Acute Lymphoblastic Leukemia (ALL)
SKINNY Reasoning
April Peters, 10 years old
Primary Concept
Cellular Regulation
Interrelated Concepts (In order of emphasis)
• Infection
• Perfusion
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
© 2018 Keith Rischer/www.KeithRN.com
, • Pharmacological and Parenteral 12-18%
Therapies
• Reduction of Risk Potential 9-15%
• Physiological Adaptation 11-17%
© 2018 Keith Rischer/www.KeithRN.com
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
April Peters is a 10-year-old female with acute lymphoblastic leukemia (ALL) who presents to the
emergency department with a temperature of 38.4 degrees C. (101.2 F.) and a complaint of a sore
throat. She has been receiving chemotherapy since her diagnosis three months ago. April’s
mother reports that her fever has been unresponsive to acetaminophen and she is two days out
from her most recent chemotherapy treatment. No reports of nausea, vomiting, or diarrhea noted.
A CBC is drawn immediately from April’s central venous access device (CVAD) and April is
admitted directly to the pediatric oncology unit where you are the nurse responsible for her care.
She weighs 57 lbs. (25.9 kg), is 51.5 inches (128.8 cm.) and has NKDA.
Personal/Social History:
April lives at home with her mother Cindy, her father Tom, and her 6-year-old sister Maggie. Tom
works full-time as an engineer while Cindy stays home with the children because of April’s
diagnosis and resulting hospitalizations and treatment. April has missed quite a few days of
school. Although her school system has provided April with a tutor to keep up with her studies,
April does not return telephone calls from her friends and refuses their visits.
Past Medical History (PMH):
• Cindy’s pregnancy was uneventful and April was born via an uncomplicated vaginal
delivery at 40 weeks and weighed 7 lbs., 1oz. (3.2 kg.)
• Tonsillectomy at 3 years old under general anesthesia.
• ALL diagnosis 3 month ago following a short history of headaches and pallor. April’s WBC
count at diagnosis was 469,000 FYI: Hyperleukocytosis is defined as a peripheral white
blood cell count greater than 100,000/mm3 and is a pediatric oncologic emergency. These
white blood cells are immature blast cells not normal cells. Hyperleukocytosis can
progress to capillary obstruction, microinfarction, and organ dysfunction, which can lead
to respiratory distress and cyanosis. Children may also experience changes in neurologic
function, including an altered level of consciousness, visual disturbances, confusion, and
ataxia.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
© 2018 Keith Rischer/www.KeithRN.com
SKINNY Reasoning
April Peters, 10 years old
Primary Concept
Cellular Regulation
Interrelated Concepts (In order of emphasis)
• Infection
• Perfusion
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
© 2018 Keith Rischer/www.KeithRN.com
, • Pharmacological and Parenteral 12-18%
Therapies
• Reduction of Risk Potential 9-15%
• Physiological Adaptation 11-17%
© 2018 Keith Rischer/www.KeithRN.com
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
April Peters is a 10-year-old female with acute lymphoblastic leukemia (ALL) who presents to the
emergency department with a temperature of 38.4 degrees C. (101.2 F.) and a complaint of a sore
throat. She has been receiving chemotherapy since her diagnosis three months ago. April’s
mother reports that her fever has been unresponsive to acetaminophen and she is two days out
from her most recent chemotherapy treatment. No reports of nausea, vomiting, or diarrhea noted.
A CBC is drawn immediately from April’s central venous access device (CVAD) and April is
admitted directly to the pediatric oncology unit where you are the nurse responsible for her care.
She weighs 57 lbs. (25.9 kg), is 51.5 inches (128.8 cm.) and has NKDA.
Personal/Social History:
April lives at home with her mother Cindy, her father Tom, and her 6-year-old sister Maggie. Tom
works full-time as an engineer while Cindy stays home with the children because of April’s
diagnosis and resulting hospitalizations and treatment. April has missed quite a few days of
school. Although her school system has provided April with a tutor to keep up with her studies,
April does not return telephone calls from her friends and refuses their visits.
Past Medical History (PMH):
• Cindy’s pregnancy was uneventful and April was born via an uncomplicated vaginal
delivery at 40 weeks and weighed 7 lbs., 1oz. (3.2 kg.)
• Tonsillectomy at 3 years old under general anesthesia.
• ALL diagnosis 3 month ago following a short history of headaches and pallor. April’s WBC
count at diagnosis was 469,000 FYI: Hyperleukocytosis is defined as a peripheral white
blood cell count greater than 100,000/mm3 and is a pediatric oncologic emergency. These
white blood cells are immature blast cells not normal cells. Hyperleukocytosis can
progress to capillary obstruction, microinfarction, and organ dysfunction, which can lead
to respiratory distress and cyanosis. Children may also experience changes in neurologic
function, including an altered level of consciousness, visual disturbances, confusion, and
ataxia.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
Problem:
© 2018 Keith Rischer/www.KeithRN.com
