William Smith, 76-year-old man, was admitted to

William Smith, 76-year-old man, was admitted to the hospital with anemia. The physician informs Mr. Smith that it is necessary to perform a bone marrow aspiration to assess the formation of the blood cells. The physician explains the procedure to the patient, including the risks, benefits, and alternatives. An informed consent is obtained. How should the nurse prepare the patient for the procedure? What instructions should the nurse provide to the patient after the procedure? Cindy Johnston, 65 years of age, is scheduled to have a right total knee replacement next week. She is at the pretesting clinic having the preoperative testing completed. The orders include: CBC, comprehensive metabolic panel, urinalysis, type and cross match for 2 units of PRBCs, chest x-ray, and ECG. Mrs. Johnston asks if she can donate her own blood for the procedure. (Learning Objective 5) How should the nurse respond? What are the advantages of autologous blood donation? Which patients would not be candidates for autologous donation? Angela Clayton, a 7-year-old girl, was diagnosed with sickle cell disease at birth. She was outside playing in the snow when she developed severe abdominal pain. Her parents immediately took her to the emergency room suspecting a sickle cell crisis. Describe the nursing process for the patient with sickle cell crisis (10 points) 2. Mary Saeger, a 56-year-old woman, is receiving outpatient chemotherapy for bladder cancer. A round of chemotherapy consists of gemcitabine on day 1 and day 8. Cisplantin is administered on day 2. A CBC with differential is ordered prior to the chemotherapy on day 1, day 8, and 1 week after the chemotherapy. The absolute neutrophil count (ANC) is 489/mm³ at 1 week after the chemotherapy. The patient’s temperature is 97.6°F. (Learning Objective 5) What is the significance of the absolute neutrophil count? Based on the reason for the neutropenia, what medical management would you anticipate? What patient teaching will the nurse provide to the patient? John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple myeloma. He presents with a spinal fracture of the fifth lumbar vertebrae. The patient is scheduled for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The patient has hypercalcemia. The patient’s uric acid level is elevated. The patient has prescriptions for zoledronic acid (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin. (Learning Objective 5) What nursing management should the nurse provide the patient? Explain the indication and action of the various medications ordered to treat the patient’s symptoms. Susan Clare, age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation. (Learning Objective 2) What laboratory results would you anticipate due to her ecchymosis and petechia? Why would it be important to inspect her gums and teeth? Why is her liver enlarged? SCIENCE HEALTH SCIENCE NURSING NURS 4417

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