A patient diagnosed with acute myeloid leukemia (AML) with a FLT3 mutation is starting induction chemotherapy. Which nursing intervention is most critical to implement during this phase of treatment to address potential complications?

C) Initiate neutropenic precautions to reduce the risk of infection.

A) Monitor vital signs every 8 hours to assess for hypertension.

B) Administer antiemetic medications prior to chemotherapy to prevent nausea.

C) Initiate neutropenic precautions to reduce the risk of infection.

D) Encourage increased fluid intake to prevent dehydration.

A patient with newly diagnosed acute myeloid leukemia (AML) presents with leukocytosis, anemia, and thrombocytopenia. A FLT3 mutation has been identified. Which nursing intervention is most critical to prioritize in the care plan for this patient?

A) Monitor for signs of infection and initiate prophylactic antibiotics as ordered.

B) Educate the patient on the importance of frequent hand washing to prevent infection.

C) Assist the patient in maintaining a high-protein diet to improve energy levels.

D) Encourage ambulation to prevent deep vein thrombosis.

A patient undergoing induction chemotherapy develops a fever, increased shortness of breath, and neutropenia. Which of the following nursing interventions is the most appropriate to address the patient's current condition?

A) Administer oxygen and monitor respiratory status closely.

B) Hold the next dose of chemotherapy and notify the healthcare provider.

C) Initiate isolation precautions to prevent transmission of infection.

D) Encourage increased fluid intake to prevent dehydration.

A patient undergoing induction chemotherapy for leukemia has developed neutropenic fever and early-stage pneumonia. What is the priority nursing intervention to address the patient’s current status?

A) Administer the prescribed broad-spectrum antibiotics immediately.

B) Initiate oxygen therapy to maintain adequate oxygen saturation.

C) Prepare for transfusion of red blood cells to address anemia.

D) Implement strict infection control measures to prevent further infection.

A patient with leukemia is experiencing severe neutropenia, low platelet count, and a confirmed Gram-negative bloodstream infection. Despite receiving broad-spectrum antibiotics, the patient's oxygen saturation has decreased, indicating respiratory distress. What is the priority nursing intervention at this time?

B) Administer prescribed supplemental oxygen to improve oxygenation.

A) Increase the patient's fluid intake to promote renal clearance of toxins.

B) Administer prescribed supplemental oxygen to improve oxygenation.

C) Initiate a transfusion of platelets to address the low platelet count.

D) Contact the healthcare provider to report the persistent fever and request an antipyretic.

A patient with acute leukemia and severe neutropenia presents with a bloodstream infection caused by Gram-negative bacilli and requires modification of her antibiotic regimen. Despite these interventions, her oxygen saturation drops to 89% on room air, necessitating supplemental oxygen. Which intervention should the nurse prioritize to prevent further deterioration of the patient's condition?

B) Administer the prescribed targeted antibiotic therapy promptly.

A) Increase the patient's intravenous fluid rate to prevent dehydration.

B) Administer the prescribed targeted antibiotic therapy promptly.

C) Initiate high-flow oxygen therapy to improve oxygenation.

D) Prepare for immediate blood transfusion to address low hemoglobin levels.

A patient with suspected acute respiratory distress syndrome (ARDS) secondary to bloodstream infection is experiencing worsening respiratory distress and declining kidney function. Which nursing intervention is most critical in prioritizing this patient's care?

B) Prepare the patient for possible intubation and invasive mechanical ventilation

A) Increase supplemental oxygen to 6 liters via nasal cannula

B) Prepare the patient for possible intubation and invasive mechanical ventilation

C) Administer diuretics to manage fluid balance and prevent pulmonary edema

D) Consult with pharmacy to adjust antibiotic regimen based on nephrotoxicity risk

A patient with suspected acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) secondary to sepsis is being managed in a critical care unit. The healthcare team is considering interventions to stabilize her condition. Which of the following nursing actions is the priority?

B) Prepare the patient for possible intubation and mechanical ventilation.

A) Increase the oxygen delivery to 6 liters per minute via nasal cannula.

B) Prepare the patient for possible intubation and mechanical ventilation.

C) Administer diuretics to manage pulmonary edema.

D) Initiate renal replacement therapy to support kidney function.

A patient with ARDS and suspected septic shock is being monitored closely. Her respiratory rate is 30 breaths per minute, oxygen saturation is 86-88%, blood pressure is 88/56 mmHg, and she is lethargic. The healthcare team is considering starting non-invasive ventilation and has initiated a sepsis management protocol. Which intervention should the nurse prioritize next?

A) Administer a fluid bolus to address hypotension.

B) Prepare for immediate intubation and mechanical ventilation.

C) Increase the flow rate of the high-flow nasal cannula.

D) Start vasopressor therapy to support blood pressure.

A patient with ARDS and suspected septic shock is showing persistent respiratory distress and declining hemodynamic status. Which nursing intervention is most critical to prioritize at this time?

