Chapter 28 Nursing Care of Patients with Hematologic and Lymphatic Disorders

Answers CHAPTER 28 NURSING CARE OF PATIENTS WITH HEMATOLOGIC AND LYMPHATIC DISORDERS AUDIO CASE STUDY Lloyd and Chronic Myelogenous Leukemia 1. Lloyd had a cold that led to pneumonia. Blood work in the hospital revealed abnormal white blood cells. 2. Ask the health care provider about an analgesic prior to the procedure because bone marrow biopsy is painful. 3. Both leukemia and the treatment for it can impair white blood cell function. Lloyd is at risk for infection. He should wear gloves for gardening and wash his hands well when he is finished. VOCABULARY 1. False. Anemia is reduced red blood cells. 2. True 3. True 4. True 5. False. Phlebotomy removes blood to reduce blood volume. 6. True 7. False. Penia means “reduced.” Thrombocytopenia is reduced platelets. 8. False. Arth refers to joints. Hemarthrosis is bleeding into joints. 9. True 10. False. Cancer of the lymph system is lymphoma. 11. True 12. True On days when he is feeling especially tired, it would be appropriate to bring him his breakfast in bed. A liquid supplement that is easy to drink might also be helpful. 2. Do a complete pain assessment using the WHAT’S UP? format. The pain might be sternal or rib tenderness from crowding of bone marrow. Administer analgesics as ordered. 3. Not all runny noses are infectious. Find out if the nursing assistant has a cold. If so, reassign Mr. Frantzis’s care to another assistant because he is at risk for infection. 4. Mr. Frantzis may be developing confusion if the leukemia has invaded the central nervous system. Clarify with him who Jennifer is, and assess him for confusion. (Keep in mind that you may look like someone named Jennifer, and he may not be confused at all.) If he is becoming confused, assess for other causes, such as medication use or oxygen saturation, and institute measures to keep him safe. 5. Provide good mouth care after each meal and as required. Use a soft toothbrush or a swab if irritation is severe. Avoid giving him foods that are irritating, acidic, or extremely hot or cold. If he has dentures, remove for cleaning and at bedtime. Inspect his mouth carefully while dentures are out. CRITICAL THINKING: HODGKIN DISEASE Corrections are in boldface. Joe is a 28-year-old construction worker diagnosed with stage I Hodgkin disease. He initially went to his health care provider because of a painless lump in his neck. He is also experiencing low-grade fevers and weight loss. The diagnosis was confirmed in a laboratory test by the presence of Reed–Sternberg cells. He expresses his fears to his nurse, who tells him that Hodgkin disease is cancer, but it is often curable. Joe takes a leave from work and begins curative radiation therapy. CRITICAL THINKING: LEUKEMIA 1. Mr. Frantzis is in the final stage of his disease, and he has opted for no treatment. Rehabilitation is no longer a goal. 1 2 Chapter 28 Answers SICKLE CELL ANEMIA REVIEW REVIEW QUESTIONS—TEST PREPARATION Brain: Thrombosis Hemorrhage (stroke) Eyes: Retinal or conjunctival hemorrhage Blindness Lungs: Atelectasis Infarction Pneumonia Abdominal organs: Hepatomegaly Gallstones Splenic enlargement Splenic infarction Bones and joints: Hand and foot syndrome Heart: Failure Kidney: Dilute urine Diuresis Hematuria Penis: Priapism Skin: Stasis ulcers REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. Red meat is high in iron. (1, 3, 4) are not as high in iron. 2. (4) is correct. The conjunctivae are pale in a patient with anemia. (1, 2, 3) are not necessarily pale in anemia, especially in a dark-skinned patient. 3. (1) is correct. The patient with anemia may experience palpitations as an early compensatory mechanism. (2, 3, 4) are later signs. 4. (4) is correct. Multiple myeloma attacks bone, making it prone to fractures. (1, 2, 3) are not directly related to multiple myeloma. 5. (1) is correct. Fluids help dilute and promote excretion of calcium. (2) is incorrect. Respiratory problems are not related to hypercalcemia. (3) is incorrect. Activity should be encouraged to keep calcium in the bones. (4) is incorrect. Heat will not affect calcium levels. 6. (1) is correct. Vitamin K can help correct clotting problems and prevent bleeding during surgery. (2, 3, 4) are not affected by vitamin K. The correct answers are in boldface. 7. (2) is correct. A high incision often discourages deep breathing and coughing because of the resulting pain. This can result in infection. (1) is incorrect. Platelet count is not related to infection. (3, 4) are incorrect. Early ambulation and discharge may help prevent infection. 8. (4) is correct. Fever is a sign of infection. (1, 2, 3) are not signs of infection. 9. (2) is correct. Hemoglobin carries oxygen to tissues; hemoglobin level is reduced in anemia. (1) is incorrect. Oxygen transport to tissues is the problem. (3) is incorrect. Oxygen, not nutrients, is the problem. (4) is incorrect. Anemia does not cause lung damage. 10. (2) is correct. Chilling and exercise may both contribute to hypoxemia and a crisis. (1, 3, 4) do not cause hypoxemia. 11. (1) is correct. Infarction of small bones in the fingers and toes causes unequal growth. (2, 3, 4) are not symptoms of hand-foot syndrome. 12. (3) is correct. The best measure of effective teaching is actual change in behavior, as evidenced by the patient using an electric razor. (1, 2, 4) are all good measures of learning, but they are not as convincing as the actual change in behavior. 13. (2) is correct. Often the patient knows best when bleeding is occurring, and treatment should be initiated as soon as possible. (1) is incorrect. Deep palpation may injure tissue and worsen bleeding. (3) is incorrect. An x-ray will waste valuable time when the patient could be receiving treatment. (4) is incorrect. Heat is a vasodilator and could increase bleeding. Also, waiting before beginning treatment is not recommended. 14. (1, 5) are correct. Crowds of people will increase risk of exposure to infection, and fruits and vegetables can transmit bacteria if not washed. Lymphoma affects the immune system. (2, 3, 4) are not necessary. 15. (3) is correct. Vaccines will help guard against infection. (1, 2) do not help prevent infection. (4) is unnecessary.