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Question: case study 35yearold esther i need help with this assignment...

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Case study: 35-year-old Esther

 I need help with this assignment

35-year-old Esther presented to her General Practitioner after experiencing two-months of spontaneous bruising to her body without any known injuries, bleeding gums, persistent fatigue, and sore throat. Esther was a recent first-time mother (9-month-old) and thought that these changes were considered normal. Her general practitioner arranged pathology to take a peripheral full blood count (FBC) which showed the following:

Haemoglobin: 75g/L (ref. range 120 - 150g/L)
WCC: 20 (x 10/L) (ref. range 3.5 - 11 (x10/L))
Neutrophils: 0.8 (x 10/L) (ref. range 1.7 - 7.0 (x10/L))
Platelets: 32 mcL (ref. range 150 - 450 (x10/L))
Blasts %: 50% (ref. range <5%)

Esther’s Diagnosis


Normal blood smear                                                                   AML blood smear


An intervention

Esther had a Hickman’s line (Central Venous Access Device- refer to image) placed in her chest, was provided with blood cell support (PRBC’s and platelets) and was to begin a high dose chemotherapy induction (7-3 : Cytarabine and DAUNOrubicin) two days following her initial presentation to her GP.




On day +6 of her treatment her blood results that morning showed:

Haemoglobin: 82g/L (ref. range 120 - 150g/L)
WCC: 8 (x 10/L) (ref. range 3.5 - 11 (x10/L))
Neutrophils: 0.01 (x 10L) (ref. range 1.7 - 7.0 (x10/L))
Platelets: 10 mcL (ref. range 150 - 450 (x10/L))

At 0800 hours, Esther rang the call bell complaining of a sore mouth and difficulty swallowing due to pain. On observation her mouth was filled with new ulcers, her gums were bleeding and mouth/lips dry indicating severe oral mucositis (refer to image). She was provided with mouth care and a stat dose of oral morphine (ordine) 2mg was given.



On a routine observation round at 1000 hours Esther was observed to be diaphoretic, she had an increased work of breathing (WOB), was rigoring (shaking) and pallor. Her vital signs were taken and were as follows:

23/02/20: 1005 hours

Heart rate


Blood pressure


Respiratory rate






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