C.O. is a 43-year-old woman who noted a nonpruritic nodular rash on her neck and chest approximately
6 weeks ago. The rash became generalized, spreading to her head, abdomen, and arms and was accompanied by polyarticular joint pain and back pain.
About 2 weeks ago, she experienced three episodes of epistaxis in 1 day. Over the past week, her gums became swollen and tender and she was severely fatigued.
Because of the progression of symptoms, she sought medical attention. Lab work was performed, and
C.O. was directly admitted to the hematology/ oncology unit under the care of a hematologist for diagnostic evaluation. Her chest x-ray examination showed normal lung expansion and heart size, without
lymphadenopathy. Skin biopsy showed cutaneous leukemic infiltrates, and bone marrow biopsy showed
moderately hypercellular marrow and collections of monoblasts. Her lumbar puncture specimen was free
of blast cells. The final diagnosis was acute myeloblastic leukemia.
C.O. is to begin remission induction therapy with cytarabine (Ara-C) 100mg/m2/day as a continuous infusion for 7 days and idarubicin (Idamycin) 12mg/m2/day intravenous (IV) push for 3 days. She is scheduled in
angiography for placement of a triple-lumen subclavian Hickman catheter before beginning her therapy.
Interpret C.O.'s CBC results. What does the presence of blasts in the differential mean?
• The elevated WBC count indicates leukocytosis.
• The decreased Hct and Hgb indicate anemia from lack of blood production and blood loss.
• The low platelet count indicates thrombocytopenia and is associated with increased risk for
bleeding.
• The monocytes are elevated. Monocytes stay in the vascular system approximately 24 hours and
then move into the tissues, where they mature into macrophages. Monocytes and macrophages
appear early in inflammation.
• The neutrophils are decreased. Neutrophils, the most common type of WBC, are attracted to
foreign material in the body (chemotaxis) and phagocytize it.
• The blasts in the differential indicate that the bone marrow is releasing immature leukemic cells.
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The nurse is appointed to a clinical-administrative task force studying critical staffing issues and care delivery models for the hospital
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A client tells you during her admission assessment that she is taking several herbs and supplements. She states she read a theory about how this would help slow down the aging process. She asks you if you believe in this approach
In preparing to respond to her question, you would consider which of the following theories of aging? A) cross-link theory B) error theory C) free radical theory D) nutritional theory
All of the following are strategies to help the nurse avoid making common diagnostic errors except
a. recognizing that the initial diagnosis will always remain constant b. avoid personal bias in interpreting data c. use of an organizational framework for clustering data cues d. continued collection and analysis of data for use in the revision process