Question

Nicole is a 13-year-old-with leukemia. She lives at home with her parents and younger siblings and for the past 3 months has been receiving chemotherapy. She has a central venous access device (CVAD) that is cared for by her parents and her-self. Nicole has experienced a number of absences from school as a result of her hospitalizations and chemotherapy, Nicole has alopecia and has been hospitalized with a line infection, stomatitis, esophagitis, and bleeding requiring platelet replacement.

Clinical assessment:

Nicole is admitted to the pediatric unit of the local hospital with a temperature of 38.8°C (101.8°F) that did not respond to the acetaminophen that she has been taking every 4 hours since yesterday. Her admission assessment indicated that Nicole’s lung sounds are clear, heart sounds are strong and regular, she is in no apparent distress, has alopecia, and has evidence of white patches in her mouth.

Her laboratory values include:  

Hematology: Hemoglobin: 10.1 g/dL   White blood cell count: 2,000/mm3

  Hematocrit: 25%   Neutrophils 20%

  Platelets: 50,000/mm3

Questions:

1. Discuss the significance of Nicole’s laboratoryfindings.

2. What other assessment data would be helpful for the nurse to have to prepare Nicole’s care plan?

3. What are the priorities of care for Nicole onadmission?

4. Discuss the common complications (adverse effects) of chemotherapy.

5. What nursing actions address the adverse effectsassociated with chemotherapy?

6. Nicole is diagnosed with a CVAD (central venous access device) line infection. Discuss how these infections occur and why.

7. Nicole’s mother is staying with Nicole during her hospitalization and expresses concern about Nicole refusing to see her friends and that Nicole seems “down” since her last chemotherapy. Discuss your impressions about her statements. (Consider Nicole’s level of growth and development)

8. Nicole tells the nurse that her mouth and throat are so sore she cannot drink or eat anything. Discuss your impressions about Nicole’s complaints and the appropriate nursing actions to help Nicole.

9. Nicole is prescribed intravenous antibiotic therapy to treat her line infection. The health care provider prescribes gentamicin sulfate 100 mg IVq8h, vancomycin hydrochloride 500 mg IV every 6 hours, and cefoxitin sodium 1 g IV every 6 hours. Nicole weighs 40 kg (88 lbs.). Discuss these agents and if the doses prescribed are safe for Nicole.

Answer 1

The noxmal hemoglobin for an deenage girl 12-16 g/dL and hemot ocrit for her age should be 3g to y Nicole's labaxatory values indicate effeds of chemo thera py. Anemia, neutropenia thrombocytopenia increases high risk of infection and bleeding all this is seen in her lab reports. Nicole's report shows anemia that occurs when hemotociit falls below 28 The nos mal platelet count For old girls is I50,000 - 450006/mm3 3-18 Nicole indicate u bropenia as her count is <s00 cells/mm3, Throm bocytepenia occur when platelet count is below so; 0 00 cells/mm3 and &he is risk for bleeding J, Hemoccult of stools , X-ray for chest 3, Urine specific gravity Urine for blood S Urine sensitivity Culture- 6, CVAD anesment for suoculing, pain, rednen,discha

high becouwe of chemotherapy (3 The isk of nausea is on Gl mucos a Due to platelet cound decrease high risk for bleeding Due to the mucositic pain isill be presend the re latedl to mpaired osa! mucous presence of mauth lesions laeffective protection due to neutrophil count Hair follicle cells destruction, Nausea, vomtings mucositis , impaired hepadic function , Myelo Suppresion is the most complication this result in netrop eni a, thrombocytopentia Myelosupre ssion: Monitosing tempenature for e Very 3-y hour Monitor urine for blo0d Stenile us e for CVAD dressing Monitor laboxatovy va lues Administer prescribed antimicrobiaks Platelete Lount should be monitened RBC Count should be moniteved Moniter or bleeding Assens signs for anemia

Nausea Administer lora zepam a nd eliminate odors Due to the pa thogenie growth at the prozimal tip of catheter which reult in fibrin homation ohich is a ood media for bactenial grows th Fox girls at this oge they ane sentitive to their appeana nce and Nicole is di Pficult to adjust to alopecio and her veason is valid if her friends comment about hes a ppeanence she is afraid they will shun them. Dne should for explain that true friends does not cage appearanee And her self esteem may develop Chemotherapy destroys oralnomal flora tohich is mucosi tis Hydration maintanence by in Eravenous Fluids Citrus Pruits should be avoided ohich Causes . irritation to the sengilie mucou membrane
9)gentamicin Is a anti microbial which kills bacteria.vancomycin hydrochloride is an Antimicrobial which kills gram positive infection but this causes renal failure as side effect.cefoxitin kills gram positive and some gram negative infections But it cause allergy and anaphylaxis and all Nicole's dosage is safe.