: CELLULAR REGULATION

Ms. Y is a 44-year-old woman diagnosed with non-Hodgkin lymphoma (NHL) 3 months ago. She finished receiving her third of six chemotherapy courses 5 days ago. Yesterday morning, she was seen at her oncologist’s office for malaise, muscle weakness, and palpitations. She had splenomegaly on examination. A computed tomography (CT) scan of the abdomen showed metastatic disease in the liver and spleen. She is admitted to the hospital with progressive weakness.

1. Name 3 risk factors for lymphoma.

A. Age

B. Sex/ Gender

C. Immune status

Chart View

Comprehensive Metabolic Panel (CMP)   Na                                                                                                                       139 mEq/L K                                                                                                                          6.3 mEq/L Cl                                                                                                                         96 mEq/L CO2                                                                                                                      28 mEq/L Glucose                                                                                                               101 mg/dL Blood urea nitrogen (BUN)                                                                                   59 mg/dL Creatinine                                                                                                             2.5 mg/dL Ca                                                                                                                         6.9 mg/dL Total protein                                                                                                          5.4 g/dL Albumin                                                                                                                 2.8 g/dL Phosphorus                                                                                                           4.9 mg/dL Uric Acid                                                                                                                21 mg/dL Total bilirubin                                                                                                         0.8 mg/dL Alkaline phosphatase                                                                                            172 units/L Aspartate transaminase (AST)                                                                              254 units/L Alanine transaminase (ALT)                                                                                  74 units/L Lactate dehydrogenase (LDH)                                                                               214 IU/L

• Interpret Ms. Y’s admitting comprehensive metabolic panel results.

• Based on the laboratory test results, which common oncologic emergency is Ms. Y experiencing?

• Describe the pathophysiology of this condition.

• What assessment findings related to this diagnosis would you expect in Ms. Y?

Complete Blood Count (CBC)   White blood cells (WBCs)                                                                                   1500/mm3 Neutrophils                                                                                                          66% Lymphocytes                                                                                                       16 % Monocytes                                                                                                           15% Eosinophils                                                                                                          5% Hemoglobin (Hgb)                                                                                               7.9 g/dL Hematocrit (Hct)                                                                                                  22.4% Platelets                                                                                                               21,000/mm3

• Interpret the lab values above.

• Name 3 additional problems for which Ms. Y is at risk.

• What are your nursing priorities right now and why?

Proper medication and care of the patient to ensure control if disease.

Medication Record   IV 0.9% normal saline at 150 mL/hr                                                                                                                     100 mEq sodium bicarbonate (NaHCO3) in the first liter of the IV fluid                                                                                                                          rasburicase 6 mg IV now                                                                                                                        allopurinol 500 mg twice a day orally                                                                                                                  furosemide 40 mg IVP now then every 6 hours                                                                                                               sodium polystyrene sulfonate (Kayexalate) 15 g orally every 6 hours                                                                                 aluminum hydroxide 2 caps orally with meals

• What is the expected outcome associated with each medication Ms. Y is receiving?
• normal saline
• NaHCO₃
• rasburicase
• allopurinol
• furosemide
• Kayexalate

1. What are your nursing responsibilities when administering Kayexalate?

It is my role as a nurse to ensure that that there are no other oral medications administered to the patient within three hours of administration of Kayexalate