How to conduct a growth and leukemia case Study: Joshua Jones (Solved)

How to conduct a growth and leukemia case Study: Joshua Jones (Solved)

Case prompt: Anna (age 35) and Tom (age 36) Jones have an appointment with you for an evaluation of their son, Joshua, who is 5 years old. They bring all of their children to the appointment, including Tommie (6 months), Joshua (5), Sally (7), Mari (11), and Janey (15). You quickly recognize that the entire family needs assistance, not just Joshua.

Joshua was recently diagnosed with acute myeloid leukemia, and he is not expected to live more than a few months. He has been withdrawn and irritable, is crying a lot, and has not been interested in playing or doing the things he used to enjoy before his diagnosis. Also since the diagnosis, his siblings have been fighting a lot at home with each other and their parents and refusing to do their chores. Mari and Janey, the two oldest, are refusing to go to school.

In your initial post, answer the following questions from your perspective as their psychiatric nurse practitioner.

1. Based on Joshua’s presentation, how would you relate his developmental milestones to his clinical presentation and perception of death and dying? When providing grief therapy, what information would you provide Joshua and his parents regarding Joshua’s perception of his terminal illness?

2. Select one of the Jones’ children (except Joshua) and identify the normal developmental milestones you would expect based on that child’s current age. Identify an age-appropriate national or community resource related to grief for a sibling with cancer and explain the benefit of the resource you provided.

3. What, if any, cultural considerations should you apply when working with the Jones family?

Solution to case study

  1. Based on Joshua’s presentation, how would you relate his developmental milestones to his clinical presentation and perception of death and dying? When providing grief therapy, what information would you provide Joshua and his parents regarding Joshua’s perception of his terminal illness?

Developmental milestones are behaviors and skills observed in infants as they grow and develop. There are different milestones for each age range. Physical growth, cognitive development, emotional and social development, linguistic development, and sensory and motor development are the five key categories of milestones. At five years of age, the cognitive milestones which involve learning, thinking, and problem-solving are slightly developed. The basic concepts of time can be understood by the child. They can distinguish fantasy from reality and are eager to please. Their fine motor skills such as climbing and jumping are improving. They also exhibit some independence.

Being diagnosed with myeloid leukemia hinders developmental milestones. The child becomes dependent on the family for things they should be doing for themselves. However, at this age, the child does not understand the concept of death and might think that it is their fault. They may think that is a punishment for something they did wrong and not a biological process that everyone goes through(National institute of health, 2017). The parents must provide adequate emotional support, listening, and love for the child. The parents should encourage the child to engage in physical activities. Some children fear that they are hurting and disappointing their parents by dying; therefore, they seek permission from their parents.

  1. Select one of the Jones’ children (except Joshua) and identify the typical developmental milestones you would expect based on that child’s current age. Identify an age-appropriate national or community resource related to grief for a sibling with cancer and explain the benefit of the resource you provided.

Janey, who is 15 years old, understands death’s concept that it’s universal, permanent, and inevitable. According to Kubler Ross, she goes through the five stages of dying: denial, anger, bargaining, depression, and acceptance (National institute of health, 2017). Joining support groups, acknowledging the grief of Janey, and listening to her fears help her to transition through the stages. The child will not feel like she is dealing with her sibling’s death alone.

 

  1. What, if any, cultural considerations should you apply when working with the Jones family?

Every culture has its own set of beliefs and values about what life is about and what occurs after death. People can benefit from rituals and customs while they go through the grief process. Some people are religious, and religious activities such as going to church provide comfort and social support (National institute of health, 2017). It’s critical to recognize that there are disparities in how people deal with death on a personal level.

References

National Institutes of Health. (2017). Grief, bereavement, and coping with loss (PDQ®)–health professional version.

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