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Asked by ProfessorCrow12774
C.O. is a 38-year-old woman who noted a nonpruritic nodular rash on her neck and chest 6 weeks ago. The rash became generalized, spreading to her head, abdomen, and arms and was accompanied by polyarticular joint pain and back pain. About 2 weeks ago, she experienced three episodes of epistaxis in 1 day. Over the past week, her gums became swollen and tender and she was severely fatigued. Because of the progression of symptoms, she sought medical attention. Lab work was performed, and C.O. was directly admitted to the hematology/ oncology unit under the care of a hematologist for diagnostic evaluation. Her chest x-ray examination showed normal lung expansion and heart size, without lymphadenopathy. Skin biopsy showed cutaneous leukemic infiltrates, and bone marrow biopsy showed moderately hypercellular marrow and collections of monoblasts. Her lumbar puncture specimen was free of blast cells. The final diagnosis was acute myeloblastic leukemia.
C.O. is to begin remission induction therapy with cytarabine (Ara-C) 100 mg/m2/day as a continuous infusion for 7 days and idarubicin (Idamycin) 12 mg/m2/day intravenous (IV) push for 3 days. She is scheduled in angiography for placement of a triple-lumen subclavian Hickman catheter before beginning her therapy.
Laboratory Test Results Complete Blood Count White Blood Cells (WBCs) Neutrophils
Blasts Lymphocytes Monocytes Hematocrit (Hct) Hemoglobin (Hgb) Platelets
39,000/mm^3 4%
17%
15%
64%
28.7%
10.4% g/dL 49,000/mm^3
1.Interpret L.M.’s CBC results. What does the presence of blasts in the differential mean? 2.What was the purpose of the bone marrow biopsy?
3. Considering all the admission data, what potential problem will the nurse be alert for when L.M. returns to the unit after insertion of the catheter?
4.What assessments regarding the central catheter are essential for the nurse to perform? 5.Identify five nursing interventions related to these side effects to include in C.O.’s plan of care.
CASE STUDY PROGRESS
On the fifth day of continuous infusion of cytarabine, the UAP reports C.O.’s vital signs to you.
Vital Signs
Blood pressure 110/54 mm Hg
Respiratory Rate Heart rate Temperature
26 breaths/min 115 betas/min 38.7 C (101.6 F)
6.What additional assessments should you make at this time? CASE STUDY PROGRESS
Your assessment findings are unremarkable, and you notify the intern on duty of C.O.’s vital signs. After evaluating C.O., the orders shown in the chart are written.
Physician’s Orders
Blood cultures no x2 sites
Acetaminophen (Tylenol) suppository 650 mg q4-6h prn
Imipenem/cilastatin sodium (Primaxin) 500 mg intravenous piggyback (IVPB) q8h
7.Do these orders seem appropriate for this patient? Explain.
 8.What will your next action be?Â
I need help answering questions 7 and 8
SCIENCE
HEALTH SCIENCE
NURSING
NURSING NUR2261
