CASE STUDY -94 NON HODJIKINS LYMHOMA ACUTE TUMOR LYSIS SYNDROME

Tara Bolger Professor Kernan Case Study 94 Non- Hodgkin’s Lymphoma Acute Tumor Lysis Syndrome Decrease in urine, fatigue, loss of appetite, headache, nausea, and vomiting, abnormal heart rhythms, which can be severe and life-threatening. Fluid balance is frequently affected, though blood pressure can be high, low or normal. 10. List four independent nursing interventions that you would include in H.J.'s plan of care and the rationale for each. Accurately record intake and output Monitor urine specific gravity. Weigh daily at same time of day, on same scale, with same equipment and clothing. Monitor heart rate (HR), BP, and JVD/CVP.’ 11. The best way to prevent infection in a patient such as H.J. is: Handwashing 12. Interpret H.J.'s laboratory results. Is his condition improving? Yes, the client is improving since the serum potassium, phosphorus, and uric acid were in the normal range. Serum calcium is still low but it is higher and near the normal range since phosphorus had gone down (Negative feed back effect) 13. Because the TLS is just resolving, what interventions would you include in your plan of care? We can take precautions to prevent tumor lysis syndrome from manifesting to our client again. If our client is about to receive chemotherapy for cancer, he/she should receive prophylactic oral or IV allopurinol as well as adequate IV hydration to maintain high urine output (2.5 L/day). Alkalization of the urine with sodium bicarbonate can be used. In addition, we should prevent the spread of infection to minimize health hazards to our client. 14. What precautions should you take when administering H.J.'s chemotherapy to reduce the risk of injury? Select all that apply a. Independently verify the completeness of the drug order and infusion rate. b. Dispose of any equipment that contained the drug in special biohazard containers. c. Scrub any skin that comes into contact with the drug for 5 minutes with a surgical brush. d. Wear goggles, powder-free gloves, and a disposable, fluid-resistant, long-sleeved gown. e. If using a peripheral site, place a disposable drape under the arm where the drug will be infused. f. Use a Luer-Lok connector to attach the drug tubing to the main IV line, using the IV port closest to H.J. 15. The UAP you are working with states she is unfamiliar with caring for patients receiving chemotherapy. What instructions do you give to the UAP to reduce her risk of injury? You can advise the UAP to prioritize limiting the spread of the infection via proper hygiene, and handwashing. Furthermore, reverse isolation to the client and prophylactic use of antibiotic might help. In addition, limiting the number of visitors, proper hydration, and food intake will help the client.