Question

1.George, an 18-year-old, requires a splenectomy after a traumatic injury. What information should you provide to the patient before he is discharged to home?

2.Mr. J. is transferred from Boston to Denver by his employer. What physiological responses would you expect because of the change in altitude?

3.Mrs. M. has been diagnosed with neutropenia, a less than normal number of neutrophils. What complications could result from this condition, and as her nurse how could you reduce the likelihood of these complications?

4.Mr. S. has a platelet count of 50,000/mm3. What does this value indicate?

5. Brenda is diagnosed with pernicious anemia. She asks you to explain how she contracted this disease and why she has to get “shots” to improve the number of erythrocytes in her blood; she also wonders how long she will need to have these injections.

6. Howard, a 56-year-old smoker, has chronic obstructive pulmonary disease (COPD). He arrives at the clinic for a regular follow-up visit. His erythrocyte count, hemoglobin, and hematocrit are all elevated. What is the name of this type of disorder, and what is the likely cause?

7. Olivia is a 3-year-old recently diagnosed with acute lymphocytic leukemia (ALL) found during her annual physical examination. Her mother is very upset; she wants to know the signs and symptoms, so she may monitor her child for worsening disease.

8. Albert is a 16-year-old who has been treated for the past year for acute lymphocytic leukemia. He arrives in the emergency department with an altered level of consciousness, low-grade fever, and purulent urine. His father states Albert reported pain on urination that morning. You require two attempts to start his intravenous catheter and detect that he continues to bleed from these needle sticks after 5 minutes with hematoma formation at the first site. You suspect that Albert has developed disseminated intravascular coagulation (DIC). What diagnostic tests would be required?

9. Mr. Jones was in a motorcycle accident yesterday. His injuries included a pelvic fracture and a right femur fracture. The nurse practitioner prescribes heparin daily. Why does Mr. Jones need heparin at this time?

Answer 1

1. Home care after splenectomy:
          ?Pain Management:-
      pain medication is not routinely required after hospital discharge.
      ?Most children only need Acetaminophen or Ibuprophen once they are at home.

?Care for Dressings:-
            Gauze and clear plastic dressings, placed over the incisions, may be removed two days after surgery. Over the incision, there will be pieces of tape called Steri-strips®.
            ?There may be a small amount of blood on the Steri-strips. This is normal. Your child can bathe with the Steri-strips in place. There will be no visible stitches to remove because they are under the skin.
            ?The stitches will dissolve after several weeks.

?Healing Ridge:-
          After the incisions are healed you will be able to feel a firm ridge just underneath. This is called a healing ridge and it is normal to find this after surgery.
          ?The healing ridge usually lasts for several months before it softens and disappears.

?Bathing Restrictions:-
           child may bathe as soon as two days after surgery.
?Antibiotics & Infections:-
        child may require daily antibiotics post splenectomy.
        ? If child develops a temperature of 101°F (38°C), at any time after the operation, Penicillin may be required to prevent an overwhelming infection.

?Activity Restrictions:-
The number of follow up visits necessary until your surgeon clears your child to:

return to school;

assume regular activities;

participate in sports without restriction;

2. Answer:- A reduction in oxygen concentration would stimulate an increase in respiration and an increase in erythropoiesis to increase oxygen carrying capacity and delivery. Thus, he would have an increasing number of erythrocytes in his circulating blood volume, which would increase his hemoglobin and hematocrit.