand his family for the improvement of their lifestyle behaviors and

health conditions.
To increaseour confidence in handling such cases in the future.

Knowledge:

To be able to describe the significant signs and symptoms, the disease

process, and the prognosis of Acute Myeloid Leukemia.

To be able to explain the complications brought about by Acute Myeloid

Leukemia.

To be able to relate the medication regimen with the patients disease.

To be able to explicate the mechanism of action, side effects, and the

nursing considerations of the drugs.

To be able to relate the concepts and theories of maternal and child

nursing with the clinical setting.

To accurately present a comprehensive assessment of the patients health

and family history.

To be able to establish a baseline data that will serve as a guide in

providing the most appropriate nursing care management.

To identify the significant factors affecting the patients health.

To formulate the most appropriate nursing diagnoses and nursing care

plans related to the patients medical condition.To provide nursing
interventions necessary for the patients condition in reference with the
patients needs and action of the disease.

To evaluate patient outcomes in relation to nursing goals.

Attitude:

To develop a professional attitude and conduct while providing nursing

care.
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To demonstrate the willingness to evaluate the patients level of condition.

To take into consideration the familys socioeconomic status before

succumbing to prescribed medical therapies.

SIGNIFICANCE OF THE STUDY

We fully believe that the study delved into by the group will significantly
help and benefit the following groups of people:
To Student Nurses: This is highly-beneficial to them considering that this
information will be valuable and important for their uses as future professionals.
This will broaden and enrich their knowledge on the various aspects of disease
process from the pathophysiology and prognosis to the appropriate medications
and interventions that will be delivered. This will practice themselves in different
aspects of learning which are skills, attitude, knowledge and application,
considering that the field of learning is continuously expanding and progressing.
To Registered Nurses and Other Healthcare Professionals: One of the
eleven key areas of responsibilities to nursing profession is personal and
professional development. This responsibility calls for the nurses to identify own
learning needs and to pursue continuing education. It is indeed inevitable for any
professional to augment ones abilities in order to enhance the efficiency and
effectivity of their work. This study will help the professionals for future references
in the medical and nursing field.
To Future Researchers and Scholars: The results and information in this
study could be utilized by future researchers and scholars. This could help in
answering queries in the discussed disease conditions of the patient. This study
will open opportunities for inquiry and will continue the interest to further follow a
line of investigation.

SCOPE AND LIMITATIONS

This study primarily focuses on the condition that Patient XYZ diagnosed
with Acute Myeloid Leukemia. Pneumoniae and Oral Bilateral Thursh. It focuses
on the signs and symptoms, the predisposing and precipitating factors
manifested by the patient, the disease process and prognosis of oral candidiasis,
of pneumonia, and of acute myeloid leukemia, the medical and nursing
interventions that was given for the condition in reference with the patients
needs.
This study includes the collection of information specifically to the
patientshealth condition. The study also includes the assessment of the
physiological andpsychological status, adequacy of support systems and care
given by the family aswell as other health care provider. The information
gathered was bounded only by the data collected from the assessment
interviews with use of pediatric assessment tool, from the daily follow-up and
monitoring of the assigned student nurse and from the patients chart. There
were certain impediments that were faced by the group especially on assessing
and gathering information in the diagnosis and the information about clients
health in regards to his previous admission in Capitol University Medical Center.
The health of the patient resulting in inability to answer properly, hence, making
the patients family as the primary source of information and the interaction,
assessment and care were only limited to a total of 16 hours with actual nursing
intervention done. It is our first time in encountering this diagnosis and the
assessment was made within the day. Thus it limit its background study and
deficiency in knowledge resulted to lack of readiness. The assessment tool was
used when the patient was assessed on December 2, 2015 was an old
assessment but during the whole duration there is a monitoring and the patients
health care is updated. There are some parts of the study that may not be
present but maybe present during the old assessment and vice versa.

