RC The Chemotherapy Generally Have a Compromised Immune System Question

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Jenny is a 3-year-old patient diagnosed with Acute Lymphocytic Leukemia. She is the youngest of 3 children and lives with her parents and two older siblings. Jenny received chemotherapy 1 week ago. Her mother called the doctor’s office to report that Jenny is very tired, hasn’t wanted to eat and has an elevated temperature of 100.4 F.

  • Based on this information, what lab work should the nurse anticipate?
  • What is the nurse’s primary concern based on the patient’s symptoms?

Jenny is admitted to the hospital later that afternoon. Her lab results are reported as:

WBC 0.1

Neutrophils 5%

Basophils 0%

Eosinophils 2%

RBC 1.0

Hgb 7.4

Hct 35

Platelets 37k

Jenny’s admitting VS are recorded as:

HR 122

BP 80/56

RR 26

Temp 101.2 F

  • What should the nurse suspect is the cause of the altered lab results?
  • What are the implications for the patient related to the lab results?
  • What precautions should the nurse take with Jenny based on her lab results?
  • What is concerning to the nurse regarding the vital signs? What are the implications of the altered vital signs?

Jenny is placed on neutropenic precautions. She is started on IV antibiotic therapy and neupogen injections. Jenny’s mother reports that she seems reluctant to bear weight and still doesn’t want to eat. Upon inspection, the nurse observes several oral lesions (oral mucositis).

  • What is the rationale for administering neupogen?
  • What are the expected side effects of neupogen? Are there any nursing actions that can reduce the side effects?
  • What is oral mucositis? What is the cause of Jenny’s oral mucositis? What are the implications of oral mucositis? What is the expected treatment?
  • What are neutropenic precautions? What are the guidelines for implementation?

Jenny’s mother confides to the nurse that she misses her family and wants to know if her husband and other kids can come for a visit. Jenny’s current lab work is:

WBC 0.7

Neutrophils 6%

Basophils 1%

Eosinophils 2%

RBC 1.8

Hgb 7.0

Hct 32

Platelets 35

  • What are the implications of Jenny’s current lab results?
  • What should the nurse anticipate is the next intervention regarding Jenny’s hemoglobin and hematocrit?
  • How should the nurse respond to the mother’s question?

The physician determines that Jenny needs a blood transfusion. The order states that 165 mL of PRBCs are to be infused over 4 hours.

  • What must occur prior to Jenny receiving her blood transfusion?
  • What are the signs/symptoms of a transfusion reaction? When are the signs/symptoms most likely to manifest?
  • What is the protocol when a transfusion reaction occurs?

Jenny’s blood is obtained from the blood bank. It contains 165ml of PRBCs. After double-checking the blood with another nurse at the bedside and verifying the right patient is receiving the right blood the nurse proceeds to hang the PRBCs.

  • What rate should the IV infusion pump be set to infuse?
  • When should vital signs be taken?
  • What should the nurse tell Jenny’s mother to report during the transfusion?

Jenny tolerates the blood transfusion without signs or symptoms of a transfusion reaction. Her mother reports that Jenny seems to be feeling a “little bit better” and is wanting to play. Her current labs are:

WBC 2.5

Neutrophils 12%

Basophils 3%

Eosinophils 6%

RBC 2.8

Hgb 9.6

Hct 36

Platelets 40k

  • What are the implications of Jenny’s lab results?
  • Based on Jenny’s assessment, what should the nurse recommend?

After 10 days in the hospital, Jenny is ready to be discharged. Her lab results are:

WBC 3.0

Neutrophils 15%

Hgb 11.8

Hct 38

Platelets 88k

  • What patient education should be included in Jenny’s discharge teaching?

Write a nursing care plan for Jenny. Choose one Actual Nursing Diagnosis and one Potential Nursing Diagnosis. You must include 2 patient goals for each nursing diagnosis. You must include 3 nursing interventions for each patient goal. Include the rationale for each nursing intervention. You must determine how you will evaluate whether or not the patient goal was met.


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