17 Jun WHAT DOES THE PRESENCE OF BLASTS IN THE DIFFERENTIAL MEAN?
C.O. is a 43-year-old woman wh Show more I need the answers and rationals for this NURSING case study Thanks. C.O. is a 43-year-old woman who noted a nonpruritic nodular rash on her neck and chest approximately 6 weeks ago. The rash became generalized spreading to her head abdomen and arms and was accompanied by polyarticular joint pain and back pain. She experienced three episodes of epistaxis in 1 day about 2 weeks ago. Over the past week her gums have become swollen and tender. Because of the progression of symptoms and increasing fatigue she sought medical attention. Lab work was performed and C.O. was directly admitted to the referred hematology/oncology unit of a teaching hospital under the care of a hematologist for diagnostic evaluation. Her chest x-ray (CXR) showed normal lung expansion heart size normal and no lymphadenopathy. Skin biopsy showed cutaneous leukemic infiltrates and a bone marrow biopsy showed moderately hypercellular marrow and collections of monoblasts. Her lumbar puncture 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 continuous infusion for 7 days and idarubicin (Idamycin) 12 mg/m 2/day IV push for 3 days. She is scheduled in angiography for placement of a triple-lumen subclavian Hickman catheter before beginning her therapy. CBC WBC 39000/mm Monocytes 64% Lymphocytes 15% Neutrophils 4% Blasts 17% Hgb 10.4 g/dL Hct 28.7% Platelets 49000/mm 1. Interpret C.O.s CBC results. What does the presence of blasts in the differential mean? 2. What is the purpose of a bone marrow biopsy? 3. Considering all the admission data listed previously what potential problem will the nurse be alert for after the patient returns to the unit following insertion of the catheter? 4. What assessments are essential for the nurse to make regarding the central catheter throughout the hospitalization? 5. What are the side effects of cytarabine (Ara-C) and idarubicin? Identify five nursing interventions related to the side effects of each chemotherapeutic agent. Vital Signs Blood pressure 110/54 mm Hg Heart rate 115 beats/min Respiratory rate 26 breaths/min Temperature 101.6 F (38.7 C) 6. What additional assessments should you make at this time? You notify the intern on duty of your findings who evaluates C.O. and writes the following orders: Physicians Orders Blood cultures now 2 sites Acetaminophen (Tylenol) suppository 650 mg q4-6 h prn Primaxin (Imipenem) 500 mg IVPB q8h Notify physician for temp over 100.0 F (37.8 C) 7. Do these orders seem appropriate for this patient? Explain. 8. What will your next step be? Laboratory Test Values WBC 1200/mm Monocytes 25% Lymphocytes 65% Neutrophils 5% Blasts 5% Bands 0% Hgb 6.8 g/dL Hct 21.3% Platelets 17000/mm 9. These are C.O.s labs on the last day of the continuous chemotherapy. What does this count indicate about her immune system? 10. Calculate C.O.s absolute neutrophil count (ANC) and describe its significance. 11. Considering the previous data what blood products will most likely be ordered for C.O.? On day 14 after completion of her therapy a bone marrow biopsy shows the patient is in complete remission. With continued blood product support and antibiotic coverage her marrow recovers and she is discharged from the hospital. HLA (human lymphocyte antigen) typing has been performed on all siblings. Her oldest brother is a perfect HLA match and has agreed to donate bone marrow or stem cells. C.O. is to be readmitted to the bone marrow transplant unit within the next few weeks. 12. What does complete remission mean for C.O. and what impact did it have on the decision to perform a bone marrow transplant? 13. What type of bone marrow transplant will she have? Briefly describe the transplant process. 14. On day 17 after the transplant she develops severe nausea and vomiting in addition to diarrhea of more than 1200mL in 24 hours. Graft-versus-host disease of the gut is suspected. Describe graft-versus-host disease. 15. Is there a potentially positive result of this complication? Explain your answer. 16. Identify four priority problems for a patient undergoing a bone marrow transplant then develop interventions and expected outcomes for each problem. Show less
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