Integration of Theory with Practice. Leukemia Case Reflection

Seminar Paper, 2018

10 Pages, Grade: 1


Introduction ... 2
Extended Discussion of Perspectives ... 3
Pathophysiology ... 3
Relevant Pharmacology ... 5
InterProfessional Roles in Patient Centered Care ... 6
Psychosocial Issues ... 7
Relating Knowledge to Clinical Practice ... 7
Conclusion ... 9
References ... 10
In nursing practice, practical skills are essential. It is through practical approaches that learners,
as well as practicing nurses apply theoretical knowledge to improve patients' outcome. This is
the principal goal of nursing interventions. However, the success of nursing interventions
depends on the professional competence of the nurses providing care. It is evident that the level
of competence varies among nurses, more or less the same as it is the case with intelligence.
Nevertheless, all nurses, as well as other healthcare professionals are expected to demonstrate
their potential for giving healthcare services to patients efficiently. This explains why all
professionals in healthcare to integrate knowledge and practical skills. This was demonstrated in
the simulation activity that involved providing nursing interventions to Jenny, a leukemia patient.
Jenny, a 10 year old girl had been diagnosed with leukemia. Six months after her diagnosis with
leukemia, she suffered pneumonia that led to her hospitalization for 10 days, after which she was
discharged home with home care support services and the palliative care team. During her
hospitalization, she received treatment in which nursing interventions were adopted to address
the underlying conditions, in order to improve the patient's health and quality of life. For

instance, our group offered nursing care to Jenny including administering Ceftriaxone 650Mg
BD IV during the simulation session. In this case scenario, several of theoretical perspectives
were required. Therefore, this critical reflection will discuss four key theoretical perspectives:
pathophysiology, relevant pharmacology, inter-professional roles in patient centered care, and
psychosocial issues related to the case scenario, and demonstrate the relationship between
theoretical concepts and clinical practice.
Understanding the pathophysiology of a given condition serves as the key approach to treatment
interventions. Ideally, pathophysiology determines the form of intervention that is required to
address the issues involved. One of the most important aspects of understanding pathophysiology
is to enable healthcare professionals to understand different aspects of diseases. For instance,
healthcare practitioners, as well as, medical students understand why diseases develop in the
human body with respect to human anatomy. They also learn how diseases develop, as well as
how their clinical manifestations appear. These help in the prognosis of a given disease or health
condition. Moreover, an extended understanding on the pathophysiology of diseases enables
nurses, as well as, other healthcare practitioners to understand the fundamental mechanisms
involved in the pathogenesis of diseases. According to theory, different diseases exhibit different
mechanisms. Some diseases exhibit neural mechanisms and others exhibit humoral mechanism.
On the other hand, diseases can exhibit cellular mechanism or molecular mechanism.
In this case scenario, understanding on the pathophysiology of pneumonia, that was the main
reason for hospitalization, as well as, the pathophysiology of leukemia, the underlying condition
was paramount. Jenny was diagnosed to have been infected with Haemophilus influenzae as the

etiological agent for pneumonia. Therefore, it is apparent that Jenny's pneumonia was caused by
an extrinsic factor. Haemophilus influenzae infested the upper airways and colonized the lung
parenchyma. As a result, bacterial pneumonia developed due to the impaired local defenses, a
phenomenon that is related to leukemia disease, deteriorated health status of the patient, and
virulence of the infecting Haemophilus influenzae. This infection in the pulmonary system led to
acute inflammation of the airways. This inflammation was caused by the filling of air spaces
with neutrophils that migrated out of capillaries (Kamangar 2015). Therefore, treatment was
aimed at eradicating the causative agent that was responsible for the pathophysiology and
restoring normal pulmonary function.
On the other hand, there was also the underlying pathophysiology related to leukemia. Leukemia
begins with the occurrence of a clone of malignant cells during lymphoid cellular maturation. In
most cases, rearrangement of the DNA in leukemic cells occurs due to external factors. Some of
these factors are chemicals, ionizing radiation and alkylating drugs. On the other hand, internal
factors such as genetic abnormalities including chromosomal mutations are responsible for DNA
changes related to the formation of malignant lymphatic cells. It is suggested that chromosomal
rearrangements cause alterations in the regulation and structure of cellular oncogenes. In the case
Jenny, the cause of leukemia appears to be caused by chromosomal abnormalities. In
lymphocytic leukemia, the sequence of genes is altered by chromosomal translocations that place
genes responsible for normal cellular proliferation and activation next to those genes that
regulate the synthesis of immunoglobulin proteins, primarily the light chain and heavy chain
immunoglobulin proteins. Therefore, these genetic alterations lead to lymphoblast proliferation,
resulting to the failure of the bone marrow. The outcome of these hematopoietic mechanisms
causes pancytopenia due to the expansion of immature cells in the bone marrow. It is also

believed that normal hematopoietic process is inhibited by secretions produced by the abnormal
lymphatic cells. Further proliferation of lymphoblasts in the bone marrow leads to the spilling of
abnormal cells into the circulation. In addition, abnormal cells infiltrate other organs including
the eyes, the spleen and the liver, and opportunistic infection serves as one of the core
manifestations (Wu 2015). This explains why Jenny presented with pneumonia following
diagnosis with leukemia.
From the nursing perspective, the rationale for addressing the pathophysiology of the disease was
to relief the symptoms associated to pneumonia. In addition, focus on the pathophysiology of
leukemia was necessary in order to assess the progression of the condition.
The second perspective involved in this case scenario was the pharmacology related to the
disease. In practice, it is apparent that understanding of pharmacology related to different
diseases forms the basis for effective therapeutic treatment of diseases. It is reported that
efficacy, safety and tolerability of medications by patients determines their clinical usefulness.
Therefore, understanding on the intended drug indications and the involved pharmacokinetics,
side effects and the associated potential adverse reactions serves paramount relevance (Berger &
Iyengar 2011). In practice, antibiotic therapy in the treatment of Haemophilus influenzae
involves the use of beta-lactamase, as well as non beta-lactamase drugs. Amoxicillin is the most
commonly used non beta-lactamase drug that is recommended as first-line therapeutic agent.
However, fluoroquinolone, azithromycin, doxycycline, and clarithromycin are used as alternative
antimicrobials for the treatment of Haemophilus influenzae infection. On the other hand, second
or third generation cephalosporin, beta-lactamase drugs are used as first-line agents for bacterial
pneumonia (Kamangar 2015).
Excerpt out of 10 pages


Integration of Theory with Practice. Leukemia Case Reflection
Egerton University
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Patrick Kimuyu (Author), 2018, Integration of Theory with Practice. Leukemia Case Reflection, Munich, GRIN Verlag,


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