Discuss the significance of Nicole's laboratory findings.

Results obtained from the laboratory indicate that Nicole is suffering from the adverse effects of chemotherapy. A common effect exhibited is myelosuppression (Keefe et al., 2007). Rapidly growing cells are often the primary target of Antineoplastics such as leukocytes, normal functioning cells, and platelets which leads to the development of conditions such as anemia that further reduces tissue perfusion and increases the chances of being infected as well as bleeding. The patient's findings characterize all the problems stated. The hemoglobin levels of Nicole is below the normal level of a normal girl of her age that ranges between 12-16 g/dL (Hoch, Goossen & Kretschmer, 2008).

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What would other assessment data be helpful for the nurse to have to prepare Nicole's care plan?

Hemoccult Test

Blood in the urine

UTI tests

Oxygen saturation, specifically using pulse oximetry

X-ray in the chest section

Examination of the CVAD for inflammation, oozing discharge and any forms of pain.

Urine specific gravity

What are the priorities of care for Nicole on admission?

On admission, Nicole is at a high risk of bleeding and any forms of injury exposes her to high risk since she has low platelet amount. Systemic analgesics from acute pain. Moreover, Nicole is at a risk of nausea which are primary effects of chemotherapy on gastrointestinal (GI) mucosa. Besides, there is scarce knowledge regarding her present conditions and treatment.

Discuss the common complications (adverse effects) of chemotherapy.

Nausea and vomiting may appear at random or after chemotherapy sessions, and dietary changes and anti-nausea drugs can significantly assist. Chemotherapy often damages hair follicles that cause hair loss and the hair that grows is much thinner and changed color from the normal/previous hair (Botchkarev & Sharov, 2016). Besides, chemotherapy can cause a patient, and caregivers and patients should take precaution to reduce injuries. The weak immune system is a result of the chemotherapy process killing

What nursing actions address the adverse effects associated with chemotherapy?

Monitoring the red blood cell account and bleeding

Monitoring blood in the urine and platelets count.

Testing for fecal occult blood

Introduce falls precautions when the hematocrit decreases to below 25%.

Report irregular laboratory findings instantly.

Monitor the patency of CVAD every hour.

Examination of the oral mucous membranes

Nicole's mother is staying with Nicole during her hospitalization and expresses concern about Nicole refusing to see her friends. She states that Nicole seems "down" since her last chemotherapy. Discuss your impressions about Nicole's mother's statements, considering Nicole's level of growth and development.

Despite Nicole's reason of risk of exposure to the infection being valid, girls at her age are susceptible to their overall look and hairstyle. Other teenagers express sensitivity and considering Nicole might have lost hair; this can result in hurtful comments or emotions from her peers. Her mother should talk to her and make her know that true friendship is not about appearance; it is accepting people the way they are. Therefore, people should change their perceptions first before she could resort to using a hair wig.

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.

The painful through exemplifies mucositis which is an effect of chemotherapy which causes pain due to the damage of normal oral flora. The prescription for the treating mucositis which includes esophagitis and stomatitis as well as interventions such as morphine sulfate (Keefe et al., 2007).

Calculate the rates of administration via an infusion pump for the following:

a. Gentamicin sulfate 100 mg in 100 mL of 5% dextrose in water to infuse over 30 minutes

Formulae areTimeVolume=TimeVolumeTherefore,30 min100mL=60 min? = 200mg/hourb. Vancomycin hydrochloride 500 mg in 250 mL of 0.9% normal saline to infuse over 45 minutes

45 min250mL=60 min? =333.3 mg/hourc. Cefoxitin sodium 1 g in 50 mL of 5% dextrose in water to infuse over 15 minutes

15 min50mL=60 min? =200mg/hour

References

Botchkarev, V. A., & Sharov, A. A. (2016). Modeling Chemotherapy-Induced Hair Loss: From Experimental Propositions toward Clinical Reality. Journal of Investigative Dermatology, 136(3), 557-559. https://doi.org/10.1016/j.jid.2015.10.068

Hoch, A. Z., Goossen, K., & Kretschmer, T. (2008). Nutritional requirements of the child and teenage athlete. Physical medicine and rehabilitation clinics of North America, 19(2), 373-398.

Keefe, D. M., Schubert, M. M., Elting, L. S., Sonis, S. T., Epstein, J. B., RaberDurlacher, J. E., ... & Peterson, D. E. (2007). Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer: Interdisciplinary International Journal of the American Cancer Society, 109(5), 820-831. DOI:10.1002/cncr.22484