CH 65 Management of Pts with Oncologic or Degenerative Neurologic Disorders

A client newly diagnosed with Huntington diease asks for information concerning management of symptoms. Which action would the nurse first take to address this request?

Perform a focused assessment on the client's needs and capabilities. Explanation: Nurses must look beyond the disease to focus on the patient's needs and capabilities first. While the client will benefit from the expertise of a Huntington disease multidisciplinary team, it is important to first establish their goals and individual needs. Only after a full assessment should medications be recommended by anyone on a health care team. In clients who present with rigidity, some temporary benefit may be obtained from antiparkinson medications, such as levodopa. Establishing a client's willingness to adhere to treatments is premature until the treatment plan is established. Huntington disease is characterized by a triad of symptoms that include motor dysfunction (the most prominent being chorea), impaired cognition, and behavioral features such as a blunted affect. Huntington disease is a progressive and terminal illness at this time. The focus for this client is optimizing quality of life with available medications and supportive treatments.

The nurse is providing education to a client who is being discharged with an outpatient treatment plan that includes taking a chemotherapeutic agent. What instructions should the nurse include? Select all that apply.

The client should seek emergency care if he or she develops a fever. Hair loss should be expected when taking the medication. The client should ensure no one else handles the medication. The client should be the only person to handle the medication. Because it is a chemotherapy agent, it is cytotoxic and can have a harmful effect on anyone who does not have a tumor. It is unsafe to take a double dose of the medication if it is missed the previous day. The client should be instructed to take the medication at the same time each day and, if a dose is missed, the client should be instructed to take it as soon as possible and then get back on the regular schedule again. Some clients taking this medication experience gastrointestinal side effects such as nausea and vomiting. Although this is not considered an emergency, the client should be instructed to discuss this side effect with the health care provider, because prolonged symptoms can lead to nutritional deficit and/or dehydration. Immunosuppression caused by the medication can lead to a white blood cell count too low to fight off an infection. A fever is a sign of infection and can be life-threatening for a person taking a chemotherapeutic agent. Care should be sought immediately in this case. A common side effect of this medication is alopecia or hair loss. The client should be made aware to anticipate that this is a possibility while taking the drug.

Which of the following is a common cancer that metastasizes to the spinal cord? Select all that apply.

Breast Prostate Lung Cancer can spread to the spinal cord. The three most common cancers that metastasize to the spinal cord are breast, prostate, and lung. Cancer can invade the cord, causing vertebral metastases. Colon and brain cancers do not commonly metastasize to the spinal cord.

Corticosteroids are used in the treatment of brain tumors for which of the following clinical manifestations? Select all that apply.

Cerebral edema Headache Altered level of consciousness Corticosteroids are used during treatment to reduce cerebral edema and reduce side effects of treatment, such as nausea and vomiting. They are also helpful in relieving headache and alterations in level of consciousness. Antiseizure agents are used to treat seizures if they occur. Corticosteroids are not used for personality changes associated with brain tumors.

A nurse helps a patient recently diagnosed with a pituitary adenoma understand that:

Most tumors produce too much of one or more hormones. Explanation: The majority of these tumors are benign. In rare cases, they may be malignant. Functioning tumors produce hormones, frequently in excessive amounts, resulting in conditions such as hyperthyroidism, Cushing's syndrome, and gigantism or acromegaly.