DEFINITION OF DISEASE

1. Acute myelogenous leukemia (AML)

Definition
Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow
the spongy tissue inside bones where blood cells are made.
The word "acute" in acute myelogenous leukemia denotes the disease's rapid
progression. It's called myelogenous (my-uh-LOHJ-uh-nus) leukemia because it
affects a group of white blood cells called the myeloid cells, which normally
develop into the various types of mature blood cells, such as red blood cells,
white blood cells and platelets.
Acute myelogenous leukemia is also known as acute myeloid leukemia, acute
myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic
leukemia.
Symptoms
General signs and symptoms of the early stages of acute myelogenous leukemia
may mimic those of the flu or other common diseases. Signs and symptoms may
vary based on the type of blood cell affected.
Signs and symptoms of acute myelogenous leukemia include:

Fever

Bone pain

Lethargy and fatigue

Shortness of breath

Pale skin

Frequent infections

Easy bruising

Unusual bleeding, such as frequent nosebleeds and bleeding from the

gums

Causes
Acute myelogenous leukemia is caused by damage to the DNA of developing
cells in your bone marrow. When this happens, blood cell production goes wrong.
The bone marrow produces immature cells that develop into leukemic white
blood cells called myeloblasts. These abnormal cells are unable to function
properly, and they can build up and crowd out healthy cells.
In most cases, it's not clear what causes the DNA mutations that lead to
leukemia. Radiation, exposure to certain chemicals and some chemotherapy
drugs are known risk factors for acute myelogenous leukemia.
Risk

factors

Factors that may increase your risk of acute myelogenous leukemia include:

Increasing age. The risk of acute myelogenous leukemia increases with

age. Acute myelogenous leukemia is most common in adults age 65 and
older.

Your sex. Men are more likely to develop acute myelogenous leukemia
than are women.

Previous cancer treatment. People who've had certain types of

chemotherapy and radiation therapy may have a greater risk of developing
AML.

Exposure to radiation. People exposed to very high levels of radiation,

such as survivors of a nuclear reactor accident, have an increased risk of
developing AML.

Dangerous chemical exposure. Exposure to certain chemicals, such as

benzene, is linked to greater risk of AML.

Smoking. AML is linked to cigarette smoke, which contains benzene and

other known cancer-causing chemicals.

Other blood disorders. People who've had another blood disorder, such
as myelodysplasia, polycythemia vera or thrombocythemia, are at greater
risk of developing AML.

Genetic disorders. Certain genetic disorders, such as Down syndrome,

are associated with an increased risk of AML.

Many people with AML have no known risk factors, and many people who have
risk factors never develop the cancer.
2. Pneumonia
Definition
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air
sacs may fill with fluid or pus (purulent material), causing cough with phlegm or
pus, fever, chills, and difficulty breathing. A variety of organisms, including
bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening It is most
serious for infants and young children, people older than age 65, and people with
health problems or weakened immune systems.
Symptoms
The signs and symptoms of pneumonia vary from mild to severe, depending on
factors such as the type of germ causing the infection, and your age and overall
health. Mild signs and symptoms often are similar to those of a cold or flu, but
they last longer.
Signs and symptoms of pneumonia may include:

Fever, sweating and shaking chills

Cough, which may produce phlegm

Chest pain when you breathe or cough

Shortness of breath
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Fatigue

Nausea, vomiting or diarrhea

Newborns and infants may not show any sign of the infection. Or they may vomit,
have a fever and cough, appear restless or tired and without energy, or have
difficulty breathing and eating.
People older than age 65 and people in poor health or with a weakened immune
system may have a lower than normal body temperature. Older people who have
pneumonia sometimes have sudden changes in mental awareness.
For some older adults and people with heart failure or chronic lung problems,
pneumonia can quickly become a life-threatening condition.
Causes
Many germs can cause pneumonia. The most common are bacteria and viruses
in the air we breathe. Your body usually prevents these germs from infecting your
lungs. But sometimes these germs can overpower your immune system, even if
your health is generally good.
Pneumonia is classified according to the types of germs that cause it and where
you got the infection.
Community-acquired pneumonia
Community-acquired pneumonia is the most common type of pneumonia. It
occurs outside of hospitals or other health care facilities. It may be caused by:

Bacteria. The most common cause of bacterial pneumonia in the U.S. is

Streptococcus pneumoniae. This type of pneumonia can occur on its own or
after you've had a cold or the flu. It may affect one part (lobe) of the lung, a
condition called lobar pneumonia.