C) Administer vasopressors to stabilize blood pressure

A) Increase fluid resuscitation to manage hypotension

B) Prepare for intubation and mechanical ventilation

C) Administer vasopressors to stabilize blood pressure

D) Adjust antibiotic therapy based on culture results

Leukemia - Nursing Case Study

Pathophysiology

• Primary mechanism: Leukemia originates from genetic mutations in hematopoietic stem cells, leading to uncontrolled proliferation of abnormal white blood cells. These mutations disrupt normal cell differentiation, resulting in the accumulation of immature leukemic cells in bone marrow and peripheral blood.

• Secondary mechanism: The overproduction of leukemic cells in the bone marrow suppresses the development of normal blood cells, causing anemia, thrombocytopenia, and neutropenia. This leads to symptoms such as fatigue, increased infection risk, and bleeding tendencies.

• Key complication: The infiltration of leukemic cells into organs and tissues can cause organ dysfunction and contribute to systemic complications, such as hepatosplenomegaly and lymphadenopathy, which further exacerbate the clinical burden of the disease.

Patient Profile

Demographics:

45-year-old female, school teacher

History:

• Key past medical history: Hypertension, occasional migraines

• Current medications: Lisinopril 10 mg daily, Acetaminophen as needed for migraines

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent fatigue and easy bruising

• Key symptoms: Frequent nosebleeds, night sweats, unintentional weight loss over the past month

• Vital signs: Temperature 100.4°F, Heart rate 110 bpm, Blood pressure 145/90 mmHg, Respiratory rate 22 breaths per minute

Section 1

New Diagnostic Results:

After the initial assessment, the patient underwent a series of diagnostic tests to further evaluate her condition and determine the extent of her leukemia. Complete blood count (CBC) results revealed significant abnormalities: a white blood cell count of 80,000/µL, which indicates leukocytosis, a hemoglobin level of 8.5 g/dL pointing to anemia, and a platelet count of 50,000/µL, confirming thrombocytopenia. A bone marrow biopsy was performed and showed a hypercellular marrow with an increased presence of blast cells, consistent with acute myeloid leukemia (AML). Further cytogenetic analysis identified a mutation in the FLT3 gene, which is known to confer a poorer prognosis and suggests a more aggressive disease course.

These results highlight the severity of the patient's condition and underscore the need for immediate intervention. The leukocytosis suggests a high burden of leukemic cells, while the anemia and thrombocytopenia explain her fatigue, easy bruising, and frequent nosebleeds. The presence of the FLT3 mutation not only impacts the selection of targeted therapies but also necessitates closer monitoring due to the increased risk of rapid disease progression.

Given the diagnosis of AML and the associated mutation, the healthcare team must now consider starting induction chemotherapy to reduce the leukemic cell burden and address the hematologic abnormalities. This decision requires careful consideration of the patient's overall health, including her hypertension and potential risks of treatment-related complications. The team must also plan for supportive care measures, such as transfusions to manage anemia and thrombocytopenia and prophylactic antibiotics to mitigate infection risks, as they prepare for the next steps in her treatment journey.

Section 2

As the healthcare team implemented the induction chemotherapy regimen, the patient's condition was closely monitored for both therapeutic response and potential complications. Within the first week of treatment, the patient developed a fever of 101.5°F (38.6°C) and reported increased shortness of breath. Vital signs indicated a heart rate of 110 beats per minute, respiratory rate of 24 breaths per minute, and blood pressure of 140/90 mmHg. A repeat CBC revealed a further decline in white blood cells to 1,500/µL, signifying the onset of neutropenia, while her hemoglobin levels dropped to 7.5 g/dL, necessitating a red blood cell transfusion. The platelet count further decreased to 30,000/µL, increasing her risk for bleeding complications.

Given these developments, the team suspected neutropenic fever, a common and potentially serious complication of chemotherapy. Prompt empirical broad-spectrum antibiotic therapy was initiated to address the risk of bacterial infection. Additional diagnostic tests, including blood cultures and a chest X-ray, were performed to identify any sources of infection. The chest X-ray revealed infiltrates indicative of an early-stage pneumonia, necessitating adjustments in her antibiotic regimen to target the respiratory infection more effectively.

This change in the patient's status underscores the complex interplay between leukemia treatment and the body's subsequent vulnerabilities. The healthcare team must now focus on balancing aggressive treatment of the leukemia with supportive care to manage the emerging complications. This includes careful monitoring of her respiratory function, ongoing blood transfusions to address anemia and thrombocytopenia, and meticulous infection control measures. The patient's response to these interventions will provide critical insights into the efficacy of the treatment plan and help guide future therapeutic decisions.

