C.P. plans to continue to work the farm as long as possible and says his brother-in-law

Question

has promised to help him. C.P. needs to have a working understanding of how to balance
his treatment with his work. You sit down with C.P.

to plan a daily work, activity, and rest
schedule to accommodate his treatments and side effects. List at least three points you would
emphasize.

Answer 1

Farming encompasses many demanding activities that have injury or infection potential
for someone receiving chemotherapy. Planning C.P.'s work to allow for sufficient rest and
conscientiously observing safety precautions while working will be essential to achieving a longterm positive outcome. Because he will be in the field, he needs to have fluids with him to avoid
dehydration and may need to consider the ease of accessing a bathroom. He should take frequent
breaks. Many antiemetic and analgesic agents have sedative components that impose limitations on
driving or operating machinery. Explore social and community resources to help C.P. and his wife; he
will not be able to maintain his farm by himself.
A month later, when C.P. returns for his second round of chemotherapy, he complains of shortness of
breath, chest tightness, and palpitations. He looks exhausted. An electrocardiogram (ECG) reveals
new-onset atrial fibrillation, and a CXR film suggests a large left lower lobe pleural effusion. C.P. is admitted to the hospital for supportive care. The pulmonologist performs a thoracentesis and drains 985 mL of
fluid, immediately relieving some of C.P.'s dyspnea and chest discomfort.
What do these laboratory values indicate?
• The WBC count is low; one of the side effects of etoposide is leukopenia. He is at increased risk for
infection.
• The sodium and chloride values are low; cisplatin is causing salt wasting.