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**Read Case Study Attached & Answer Question 1**
Ms. Mason’s Decision: Carry her fetus to term or have a partial birth abortion.
Question 1: On the day the physician explained the options to Ms. Mason you are the nurse and try to establish a genuine ethical relationship with her in an effort to convey caring and give support. What are the specific ethical competencies you will exercise for this encounter?
**Read Case Study Attached For Daphoene Haemon & Answer Question 2**
2. DH has been having problems with bleeding. It has been difficult to get the bleeding to stop once it has started. Discuss how AML could affect the formation of and numbers of platelets circulating in DH’s blood. (Hint: Discuss how platelets are associated with the myeloid cell line.)
** Read Below & Answer Question 3**
3. Briefly Describe Osteoporosis & include factors that affect bone growth like nutrition or pregnancy. Describe the causes, symptoms and possible treatments. You should have a minimum of 2 academically appropriate resources (your textbook can be one source).
** Read Below & Answer Question 4**
4. Do you have any idea how much sodium you usually consume? Have you ever tried to reduce your sodium intake? For this exercise, track your sodium intake for at least one day and discuss what changes you could have made to achieve a total sodium intake under 2,000 mg. Remember to check the sodium content of each food product on the Nutrition Facts panel of the label, and keep a record of your food choices and estimate the total grams of sodium. You may want to use the handout below, “Spices to Enhance Salt-Free Dishes,” to help brainstorm strategies for cooking without salt.
Word Count Is Your Discretion
MLA Format
Due 1/30/18
4pm American/New York Time
The Case of Daphoene Haemon
Introduction
Daphoene Haemon (DH), an eight-year-old girl, has been battling various illnesses since
her birth. Developmental disabilities have left DH with moderate learning disabilities and
physical manifestations such as incomplete extra thumbs on each hand. DH is well below the
normal body weight for her age; her head and eyes appear too small for her little body. She has
been monitored closely by a cardiologist, her heart doctor, because of a problem with the valves
in her heart. Recently, DH had been suffering from continual sinus, skin, and ear infections.
Bleeding had also become an issue for her recently; even minor injuries seemed to bleed
uncontrollably. Her nose and gums seemed to bleed spontaneously, without even a sneeze or the
use of dental floss.
DH and her parents are accustomed to sitting in doctor’s office waiting rooms together.
However, once they saw the doctor this time, the news was particularly awful. A blood test that
her pediatrician had ordered during her most recent struggle to heal, as well as another infected
wound on her leg, suggested that DH had developed acute myeloid leukemia (AML). AML is a
cancer of white blood cells and bone marrow that usually affects adults well in the fourth or fifth
decade of life. Is cancer the reason for DH’s poor health, or is there some common thread that
links all of her maladies into one underlying disorder? Follow DH’s case as her appointment
with a pediatric oncology (cancer) specialist quickly becomes an emergency.
DH’s pediatrician wanted input from the oncologist before confirming a diagnosis of
acute myeloid leukemia (AML), as this type of leukemia is not commonly found in children. As
you would expect, DH’s parents had a long list of questions and concerns for yet another medical
specialist. The pediatrician did not want to scare the family, but AML needs immediate attention.
The bottom line, according to the pediatrician, was that if DH did have AML, she would need to
be treated quickly or her life would be in grave danger. Arrangements were made for DH and her
family to see an oncologist that very same afternoon.
DH’s parents were hopeful that there had been some mistake with the blood tests. In
addition to confirming the acute myeloid leukemia diagnosis, the cause of her recurring
infections was at the top of their list of questions. Could AML also cause fatigue or the bleeding
gums and nosebleeds? DH was also recently much more easily fatigued and short of breath while
doing her usual activities. Could AML explain all of DH’s recent medical issues?
The oncologist always set aside a large block of time for new patients and their families,
as she expected many questions and concerns. She anticipated that DH might need to be
hospitalized for close monitoring and treatment. More information could hopefully explain some
of DH’s most recent symptoms. DH did have blood work findings consistent with leukemia. In
addition, AML had been verified by some new blood work results. The diagnosis certainly
explained the recurring infections, bleeding, and fatigue. DH also had anemia, which is common
with bone marrow cancer such as AML. However, it was the type of anemia that caught the
attention of the oncologist—the few visible red blood cells didn’t look normal when examined
under the microscope.
Unfortunately, DH’s condition had deteriorated quickly during the course of the day. She
began the day at her pediatrician’s office weak but otherwise normal. In the oncologist’s office,
however, she looked quite ill and was only able to open her eyes briefly to answer some simple
questions. The oncologist quickly gave DH’s parents as much information as she could while
making preparations to send DH to the hospital.