Section 3

As the healthcare team continued to manage the patient's condition, they closely monitored her response to the interventions put in place. Over the next 48 hours, the patient's fever persisted, albeit with slight fluctuations, and her respiratory symptoms showed minimal improvement. Vital signs remained concerning, with a heart rate of 115 beats per minute and a respiratory rate of 26 breaths per minute, although her blood pressure stabilized at 135/88 mmHg. Despite the administration of broad-spectrum antibiotics, her oxygen saturation levels dropped to 89% on room air, prompting the need for supplemental oxygen therapy.

A follow-up CBC demonstrated a further decline in white blood cell count to 1,200/µL, confirming ongoing severe neutropenia, while her hemoglobin level slightly improved to 8.0 g/dL post-transfusion. However, the platelet count remained critically low at 28,000/µL. Recent blood cultures returned positive for Gram-negative bacilli, indicating a bloodstream infection that required a modification in her antibiotic regimen to include agents specifically targeting these pathogens.

These findings reflect the patient's precarious balance between fighting the leukemia and combating infection. The healthcare team must now prioritize optimizing her antimicrobial therapy while continuing supportive measures to manage her respiratory distress and hematological deficiencies. This stage of her treatment highlights the importance of vigilant monitoring and the need for dynamic adjustments to her care plan. The team will continue to evaluate her clinical status closely, anticipating potential complications such as sepsis or worsening respiratory failure, and will be prepared to escalate care as necessary.

Section 4

As the healthcare team continued to monitor the patient, new complications emerged that necessitated swift clinical reasoning and intervention. Within the next 24 hours, the patient's respiratory status deteriorated further. She became increasingly tachypneic, with a respiratory rate climbing to 32 breaths per minute, and her oxygen saturation dropped to 85% despite being on 4 liters of supplemental oxygen via nasal cannula. Auscultation revealed diffuse crackles in both lung fields, suggesting pulmonary involvement beyond her initial infection. The team suspected acute respiratory distress syndrome (ARDS) secondary to her bloodstream infection and considered escalating her oxygen support to a high-flow nasal cannula or non-invasive ventilation to improve gas exchange and reduce work of breathing.

Concurrently, new diagnostic results from a chest X-ray showed bilateral infiltrates, corroborating the clinical suspicion of ARDS. In addition to managing her respiratory complications, her bloodwork revealed worsening kidney function, with serum creatinine rising to 2.1 mg/dL, indicating potential acute kidney injury (AKI) likely due to sepsis. The interdisciplinary team, including nephrology and pulmonology specialists, was consulted to provide a comprehensive assessment and guide further treatment interventions. The patient's fluid balance was reassessed to ensure adequate perfusion without exacerbating pulmonary edema.

These developments required the healthcare team to prioritize interventions aimed at stabilizing her respiratory status and managing emerging organ dysfunctions. The focus shifted to optimizing ventilatory support and adjusting her antibiotic regimen to effectively target the identified pathogens while minimizing nephrotoxic effects. The team remained vigilant for signs of worsening sepsis or multi-organ failure, prepared to implement more aggressive treatment strategies, including potential escalation to invasive mechanical ventilation or renal replacement therapy if indicated. This phase of her care underscored the critical need for dynamic clinical reasoning and timely adaptation of the treatment plan to respond effectively to the evolving clinical landscape.

Section 5

As the healthcare team continued to provide intensive monitoring and support, there was a notable change in the patient's status over the next 12 hours. Despite the escalation to high-flow nasal cannula, her respiratory distress remained significant, with minimal improvement in oxygenation. Her respiratory rate persisted at around 30 breaths per minute, and her oxygen saturation hovered between 86% and 88%. Recognizing the need for more intensive respiratory support, the team prepared for potential transition to non-invasive ventilation while closely monitoring for signs indicating the need for mechanical ventilation.

In parallel, the patient developed new complications that warranted attention. Her blood pressure showed a downward trend, with readings averaging 88/56 mmHg, raising concerns about septic shock in the context of her bloodstream infection and ARDS. Tachycardia was evident, with a heart rate consistently above 110 beats per minute. Her mental status also subtly shifted; she became increasingly lethargic, with delayed responses to questions, prompting the team to consider the possibility of hypoperfusion and worsening sepsis. The healthcare team increased their vigilance, ensuring continuous monitoring of vital signs and frequent reassessment of her neurological status.

Laboratory results added another layer of complexity to her care. Her white blood cell count remained elevated at 19,000/µL, and her lactate level increased to 4.5 mmol/L, further indicating systemic hypoperfusion and metabolic stress. Given the clinical picture and lab findings, the team initiated a protocol-driven sepsis management strategy, which included fluid resuscitation with careful titration to avoid exacerbating her pulmonary edema. Broad-spectrum antibiotics were reviewed and adjusted, balancing the need for effective infection control with the risk of additional renal compromise. This dynamic situation required ongoing clinical reasoning to assess the effectiveness of interventions and anticipate the need for more aggressive therapies, maintaining a delicate balance between supporting organ function and preventing further complications.