UST COLLEGE OF NURSING

RELATED LEARNING EXPERIENCE

ALTERNATIVE LEARNING

“Nicole”

Nicole is a 13-year-old-with leukemia. She lives at home with her parents and
younger siblings and for the past 3 months has been receiving chemotherapy. Nicole has experienced a
number of absences from school as a result of her hospitalizations, chemotherapy, and the effects of her
chemotherapy regimen. Nicole has alopecia and has been hospitalized with infection, stomatitis and
esophagitis, and bleeding requiring platelet replacement. She refuses to see her friends although she
speaks with them frequently on the phone. She tells them her refusal is based on the fact that she is
prone to infection and doesn’t want to risk exposure and have to be hospitalized again.

Nicole is admitted to the pediatric unit of the hospital with a temperature of 38.8° C that did not
respond to the paracetamol that she has been taking every 4 hours since admission. Her admission
assessment indicated that Nicole’s lung sounds are clear, heart sounds are strong and regular, she is in
no apparent distress, has alopecia, and has evidence of white patches in her mouth.

Case Study Questions

1. Discuss very briefly the pathophysiology of Leukemia.

2. If you were to choose which room / bed will Nicole be put in, what will be your basis and why?
3. Discuss the most common complications (adverse effects) of chemotherapy.
4. What nursing actions address the adverse effects associated with chemotherapy?
5. Nicole’s mother is staying with Nicole during her hospitalization and expresses concern about Nicole
refusing to see her friends and that Nicole seems “down” since her last chemotherapy. Discuss your
impressions about Nicole’s mother’s statements, considering Nicole’s level of growth and
development.
6. List 3 nursing diagnosis applicable to the current situation of Nicole and give 2 interventions for each
diagnosis (You may include both actual and potential problem)

“Pocholo”

Pocholo, a 7-year-old male came to the ER with acute respiratory distress. His mother noted that
he was well until an hour before, when he began to cough and “couldn’t catch his breath.” He has been
playing outside all morning. On closer questioning, the mother related that he has never been
hospitalized and has always been well, except for infantile eczema. In the past months, he has had
recurrent, nonproductive cough nor associated with fever or congestion.
 On examination, Pocholo is found to be in moderate respiratory distress. He is restless and
apprehensive and insists on sitting upright with his shoulders flexed. He has intercostals retractions and
use of neck muscles when breathing. On auscultation there is diffuse wheezing on all lung fields and a
prolong expiratory phase of respiration. A chest x-ray examination reveals bilateral hyperinflation and
there are evidences of air trapping. On admission, he was given epinephrine 1:1000 SQ without relief.
Two additional doses followed but again, without effect. He was admitted for further evaluation and
treatment.

Case study questions:

1. What do you think is Pocholo’s respiratory condition? Why do you think so? (Give the proofs
from the scenario)
2. Identify the mechanisms responsible for the production of symptoms of the condition?
3. What are the possible causes of his condition?
4. Explain the result of his chest x-ray. What are the mechanisms causing such effects on his lungs.
5. The patient was given epinephrine initially. Why?
6. If epinephrine did not work for the patient, what other drugs may be given to relieve his
symptoms? Give the actions and indications of these drugs.
7. List 3 nursing diagnosis applicable to the current situation of Pocholo and give 2 interventions
for each diagnosis (You may include both actual and potential problem)

“Winnie D. Pooh”

Baby Girl Winnie, 8 months old, was admitted to Pedia Ward CD because of fever which started
two days PTA. Mother says she thinks the fever is high grade because Winnie feels “so hot”. Since they
don’t have thermometer at home, mother does not have idea what her temperature is. Mrs. Pooh
decided to finally bring Winnie to the hospital because the “home remedies” she has been doing to
relieve Winnie’s diarrhea seems not working and she has been febrile lately. Winnie has been having
watery stools for almost 10 days. She also claims that Winnies “has not been doing alright” because she
“seems to be sleeping most of the time.” Mother says she does not even wake up for her feeding and
could hardly consume the milk she prepares which she mixes with “a small amount of tea”. She said she
does not understand what causes Winnie to have watery stools wherein she does not give Winnie fluids
other than the amount she uses to dilute the milk with and Winnie does not take any other food other
than milk anyway. She says she makes sure the water is clean coming from the deep well at the back of
their house.
Assessment reveals Winnie to be really very weak and pale. Her skin feels dry and so does her
lips. She is really febrile and the nurse noticed her wet diaper to be stained concentrated yellow. Aside
from this, the nurse also noticed that Winnie has an unusually large abdomen. Mother was ordered to
get specimen for her urine and stool exams. She asked the nurse how this could be done as Winnie does
not say yet when she will urinate or defecate. Referral to the nutritionist is being prepared.
Case study questions:
1. Based on the scenario, what do you think are the contributory factors to Winnie’s diarrhea?
2. Is Winnie already dehydrated? Prove your answer.
3. Is Winnie’s “sleeping most of the time” normal? If no, what do you think is causing this?
4. What are the mother’s wrong nutritional practices that must be corrected and why are they
not correct?
5. What does Winnie being pale mean?
6. List 3 nursing diagnosis applicable to the current situation of Winnie and give 2 interventions
for each diagnosis (You may include both actual and potential problem)

“Renesmee”

Renesmee, a 4-year old child was brought by her mother to the ER with the chief complaint of
high grade fever for the past 4 days. Mother says her temperature reaches 39.4 degrees but goes down
to 37.7 after giving Paracetamol and sponging but goes up immediately after an hour to near the same
level as before giving the treatment. Nurse also noticed some red pinpoint rashes all over her arms ansd
legs. She has no cough nor colds. They came from the province (Laguna) a week ago to visit Renesmee’s
grandparents. There are many plants around her grandparents house and there was a small pond beside
it. Mother also mentioned that two cousins of Renesmee also had fever almost at the same day that
Resnesmee had it. Assessment of the child reveals the following findings:
She cries every now and then and when asked why, she says her abdomen “hurts”. She has
slightly pale palpebral conjunctiva. She screamed louder while undergoing IV insertion?
When mother was asked about feeding history, she said the child is a very “picky” eater, does
not like vegetables and prefers fried foods only. She hardly drinks milk and when she asks for it, mother
gives condensed milk with hot water as it is also Renesmee’s favorite pandesal filling.
Doctor immediately ordered CBC with hematocrit and platelet count. She was put on Full Diet
with no dark colored food. Her VS especially her BP was ordered to be monitored every hour.

Case study questions:

1. Based on her presenting symptoms, what would most likely be her illness/(es)? What made you
arrive at that conclusion?
2. What would be the most likely cause/(es) of her condition?
3. What are the abnormalities in her assessment findings?
4. Why is she so afraid of the IV insertion?
5. What are the indications for the laboratory tests ordered?
6. What are the reasons for the doctor’s dietary order of no dark colored food during admission?
7. What can you say about her pre-edmission nutritional intake?
8. List 3 nursing diagnosis applicable to the current situation of Renesmee and give 2 interventions
for each diagnosis (You may include both actual and potential problem)