solved

Ms. Y is a 44-year-old woman diagnosed with non-Hodgkin lymphoma (NHL) 3 months ago. She finished receiving her third of six chemotherapy courses 5 days ago. Yesterday morning, she was seen at her oncologist’s office for malaise, muscle weakness, and palpitations. She had splenomegaly on examination. A computed tomography (CT) scan of the abdomen showed metastatic disease in the liver and spleen. She is admitted to the hospital with progressive weakness.
Name 3 risk factors for lymphoma.
A.
B.
C.
Chart View
Comprehensive Metabolic Panel (CMP)
Na 139 mEq/L
K 6.3 mEq/L
Cl 96 mEq/L
CO2 28 mEq/L
Glucose 101 mg/dL
Blood urea nitrogen (BUN) 59 mg/dL
Creatinine 2.5 mg/dL
Ca 6.9 mg/dL
Total protein 5.4 g/dL
Albumin 2.8 g/dL
Phosphorus 4.9 mg/dL
Uric Acid 21 mg/dL
Total bilirubin 0.8 mg/dL
Alkaline phosphatase 172 units/L
Aspartate transaminase (AST) 254 units/L
Alanine transaminase (ALT) 74 units/L
Lactate dehydrogenase (LDH) 214 IU/L
Interpret Ms. Y’s admitting comprehensive metabolic panel results.
Based on the laboratory test results, which common oncologic emergency is Ms. Y experiencing?
Describe the pathophysiology of this condition.
What assessment findings related to this diagnosis would you expect in Ms. Y?
Complete Blood Count (CBC)
White blood cells (WBCs) 1500/mm3
Neutrophils 66%
Lymphocytes 16 %
Monocytes 15%
Eosinophils 5%
Hemoglobin (Hgb) 7.9 g/dL
Hematocrit (Hct) 22.4%
Platelets 21,000/mm3
Interpret the lab values above.
Name 3 additional problems for which Ms. Y is at risk.
What are your nursing priorities right now and why?
Medication Record
IV 0.9% normal saline at 150 mL/hr
100 mEq sodium bicarbonate (NaHCO3) in the first liter of the IV fluid
rasburicase 6 mg IV now
allopurinol 500 mg twice a day orally
furosemide 40 mg IVP now then every 6 hours
sodium polystyrene sulfonate (Kayexalate) 15 g orally every 6 hours
aluminum hydroxide 2 caps orally with meals
What is the expected outcome associated with each medication Ms. Y is receiving?
normal saline
NaHCO3
rasburicase
allopurinol
furosemide
Kayexalate
What are your nursing responsibilities when administering Kayexalate?
Discuss 2 major complications that could happen if Ms. Y’s abnormal laboratory test results (CMP results) will not be resolve?
A.
B.
Name 3 signs and symptoms for each of the following problems.
A. anemia
B. neutropenia
C. thrombocytopenia
List at least 7 independent nursing interventions that you would include based on the client’s abnormal laboratory test results.
A.
B.
C.
D.
E.
F.
G.
Comprehensive Metabolic Panel (CMP) day 2
Na 136 mEq/L
K 4.7 mEq/L
Cl 104 mEq/L
CO2 26 mEq/L
Glucose 110 mg/dL
Blood urea nitrogen (BUN) 36 mg/dL
Creatinine 2.1 mg/dL
Ca 7.9 units/L
Total protein 5.4 g/dL
Albumin 2.8 g/dL
Phosphorus 4.1 mg/dL
Uric Acid 2.0 mg/dL
Total bilirubin 1.0 mg/dL
Alkaline phosphatase 94 units/L
Aspartate transaminase (AST) 46 units/L
Alanine transaminase (ALT) 44 units/L
Lactate dehydrogenase (LDH) 222 IU/L
Interpret Ms. Y’s latest lab results by comparing it with the previous laboratory test results 24 hours ago.
If you think that the client’s condition is resolving, what other interventions would you include in her plan of care?
List at least 5 other oncologic emergencies and give at least two nursing interventions for each.
A.
B.
C.
D.
E.

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