Study plan: Module 4 – Pathophysiology Please note references are the most important part of this assignment to pass the topic. Module 4 - Case study 4 - Acute leukaemia Jenny is a ten year old girl who was diagnosed with Leukaemia 6 months ago. She has been hospitalised for 10 days with pneumonia and remains very weak. Jenny lives with her parents, Sam and Henry and two older siblings, Josh and Annalise. Jenny has been discharged home with the Palliative care team and home care support services. Cancer is the biggest cause of mortality worldwide, responsible for 8.2 million deaths per year and rising. The treatment of cancer may involve surgery, irradiation or drug therapy, or a combination of these modalities. Cancer is a common disease of adults in Australia and New Zealand, however it does affect people from across the lifespan with different types1. Cancer is a collection of over 200 diseases, all caused by an accumulation of genetic alterations in the bodies cells. Environmental and heredity risk factors often combine to lead to disease development and progression and affect treatment responses. The most significant cancers in Australia (those that have the highest incidence, mortality and impact) are lung, colorectal, breast, prostate, pancreatic and melanoma1. Video YouTube 2013, 'What is cancer?', Cancer Treatment Centers of America, The word cancer itself specifies a complex and often frightening disease, as the people who are diagnosed with it, deal with individual issues of mortality and morbidity. Palliative care is a subject that many people find confronting and difficult to approach and it is one that is often misunderstood. Many people think that it is only offered when there is nothing else to be done for a patient and that it is only about the care of the dying. While there may have been some truth in these ideas in the past, modern palliative care is very much about support for the living as well as the dying. Palliative care improves quality of life by addressing the physical, psychological, social and spiritual needs of people living with an incurable illness or condition. By improving quality of life for patients and their families, palliative care may in some cases extend life. Jenny is diagnosed with one of the 200 cancer disease types - leukaemia. Cancer is second only to injury as a cause of death in children older than 3 months2. The incidence of childhood cancer is significant and the related emergencies that develop acutely carry significant morbidity and mortality2. Acute Lymphoblastic Leukaemia (ALL) is the most common childhood leukaemia and is seen in both genders and across the lifespan1. Therefore to align with our case, our cancer focus will be on Acute Lymphocitic Leukaemia. Blood is essential for life as an adequate supply of oxygen and nutrients is required for the survival of all body cells, and blood provides this transport function. It also removes carbon dioxide, waste products and toxins. The components of blood are numerous and all have a vital role to perform. As we learnt in the previous case, blood cells are produced in the bone marrow and cellular production is equal to cellular loss. An increase or decrease in production occurs in response to physiological challenges or can happen as a result of haematopoietic disease. Acute Leukaemia is defined as 'a malignant disorder of the blood and blood forming organs, with the common pathological feature being an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of the bone marrow and the decreased production and function of normal haematopoietic cells'1. Preparation for Case study 4 Each piece of information tells you about the patient, their pathophysiology and the pharmacology used to manage this case. By using the signs and symptoms we begin a process of elimination and confirmation. Case studies are mainly not straightforward 'textbook' answers. Sometimes we have to ask lots of questions and explore each fact before we really understand the case. Understanding pathophysiology and pharmacology can be simple by using the following 10 steps: 1 Underline/identify key words. 2 Define the disease or condition. Do you understand these terms? If you don't understand, begin reading around these terms. You may also need to look at and or revise your old anatomy and physiology notes to really understand how 'normal' bodies work before you can explore your patient in the case study. 3 List the common signs and symptoms associated with the disease or condition. Again if you are unsure look them up in a text book. Can you explain why each of these signs and symptoms manifest? 4 List the signs and symptoms your patient in the case study has presented with. Ask yourself do these signs and symptoms match those listed in the text book? 5 Are there signs and symptoms that don't match or don't make sense? What are some possible reasons for this (we could call this an hypothesis)? Begin exploring and eliminating possible reasons based on further reading. 6 Now ask yourself: are there any reasons this case could be complicated? Is it the condition/disease, the patient's management of the condition, are there investigations missing or does the patient have other co-morbidities? 7 How would you investigate this case study? What might a doctor order to better understand this case study, e.g. blood tests or x-rays? 8 How is this condition treated/managed? 9 What pharmacotherapy is used to manage the disease/signs/symptoms? 10 When looking at pharmacotherapy: look at mode of action, therapeutic use, pharmacokinetics, side effects, drug interactions and nursing considerations. Often on clinical you see a more simplified example of this 10 step process called ISBAR. ISBAR (or introduction, situation, background, assessment and recommendations) is a tool or framework that can be used to assist health professionals to communicate critical information to each other. As you explore the case study ask yourself the following questions: • What is the situation at the moment with this case study? • What is the background to this condition(s)? • What is your assessment of the situation or the patient? • What action do you recommend now (to make a recommendation you need to have a hunch, a hypothesis or a nursing diagnosis). • Use the 10 steps or ISBAR to assist unpacking the many aspects of each case study. The more you do this the quicker, easier and more detailed your analysis of the case study will be. This is good news for your assignments. Assignment 2—Exploration of A&P and pathophysiology relating to a case [NOT for NURS2003B students] Mode of submission Online through FLO Graded Weighting: 40% Length: Refrencing Equivalent to 1500 words (+/- 10%) This word count will be rigorously adhered to. Study plan: Module 4 - Pharmacology Meeting your learning outcomes Microbiology In our case Jenny has been in hospital with fungal pneumonia, before being discharged home with palliative care. Opportunistic fungal pneumonia is only a problem with a small amount of patients - usually those who are immunosuppressed. We don't know what type of fungus Jenny was infected by, so we need to be aware of the common factors involved. Video For this week please watch the following YouTube video as an introduction. Naked Scientists 2012, 'What is a fungus - Naked Science scrapbook', Now read the following to increase your knowledge. Text readings Lee, GM & Bishop, P 2013, Microbiology and infection control for health professionals, 5th edn, Pearson Australia, Frenchs Forest, NSW. Chapter 6 'Eucaryotic microorganisms: fungi, protozoa and multicellular parasites', pp. 116-120. Chapter 17 'Respiratory tracts infections' pp. 440-441. eReading Please read and note the following article. Mandanas, RA 2014, 'Overview of fungal pneumonia', Medscape,http://emedicine.medscape.com/article/300341-overview#aw2aab6b2 Meeting your learning outcomes Pharmacology Text reading Lehne, R 2012, Pharmacology for nursing care, 8th edn, WB Saunders Company, Philadelphia. Chapter 3 'Over the counter drugs', pp. 23-24 plus key points, p. 25. Chapter 8, 'Individual variation in drug responses', pp. 79-83. Chapter 92 'Antifungal agents', pp. 1137-1139 & 1148. Chapter 101 'Basic principles of cancer chemotherapy' Web readings Answer the following questions from the article by Rose-Inman, H & Kuehl, D 2014, 'Acute leukaemia', Emergency Medicine Clinics North America, vol. 32, pp. 579-596. • What are the common backbone medications of pharmacologic treatment for ALL? • What medications make up maintenance therapy? • List the important longterm complications of ALL in children? • What is the most common site of relapse? • What is the last chance treatment for ALL?