DH’s parents asked the oncologist to explain the complete blood count (CBC) in terms
that they could understand. They had been told that a high white blood cell count just meant that
DH had an infection. How was the white blood cell count different in AML? The oncologist
explained that DH’s white blood cell count was much higher than what would be expected with
an infection alone. DH could have an infection as well, but one thing was certain—DH needed to
be admitted to the hospital. She needed a complete work up of her condition, a treatment plan for
AML, blood transfusions, possibly antibiotics, and close monitoring. The oncologist needed
more information, and she wasn’t sure they had much time to sort this case out.
More extensive blood work was performed once DH was settled in the pediatric oncology
wing of University Hospital. A bone marrow biopsy was also quickly performed, so the results
could be interpreted and used to formulate a treatment plan for DH. DH’s blood was typed and
cross matched in the probable event that she would need transfusions. There was concern that
she might also need platelet transfusions to prevent further bleeding. DH’s parents were
obviously frightened by the urgency with which the oncology team performed their tasks. The
oncologist was doing her best to keep them informed, but it was difficult. The pediatric oncology
service had counselors knowledgeable in the field that could assist with family communication.
DH didn’t feel very well. She ached all over but she seemed to like the attention from the
nursing staff and the young doctors who visited with her oncologist early in the morning. She
missed her parents when they were away from her hospital room. The nurses were in her room
constantly changing the dressing from where the bone marrow biopsy was taken.
The biopsy site was still oozing blood and had been since the procedure was performed.
DH’s nurse contacted the oncologist, who had already contacted DH’s parents for their consent
to administer both plasma containing clotting factors and platelets. DH would need to be
stabilized before the oncology team would be able to treat the AML.
Although DH had been put on a ventilator to assist with her respiration and she was
continuously receiving intravenous fluids, her vital signs were becoming unstable. The oxygen
saturation in her tissues was dropping, her heart rate was elevated, and her blood pressure was
becoming dangerously low. DH needed functional erythrocytes to carry oxygen that her plasma
did not contain. The typed and cross-matched blood the medical team was waiting for would not
be ready in time. DH needed to be transferred to the pediatric intensive care unit (PICU)
immediately. Her condition was rapidly declining.
DH’s blood type was A+, and four units of blood had been ordered for her, but there was
a delay at the blood bank. The oncology unit had an emergency supply of O- blood. One unit of
type O- blood began transfusing while DH was transferred. A second and third bag of O- blood
was prepared for transfusion as well. DH’s parents were beginning to panic when the oncologist
met them and escorted them to the PICU waiting room. The next few hours would be critical,
and there was a possibility that DH would not survive the night.
DH survived the night and was responding well. The PICU team was confident that they
would be able to remove the breathing tube for the ventilator within a day or so. The plasma,
platelets, and erythrocytes that had been transfused were helping to stabilize DH’s vital signs.
Her heart rate and blood pressure were nearly normal, and the oxygen saturation in her tissues
was stable. Treatment for acute myeloid leukemia would need to begin quickly to prevent
another decline in her condition.
Based on DH’s medical history, her developmental disability and physical deformities,
and the presentation at her office with AML, the oncologist had ordered several genetic tests that
were not immediately available for review. A chemotherapy regimen aimed at suppressing the
production of abnormal blood cells in DH’s bone marrow had been designed and initiated, and
she was responding to the treatment.
Several weeks after DH’s presentation to the PICU, results from one of the blood tests
called a chromosome breakage test was available. The test was positive. DH’s chromosomes
from her blood sample were broken when mixed with the testing chemicals. This test is
commonly used to diagnose an inherited genetic disorder called Fanconi’s anemia.
Fanconi’s anemia (FA) is a disorder of the bone marrow that can lead to aplastic anemia
and pancytopenia, which involves decreased numbers of erythrocytes, leukocytes, and platelets.
Children with FA are usually smaller than average and some have developmental defects,
including thumb and arm deformities. The first signs and symptoms of FA, which are associated
with anemia and pancytopenia, include extreme fatigue, frequent infections, and nosebleeds or
easy bruising. Myelodysplastic syndrome (MDS), squamous cell carcinoma, and acute myeloid
leukemia (AML) are disorders that can appear in children before the diagnosis of FA has been
made.
Many children affected by FA develop bone marrow failure that requires treatment with
stem cell transplantation. Children that have had successful stem cell transplants are cured of the
anemia-related problems associated with FA, but must have regular examinations to monitor for
signs of cancer. Children who survive into adulthood are at risk for the development of head and
neck, gynecologic, and/or gastrointestinal cancers, which occur at a much earlier age (20s, 30s,
and 40s) than in the general population. The expected average lifespan for FA children is 33
years.