Bacteria-like organisms. Mycoplasma pneumoniae also can cause

pneumonia. It typically produces milder symptoms than do other types of
pneumonia. Walking pneumonia, a term used to describe pneumonia that
isn't severe enough to require bed rest, may be caused by M. pneumoniae.

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Viruses. Some of the viruses that cause colds and the flu can cause
pneumonia. Viruses are the most common cause of pneumonia in children
younger than 5 years. Viral pneumonia is usually mild. But in some cases it
can become very serious.

Fungi. This type of pneumonia is most common in people with chronic

health problems or weakened immune systems, and in people who have
inhaled large doses of the organisms. The fungi that cause it can be found in
soil or bird droppings.

Hospital-acquired pneumonia
Some people catch pneumonia during a hospital stay for another illness. This
type of pneumonia can be serious because the bacteria causing it may be more
resistant to antibiotics. People who are on breathing machines (ventilators), often
used in intensive care units, are at higher risk of this type of pneumonia.
Health care-acquired pneumonia
Health care-acquired pneumonia is a bacterial infection that occurs in people
who are living in long-term care facilities or have been treated in outpatient
clinics, including kidney dialysis centers. Like hospital-acquired pneumonia,
health care-acquired pneumonia can be caused by bacteria that are more
resistant to antibiotics.
Aspiration pneumonia
Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into
your lungs. Aspiration is more likely if something disturbs your normal gag reflex,
such as a brain injury or swallowing problem, or excessive use of alcohol or
drugs.
Risk factors
Pneumonia can affect anyone. But the two age groups at highest risk are:

Children who are 2 years old or younger developing

People who are age 65 or older

Other risk factors include:

Chronic disease. You're more likely to get pneumonia if you have

asthma, chronic obstructive pulmonary disease or heart disease.
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Weakened or suppressed immune system. People who have HIV/AIDS,

who've had an organ transplant, or who receive chemotherapy or long-term
steroids are at risk.

Smoking. Smoking damages your body's natural defenses against the

bacteria and viruses that cause pneumonia.

Being hospitalized. You're at greater risk of pneumonia if you're in a

hospital intensive care unit, especially if you're on a machine that helps you
breathe (a ventilator).

Complications
Pneumonia can be treated successfully with medication.However, some people,
especially those in high-risk groups, may experience complications, including:

Bacteria in the bloodstream (bacteremia). Bacteria that enter the

bloodstream from your lungs can spread the infection to other organs,
potentially causing organ failure.

Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An

abscess is usually treated with antibiotics. Sometimes, surgery or drainage
with a long needle or tube placed into the abscess is needed to remove the
pus.

Fluid accumulation around your lungs (pleural effusion).Pneumonia

may cause fluid to build up in the thin space between layers of tissue that
line the lungs and chest cavity (pleura). If the fluid becomes infected, you
may need to have it drained through a chest tube or removed with surgery.

Difficulty breathing. If your pneumonia is severe or you have chronic

underlying lung diseases, you may have trouble breathing in enough oxygen.
You may need to be hospitalized and use a breathing machine (ventilator)
while your lung heals.
3. Oral thrush

Definition

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Oral thrush also called oral candidiasis (kan-dih-DIE-uh-sis) is a condition

in which the fungus Candida albicans accumulates on the lining of your mouth.
Candida is a normal organism in your mouth, but sometimes it can overgrow and
cause symptoms.
Oral thrush causes creamy white lesions, usually on your tongue or inner cheeks.
Sometimes oral thrush may spread to the roof of your mouth, your gums or
tonsils, or the back of your throat.
Although oral thrush can affect anyone, it's more likely to occur in babies, the
elderly, and in people with suppressed immune systems or certain health
conditions, or those who take certain medications. Oral thrush is a minor problem
if you're healthy, but if you have a weakened immune system, symptoms of oral
thrush may be more severe and difficult to control.
Symptoms
Children and adults
Signs and symptoms may include:

