Magazine article American Nurse Today

Recognizing Complications in the Oncology Patient: Quick Response Includes Paying Attention to the Details

Magazine article American Nurse Today

Recognizing Complications in the Oncology Patient: Quick Response Includes Paying Attention to the Details

Article excerpt

KAREN LITTLE, a 58-year-old woman with type 2 diabetes mellitus and monophasic synovial sarcoma, completed a chemotherapy infusion of doxorubicin at 9 A.M. at her oncologist's office. Now she's in an outpatient clinic for her 12:30 P.M. radiation treatment. In the waiting room, Ms. Little has a brief episode of syncope. Susan, a nurse in the clinic, wheels Ms. Little into one of the clinic's examination rooms.

[ILLUSTRATION OMITTED]

Assessment hints

Susan finds Ms. Little to be pale, but alert, with clear, coherent speech. She was dizzy earlier in the day, but had no previous episodes of syncope and now says, "I'm fine." Vital signs are temperature 98.4[degrees] F (36.9[degrees] C), pulse 107 beats/minute (bpm), and respiratory rate 24 breaths/minute. Ms. Little says she is a bit short of breath. Blood pressure is 67/51 mm Hg, and oxygen saturation ([O.sub.2] sat) is 91% on room air. When Susan places Ms. Little on a cardiac monitor, it shows sinus tachycardia.

Susan starts oxygen 2 L by nasal cannula per protocol and activates the rapid response team (RRT). Before the team arrives, Ms. Little says she had a banana and half a glass of milk for breakfast around 7 A.M. She admits she has been nauseated for a few days, information she didn't share during chemotherapy, and has consumed few liquids. Susan does a bedside glucose check, which shows 110 mg/dL. Susan also learns that Ms. Little received fluids before her chemotherapy.

Ms. Little expresses concern about getting her blood transfusion, which is scheduled for the next day. Susan notes on Ms. Little's health record that her most recent hemoglobin (Hb) is 7.1 g/dL, but she sees no signs of active bleeding.

On the scene

The RRT arrives and orders a complete blood count and chemistry panel, as well as a 1 L bolus of normal saline (NS) to be given through Ms. Little's port, which was placed in her right subclavian vein. Susan sees no edema, erythema, tenderness, or leakage around the site that would indicate infection. Using good hand hygiene and wearing gloves, Susan flushes the port with NS, discards some blood from the catheter, then draws blood for the labwork. Because she knows the catheter is patent, Susan then starts the NS bolus. …

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