Case Study: Nicole Background: Nicoleis a 13-year-old-with

Case Study: Nicole Background: Nicoleis a 13-year-old-with leukemia. She lives at home with her parents and younger siblings and for the past 3 months has been receiving chemotherapy. She has a central venous access device (CVAD) that is cared for by her parents and her-self. Nicole has experienced a number of absences from school as a result of her hospitalizations, chemotherapy, and the effects of her chemotherapy regimen. She has had a tutor at home to keep her current with her studies. Nicole has alopecia and has been hospitalized with a line infection, stomatitis, esophagitis, and bleeding requiring platelet replacement. She refuses to see her friends although she speaks with them frequently on the phone. She tells them her refusal is based on the fact that she is prone to infection and doesn’t want to risk exposure and have to be hospitalized again. Clinical assessment: Nicole is admitted to the pediatric unit of the local hospital with a temperature of 38.8°C (101.8°F) that did not respond to the acetaminophen that she has been taking every 4 hours since yesterday. Her admission assessment indicated that Nicole’s lung sounds are clear, heart sounds are strong and regular, she is in no apparent distress, has alopecia, and has evidence of white patches in her mouth. Her laboratory values include: Hematology: Hemoglobin: 10.1 g/dL White blood cell count: 2,000/mm3 Hematocrit: 25% Neutrophils 20% Platelets: 50,000/mm3 Questions: Discuss the significance of Nicole’s laboratory findings. What other assessment data would be helpful for the nurse to have to prepare Nicole’s care plan? What are the priorities of care for Nicole on admission? Discuss the common complications (adverse effects) of chemotherapy. What nursing actions address the adverse effects associated with chemotherapy? Nicole is diagnosed with a CVAD (central venous access device) line infection. Discuss how these infections occur and why. Nicole’s mother is staying with Nicole during her hospitalization and expresses concern about Nicole refusing to see her friends and that Nicole seems “down” since her last chemotherapy. Discuss your impressions about her statements. (Consider Nicole’s level of growth and development) Nicole tells the nurse that her mouth and throat are so sore she cannot drink or eat anything. Discuss your impressions about Nicole’s complaints and the appropriate nursing actions to help Nicole. Nicole is prescribed intravenous antibiotic therapy to treat her line infection. The health care provider prescribes gentamicin sulfate 100 mg IVq8h, vancomycin hydrochloride 500 mg IV every 6 hours, and cefoxitin sodium 1 g IV every 6 hours. Nicole weighs 40 kg (88 lbs.). Discuss these agents and if the doses prescribed are safe for Nicole. SCIENCE HEALTH SCIENCE NURSING NURSING MS 580

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