Creamy white lesions on your tongue, inner cheeks, and sometimes on

the roof of your mouth, gums and tonsils

Slightly raised lesions with a cottage cheese-like appearance

Redness or soreness that may be severe enough to cause difficulty eating

or swallowing

Slight bleeding if the lesions are rubbed or scraped

Cracking and redness at the corners of your mouth (especially in denture

wearers)

A cottony feeling in your mouth

Loss of taste

In severe cases, the lesions may spread downward into your esophagus the
long, muscular tube stretching from the back of your mouth to your stomach
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(Candida esophagitis). If this occurs, you may experience difficulty swallowing or

feel as if food is getting stuck in your throat.
Infants and breast-feeding mothers
In addition to the distinctive white mouth lesions, infants may have trouble
feeding or be fussy and irritable. They can pass the infection to their mothers
during breast-feeding. The infection may then pass back and forth between the
mother's breasts and the baby's mouth.
Women whose breasts are infected with candida may experience these signs
and symptoms:

Unusually red, sensitive, cracked or itchy nipples

Shiny or flaky skin on the darker, circular area around the nipple (areola)

Unusual pain during nursing or painful nipples between feedings

Stabbing pains deep within the breast

Causes
Normally, your immune system works to repel harmful invading organisms, such
as viruses, bacteria and fungi, while maintaining a balance between "good" and
"bad" microbes that normally inhabit your body. But sometimes these protective
mechanisms fail, increasing the number of candida fungi and allowing an oral
thrush infection to take hold.
Oral thrush and other candida infections can occur when your immune system is
weakened by disease or by drugs such as prednisone, or when antibiotics disturb
the natural balance of microorganisms in your body.
These diseases and conditions may make you more susceptible to oral thrush
infection:

HIV/AIDS. Human immunodeficiency virus (HIV) the virus that causes

AIDS damages or destroys cells of your immune system, making you
more susceptible to opportunistic infections that your body would normally
resist. Repeated bouts of oral thrush, along with other symptoms, may be
early indications of an immune deficiency, such as HIV infection.
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Cancer. If you have cancer, your immune system is likely to be weakened

from the disease and from treatments such as chemotherapy and radiation.
Both the disease and treatments can increase your risk of candida infections
such as oral thrush.

Diabetes mellitus. If you have untreated diabetes or the disease isn't

well-controlled, your saliva may contain large amounts of sugar, which
encourages the growth of candida.

Vaginal yeast infections. Vaginal yeast infections are caused by the

same fungus that causes oral thrush. Although a yeast infection isn't
dangerous, if you're pregnant you can pass the fungus to your baby during
delivery. As a result, your newborn may develop oral thrush.

Risk factors
Anyone can develop oral thrush, but the infection is more common in certain
people. Risk factors include:

Being an infant or elderly

Having a weakened immune system

Wearing dentures

Having other health conditions, such as diabetes

Taking certain medications, such as antibiotics or oral or inhaled

corticosteroids

Undergoing chemotherapy or radiation treatment for cancer

Having conditions that cause dry mouth

Complications
Oral thrush is seldom a problem for healthy children and adults, although the
infection may return even after it's been treated. For people with lowered
immunity, such as from HIV or cancer, however, thrush can be more serious.
Untreated oral thrush can lead to more-serious systemic candida infections.
If you have a suppressed immune system:

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Thrush is more likely to spread to other parts of your body, such as your
digestive tract, lungs, liver and heart valves

You may have especially severe symptoms in your mouth or esophagus,

which can make eating painful and difficult

The infection can spread to the intestines, making it difficult to receive

adequate nutrition

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