Question

Case Study: Nicole is admitted to the pediatric unit of the local hospital with a temperature of 38.8º C (101.8º 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 Hematocrit: 25% Platelets: 50,000/mm3 White blood cell count: 2,000/mm3 Differential: Neutrophils 20%

Questions

1. Discuss the significance of Nicole's laboratory findings.

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

3. What are the priorities of care for Nicole on admission?

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

5. What nursing actions address the adverse effects associated with chemotherapy?

6. Nicole is receiving cyclophosphamide intravenously. Discuss this agent including any nursing interventions necessary specifically related to its use. 7. Nicole is diagnosed with a CVAD line infection. Discuss how these infections occur and why.

8. 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 Nicole's mother's statements, considering Nicole's level of growth and development.

9. 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.

10. Nicole is prescribed intravenous antibiotic therapy to treat her line infection. The health care provider prescribes gentamicin sulfate 100 mg IV q8h. vancomycin hydrochloride 500 mg IV every Case Studies Product Sampler Case Studies in Pediatrics CASE STU DY 5 NICOLE 6 hours, and cefoxitin sodium 1 g IV every 6 hours. Nicole weighs 40 kg (88 lb). Discuss these agents and if the doses prescribed are safe for Nicole.

11. The pharmacy schedules Nicole's antibiotic therapy as follows: Gentamicin 2400h 0600h 1200h 1800h Vancomycin 0200h 0800h 1400h 2200h Cefoxitin 2400h 0600h 1200h 1800h Discuss this schedule and what alterations the nurse should make, if any.

12. Calculate the rates of administration via a volumetric intravenous infusion pump for the following: Gentamicin sulfate: 100 mg in 100 mL of 5% dextrose in water to infuse over 30 minutes Vancomycin hydrochloride: 500 mg in 250 mL of 0.9% normal saline Cefoxitin sodium :1 gin 50 mL of 5% dextrose in water to infuse over 15 minutes

Answer 1

1) Nicole's laboratory values are below the normal range. This can be due to adverse effects of chemotherapy. The normal hemoglobin for an adolescent girl is 12 - 16 g/ dl and the normal hemocrit for her age group is 38% to 47% . Nicole's values indicate anemia. This happens when hematocrit falls below 28%. The normal white blood cell count for Nicole is 4100- 10800/ mm cube and neutrophils should be 58% to 67%. Neutrophil count < 500 cell/ mm cube which indicate neutropenia. The normal platelet count for 13 to 18 year old girl is 150000 to 450000/ mm cube. Decreased platelet count of 50,000 indicate thrombocytopenia.

2) Other assessment data which would be helpful for the nurse to have to prepare Nicole's care plan are as follow:-

a) Urine specific gravity

b) Urine for blood

c) Hemoccult of stool

d) Assessment of Central Venous Access Device ( CVAD) for redness, swelling, purulent discharge, pain

e) Urine culture and sensitivity

f) Chest X - ray

g) Oxygen saturation via pulse oximetry

h) Peripheral blood cultures and cultures from CVAD

3) The priorities of care for Nicole on admission are :-

a) Ineffective protection related to neutrophil count.

b) High risk for injury and bleeding related to platelet count.

c) Risk for ineffective perfusion related to hemoglobin and hematocrit values.

d) Impaired oral mucous membranes related to presence of mouth lesions.

e) Acute pain related to presence of mucositis.

f) Risk for nausea related to effects of chemotherapy on gastrointestinal ( GI) mucosa.

g) Disturbed body image related to alopecia.

h) Deficient knowledge related to Nicole's current condition, treatment and home care.

4) The most common adverse effect of chemotherapy is Myelosuppression. Cancer drugs target any fast growing cells including erythrocytes, leucocytes and platelets which can lead to Anemia, Neutropenia and Thrombocytopenia. Some of common side effects of chemotherapy are Hair loss, Easy bruising and Bleeding, Infection, Constipation, Diarrhoea, Mouth ulcer and weight changes.