CANCER, WOMEN HEALTH, CHEMO, NEUTROPENIC
A 52-year-old male was discharged from the hospital for cancerrelated pain. His pain appeared to be well controlled on the IV morphine. He was switched to oral morphine when discharged 2 days ago. He now reports his pain as an 8 on a 10-point scale and wants the IV morphine. Which explanation is the most likely for the client's reports of inadequate pain control? 1. He is addicted to the IV morphine. 2. He is going through withdrawal from the IV opioid. 3. He is physically dependent on the IV morphine. 4. He is undermedicated on the oral opioid.
4. Most clients with cancer who are experiencing inadequate pain control while taking an oral opioid after being switched from IV administration have been undermedicated. Equianalgesic conversions should be made to provide estimates of the equivalent dose needed for the same level of relief as provided by the IV dose. There is research to suggest that cancer clients do not become addicted to opioids when dosed adequately. There is no evidence to suggest that the client is physically addicted or is having withdrawal symptoms.
The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast
ANS: A Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people; the nurse should see the client with chemotherapy-induced neutropenia first. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.
The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? (Select all that apply.) A Assess for fever. B Observe for bleeding. C Administer pegfilgrastim (Neulasta). D Do not permit fresh flowers or plants in the room. E Do not allow the client's 16-year-old son to visit. F Teach the client to omit raw fruits and vegetables from the diet.
ANS: A, C, D, F Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms. Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well; however, very small children, who may get frequent colds and viral infections, may pose a risk.
What are the clinical manifestations of menopause?(Select all that apply.) a Vaginal dryness b Thinning hair c Headaches d Hot flashes e Cold intolerance
a,b,c,d (The physical manifestations of menopause are thought to be related to diminishing estrogen. This accounts for the hot flashes, vaginal dryness, thinning hair, and headaches. Women experiencing menopause do not typically experience cold intolerance.)
A client in a hospice program has increasing pain. The nurse and client collaborate to schedule analgesics to provide: 1. doses of analgesic when pain is a 5 on a scale of 1 to 10. 2. enough analgesia to keep the client semisomnolent. 3. an analgesia-free period so that the client can carry out daily hygienic activities. 4. around-the-clock routine administration of analgesics for continuous pain relief.
4. The desired outcome for management of pain is that the client's or family's subjective report of pain is acceptable and documented using a pain scale; the goal is that behavioral and physiologic indicators of pain are absent around the clock. The nurse and client/family should develop a systematic approach to pain management using information gathered from history and a hierarchy of pain measurement. Pain should be assessed at frequent intervals. The client should not wait to receive medication until the pain is midpoint on the pain scale, nor should the client receive so much pain medication that he or she is not alert. Continuous pain relief is the goal, not just during particular periods during the day.
A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work done.
ANS: A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.
A 52-year-old woman complains of hot flashes, night sweats, irritability, decreased vaginal lubrication, and no menstrual period in the past 15 months. Over the past several weeks, the hot flashes and night sweats have increased in frequency, and she has noticed that she is more irritable. Laboratory values reveal increased follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse initiate?(Select all that apply.) a Asking open-ended questions about the client's body image b Instructing the client to avoid over-the-counter vaginal lubricants c Explaining such physiological manifestations of menopause as hot flashes and night sweats d Providing information about medications that might be prescribed to help with menopausal symptoms e Encouraging discussion of how menopausal symptoms are affecting sexual functioning
a,c,d,e Rationale The client is undergoing menopause. The client with menopause may have problems understanding the natural female aging process, sexual dysfunction, low self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiological manifestations of menopause; providing information about medications that might be prescribed to help with menopausal symptoms; encouraging discussion of how menopausal symptoms are affecting sexual functioning; and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking open-ended questions will further explore the client's thoughts and feelings about body image in a therapeutic manner.)
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife: (Select all that apply.) 1. gives her husband a long-acting or sustained-release oral pain medication regularly around the clock. 2. uses an immediate-release medication (oxycodone) for breakthrough pain. 3. avoids long-acting opioids due to her concern about addiction. 4. uses music for distraction as well as heat or cold in combination with medications. 5. substitutes acetaminophen to avoid tolerance to the medications. 6. has her husband use a pain rating scale to measure the effectiveness at reaching his individual pain goal.
. 1,2,4,6. Scheduled use of long-acting opioids and an around-theclock dosing are necessary to achieve a steady level of analgesia. Whatever the route or frequency, a prescription should be available for "breakthrough" pain medication to be administered in addition to the regularly scheduled medication. Oral drug administration is the route of choice for economy, safety, and ease of use. Even severe pain requiring high doses of opioids can be managed orally as long as the client can swallow medication and has a functioning gastrointestinal system. Tolerance occurs due to the need for increasing doses to achieve the same pain relief and will not be avoided with the use of acetaminophen. Addiction is a complex condition in which the drug is used for psychological effect and not analgesia. Nurses need to educate families about the appropriate use of opioids and assure them that addiction is not a concern when managing cancer pain. Nonpharmacologic methods are useful as an adjunct to assist in pain control. Self-report is the best assessment of pain and is an individual response
The nurse is working with a patient who expects to begin menopause in the next few years. What educational topic should the nurse prioritize when caring for a healthy woman approaching menopause? A) Patient teaching and counseling regarding healthy lifestylesB) Referrals to local support groupsC) Nutritional counseling regarding osteoporosis preventionD) Drug therapy options
ANS : A The individual womans evaluation of herself and her worth, now and in the future, is likely to affect her emotional reaction to menopause. Patient teaching and counseling regarding healthy lifestyles, health promotion, and health screening are of paramount importance. This broad goal of fostering healthy lifestyles transcends individual topics such as drug treatment, support groups, and osteoporosis prevention.
A client who is immunosuppressed is being admitted to the hospital on neutropenic precautions. Which nursing interventions should be implemented to protect the client from infection? Select all that apply. 1. Restrict all visitors. 2. Admit the client to a private room. 3. Place a mask on the client if the client leaves the room. 4. Use strict aseptic technique for all invasive procedures. 5. Place a "See the Nurse Before Entering" sign on the door to the room. 6. Remove a vase with fresh flowers in the room that was left by a previous client.
Answer: 2, 3, 4, 5, 6 Rationale: The client should wear a mask for protection from exposure to microorganisms whenever he or she leaves the room. The client who is on neutropenic precautions is immunosuppressed and therefore is admitted to a private room on the nursing unit. The use of strict aseptic technique is necessary with all invasive procedures to prevent infection. A sign indicating "See the Nurse Before Entering" should be placed on the door to the client's room, so the nurse can ensure that neutropenic precautions are implemented by anyone entering the room. Sources of standing water and fresh flowers should be removed to decrease the microorganism count. Not all visitors must be restricted; however, visitors need to be restricted to healthy adults and must perform strict hand-washing procedures and don a mask before entering the client's room.