Question

minimize side ellu black stools, vomit that looks bleeding/bruising, or hematuria. • Report symptoms of adverse effects or severe side effects promptly, especially chest pain; swelling of the face, neck, tongue, or lips: weight gain or loss; increasing short- ness of breath; fever or chills: convulsions; or difficulty speaking CRITICAL THINKING CASE STUDY count (ANC) of 0.096 x 10 /L.JW was started on erythropoi- JW, a 75-year-old man, has metastatic non-small cell cancer on me rung. His past treatment regimen included external etin 40,000 units subcutaneously once a week and filgrastim, beam chest irradiation and combination chemotherapy. Two G-CSF 5 mcg/kg/day given subcutaneously. Parenteral antibi- weeks before hospitalization, JW received a course of carbo- otic therapy was also initiated. platin and paclitaxel as an outpatient. He was admitted to the 1. Why were filgrastim and erythropoietin (EPO) indicated? hospital with neutropenia, thrombocytopenia, and anemia. 2. What must be monitored closely in patients receiving EPO Upon assessment, he was cachectic and weak but was able and why? to perform activities of daily living with only minimal assis 3. List three nursing diagnoses for this patient, tance. Admitting laboratory data were hemoglobin (Hgb) 6.9 4. Identify three nursing actions for each of the nursing diagno g/dL, hematocrit (Hct) 20.6%, platelets 16 x 10/L, a white ses identified in question 3 above. blood cell (WBC) count of 6 x 109/L with absolute neutrophil NGLEX STUDY QUESTIONS

Answer 1

1.) Person on radiation therapy has a tendency of lower hb level and lower white blood cell count (Neutropenia) which usually treated with filgastrim & erythropoietin as a adjuvant therapy . filgastrim helps to increase white blood cell count & erythropoietin helps to increase red blood cell count which treats anemia due to radiation therapy.

2) patients receiving EPO must be monitored for hematocrit level,RBC count hb level,reticulocyte count,serum ferritin level if iron stores are inadequate to support the increased erythropoiesis ,then appropriate iron replacement therapy should be provided.Monitoring also involve assessment of BP and it's control because development of hypertension is most common side effect of this treatment.

3) A)Fatigue related to lower heamoglobin level in blood(anemia)due to cancer and radiation therapy

Nursing action=

i.assist patient in performing activities of daily living

ii.advise patient not to do strenuous activity which can make him tired

iii.encourage patients to take diet properly

B) Risk for bleeding related to lower platelet count related to radiation therapy

Nursing action=

i. Advise patient not to do activities which can cause harm

C)Risk for infection related to neutropenia ( low white blood cell count)

Nursing action=

i.maintain hand hygiene techniques

ii.maintain aseptic technique before and after doing any procedure.