In: Nursing

CASE STUDY PROGRESS M.D. has now completed three cycles of chemotherpy, with her last treatment 12…


M.D. has now completed three cycles of chemotherpy, with her last treatment 12 days ago. She comes to the emergency department with a 1-day history of fever, chills, and shortness of breath. On arrival, she is slightly confused and agitated. Vital signs are 100/60, 119, 26, 103.6° F (39.8° C), Spo2 86% on room air. The chest x-ray examination shows diffuse infiltrates in the left lower lung consistent with pneumonia. Her basic metabolic panel is within normal limits, except the blood urea nitrogen (BUN) 28 mg/dL (10.0 mmol/L) and creatinine 1.6 mg/dL (141 mcmol/L).

Chart View

Complete Blood Count

White blood cells (WBCs) 1200/mm3 (1.2 x 109/L)
Neutrophils 34%
Segmented (“polys”) 30%
Bands 4%
Lymphocytes 60%
Monocytes 3%
Eosinophils and basophils 2%
Hematocrit (Hct) 24.9%
Hemoglobin (Hgb) 8.7 g/dL (87 g/L)
Platelets 85,000/mm3 (85 x 109/L)
  1. Interpret M.D.’s laboratory results and explain the reason for any abnormal results.
  2. M.D.’s absolute neutrophil count (ANC) is calculated as less than 500/mm3, describe the significance of this value.
  3. What is your nursing priority at this time?
  4. What is the single most important nursing intervention for a patient with an ANC below 500/mm3?
  5. When is neutropenia most likely to occur in a person receiving chemotherapy?
  6. What type of isolation do you need to initiate for M.D.? Outline the guidelines for maintaining this type of isolation.
  7. What collaborative care interventions do you expect for M.D.?
  8. What immediate nursing interventions do you need to take?
  9. What actions do you need to take because M.D. had a left axillary lymph node dissection and why?
  10. The provider orders a 500-mL normal saline bolus now, with orders to infuse over 2 hours. You decide to use M.D.’s implanted port for IV access. After you access the port and connect the fluid, the infusion pump alarms that the line is occluded. What will you do?

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