The case exemplifies the continuity of care for a patient and is constructed based on national guidelines and an interview with a nurse at the children's oncology ward, Aarhus University Hospital. The case is thus a specific example of data that is to be standardized in the profiles.
An 8 year old patient attends their general practitioner with fatigue and vague symptoms. After an examination at the general practitioner and the local hospital's children’s ward, the standardized care plan and treatment process for AML begins due to reasonable suspicion. The next day, the patient is sent to a central children’s oncology ward for further examinations and diagnosis. The diagnosing process consists of a clinical examination with the following findings:
- Height: 129 cm
- Weight: 23 kg
- Respiration frequency: 25 breaths pr. minute
- Blood pressure: 140/90 mmHg (mean 115 mmHg)
- Pulse: 120 beats pr. minute
- Temperature: 37.9 degrees Celsius
Palpation of the liver shows signs of liver enlargement, but no abnormalities are found in the lymph nodes. In the patient's anamnesis, symptoms such as general malaise and multiple episodes of recurrent fevers are registered. During the examination, the patient seems feeble and has pale skin and mucosa. The patient's state of nutrition is slightly below the age average and the patient's development is age-appropriate.
After the clinical examinations, the child is put under general anaesthesia and a bone marrow examination is performed and completed. A central venous catheter is also operated into the patient and intra-spinal chemotherapy treatment is given. The blood samples taken during the bone marrow examinations are analyzed at the biochemical department and show 16.3 . 109 leukocytes pr. litre blood, 113 . 109 thrombocytes pr. litre blood and 6.4 mmol hemoglobin pr. litre blood, which supported the reasoned suspicion. The bone marrow samples taken during the bone marrow examination are sent to the pathology department for analysis and confirm the presence of cancer, thus defining the diagnosis of AML. All observations and measurements during the diagnosis process are documented in the patient's EHR at the central ward.
After a consultation with the patient, the parents and an oncology doctor, the initial chemotherapy treatment is begun. The next day, a new set of blood samples are drawn from the patient and are analyzed at the biochemical department, thus obtaining the most recent pathological picture. The blood sample results show 15.7 . 109 leukocytes pr. litre blood, 139 . 109 trombocytter pr. litre blod and 6.9 mmol hemoglobin pr. litre blood. Hence, the first round of chemotherapy is given through lumbar puncture. The patient also receives nausea medication and diuretics to ensure discharge of waste products. After a series of chemotherapy treatments, a status examination is conducted with another bone marrow examination and blood samples which showed signs of an oppressed immune system. All observations and measurements during the initial treatment process are documented in the patient's EHR at the central ward.
Five days after the chemotherapy treatment, the patient's parents notice a decline in the patient's health status. The patient is feeble, short of breath and has a fever of 39.2 degrees Celsius. The patient is admitted to the nearest decentral ward due to reasonable suspicion of an infection. The patient is examined with the following observations:
- Glasgow Coma Score: 14
- Systolic blood pressure: 135 mmHg
- Pulse: 124 beats pr. minute
- Respiratory rate: 26 breaths pr. minute
- Saturation: 94%
- Temperature: 39.6 degrees Celsius
From the observations, a TOKS-score of 11 is calculated. A larger set of blood samples are taken and their results are:
- Leukocytes: 14.7 . 109 pr. litre blood
- Hemoglobin: 7.0 mmol pr. litre blood
- Thrombocytes: 150 . 109 pr. litre blood
- Albumin: 36 g/L
- Creatinine 30 mikro-mol/L
- E-GFR: 60 min/min/1.73 m2
- Potassium: 2.6 mmol/L
- Sodium: 125 mmol/L
- ALAT: 30 U/L
- BASP: 100 U/L
- Bilirubin: 15 mikro-mol/L
- INR: 1.8
- LD: 290 U/L
- CRP: 185 mg/L
The blood samples determine that the patient has an infection. Intravenous antibiotics treatment with Ampicillin (dose 200 mg/kg/day, six doses) is started. The patient is monitored every 15 minutes as defined by the TOKS-score of 11. The patient also receives morphine for the pain (morphine DAK 20 mg/mL) and an intravenous therapy with saline is established. A stomach tube is also inserted to ensure the patient's nutrition.
After six days of hospitalization, the patient is in recovery and has no fever, thus ceasing the fluid therapy and the stomach tube. The patient's blood samples are improved; however, hemoglobin and leukocyte are still low at 4 mmol litre blood and 9 . 109 pr. litre blood, respectively. Therefore, the patient receives a blood transfusion after which the hemoglobin and leukocyte levels have risen above an acceptable level. All observations and measurements obtained during the admission are documented in the patient's EHR at the decentral wa