Help understanding a question

krazykev · May 1, 2007

Fellow Humans:

I am in the middle of studying for final exams and I need help understanding a few questions. So if you would be so kind and share your wisdom, I will definitely appreciate it.

A client with anemia due to chemotherapy has hemoglobin of 7.0 d/L. Which of the following complaints would be indicative of tissue hypoxia related to anemia?

1. Dizziness

2. Fatigue relieved by rest

3. Skin that is warm and dry to the touch

4. Apathy

I think the answer is 1.

Because when an individual is low on oxygen in the tissues they would become dizzy upon standing (orthostatic hypotension).

Once again, thanks for your help.

krazykev · May 1, 2007

Fellow Humans:

I am in the middle of studying for final exams and I need help understanding a few questions. So if you would be so kind and share your wisdom, I will definitely appreciate it.

The nurse is caring for client with leukemia who is experiencing bleeding into the knee joint. What is the best nursing care for this client regarding joint mobility and anxiety?

1. Encourage short walks around the room every 2 hours.

2. Keep the joint immobilized and maintain bed rest for the client.

3. Gently put the legs through passive range of motion every 4 hours.

4. Keep the legs wrapped with elastic bandages and immobilized in splints.

I think the answer is 1.

Because I think that this person has hemophilia because he is bleeding into the joints.

Also, by encouraging short walks around the room every 2 Hrs, he will be receiving the exercise necessary to strengthen the muscles around the joints.

Finally, he will be able to work off some of the anxiety instead of lying in bed becoming even more anxious.

Once again, thanks for your help.

NPinWCH · May 1, 2007

#1 - Agree with your answer, but normal cells are exposed at the same rate as the cancer cells BUT they have a better ability to correct the damage to their DNA

#2 - Answer is "Fatigue relieved by rest". Acute blood loss is very likely to cause dizziness and decreased BP, while at the same time causing anemia, BUT the anemia caused by chemotherapy isn't a volume problem. It's a red cell problem. The chemo causes bone marrow depression, decreasing it's production of red blood cells (stem cells are undifferentiated) which causes a drop in the amount of circulating RBC and thereby hgb. These people tire out quickly, need frequent rest periods and often have dyspnea with exertion.

#3 - I go with "Keep immobilized and maintain bed rest". Joint bleeds are very painful, and swollen. Treat for pain, and aim to decrease the swelling with immobilization and ice. Movement can actually increase the bleeding as well as cause more pain and swelling. The more swelling and bleeding there is the more damage to the joint. Once the bleeding, swelling and pain are gone then physical therapy may be indicated to maintain mobility.

bklynborn · May 1, 2007

I totally agree with the answers and rationals above.

Daytonite, BSN, RN · May 1, 2007

Which of the following cells is likely to be most radiosensitive?
1. A well differentiated, nondividing, and well-oxygenated cell.
2. An undifferentiated, dividing, and poorly oxygenated cell.
3. A well differentiated, nondividing, and poorly oxygenated cell.
4. An undifferentiated, dividing, well oxygenated cell.

The answer is #4, but your rationale is wrong. Radiation is unable to make a distinction between what is a normal or a cancerous cell and so both cell types are destroyed. The goal of radiation therapy is to destroy as few of the normal cells as possible and that is done through the adjustment of the dosage that is delivered. The highest number of cells that will be destroyed by radiation are those that are most frequently dividing--and that would be the undifferentiated malignant cells. You can think of well-differentiated cells as normal cells that are still making up their mind as to whether to go over to the enemy's side although they are showing malignant signs. As tumor cells, the well-differentiated ones are slower growing and dragging their feet about it. A well-differentiated cell can still be identified as to what organ of the body it belongs to. Undifferentiated cells are different. They are totally in rebellion and committed to what they are doing. They are so whacked out that their original source, tissue or organ of existence can no longer be identified. Their cell division process is off the charts and that is what radiation therapy targets. The radiation interacts with the oxygen in the nucleus of all cells to break apart the strands of DNA which screws up the replication process. The radiation also interacts with water in the surrounding body fluids causing free radicals to form which also contributes to the damage to the cellular DNA. If you go back to your basic biology class and chemistry principals and think back on the process of cell division and DNA replication then you will understand why free radicals that can no longer form bonds and the importance of oxygen in these different compounds is so important. The tumor cells get killed off faster because their cell division rates are faster. But the "good" cells are also getting killed off as well, just at a slower rate because their cell division rates are normal.

A client with anemia due to chemotherapy has hemoglobin of 7.0 d/L. Which of the following complaints would be indicative of tissue hypoxia related to anemia?
1. Dizziness
2. Fatigue relieved by rest
3. Skin that is warm and dry to the touch
4. Apathy

The answer is #1. This is a bit of a tricky question because two of the symptoms of anemia are listed (dizziness and fatigue). The anemia that results from chemotherapy is called sideroblastic anemia. The patient will frequently report anorexia, fatigue, weakness, dizziness and dyspnea. I think the issue of anemia was a red herring thrown in to see if you were reading the question. The issue is actually about the signs of tissue hypoxia. When you get into a situation of hypoxia or hypoxemia you are in a bad state because the cells aren't getting enough oxygen to carry out their functions. A Hbg of 7.0 is a situation that requires urgent transfusion. The symptoms of hypoxia are generally related to the heart and lungs and are impaired judgment, tachycardia, dyspnea and cyanosis. Absent those, you'd look to symptoms related to the cause of the hypoxia. Dizziness results from inadequate blood flow and oxygen supply to the cerebrum and spinal cord compounded by any tachycardia that is present (review the physiology of cardiac output) which is also a symptom of the anemia. Dizziness can be aggravated by postural changes or exertion, so long before the patient felt the fatigue they would have been on the floor from fainting.

The nurse is caring for client with leukemia who is experiencing bleeding into the knee joint. What is the best nursing care for this client regarding joint mobility and anxiety?
1. Encourage short walks around the room every 2 hours.
2. Keep the joint immobilized and maintain bed rest for the client.
3. Gently put the legs through passive range of motion every 4 hours.
4. Keep the legs wrapped with elastic bandages and immobilized in splints.

The answer is #3. This goes right to basic fundamentals of nursing. When these patients have a low platelet count and are likely to experience bleeding, precautions to keep that bleeding to a minimum must be taken. However, you can't stop ADLs altogether because there would be other consequences. You want to maintain as much physical mobility as you can without injury to the patient. You don't want the patient to suffer joint contractures from lying immobile in bed or swollen up contused joints from being walked around during the hemorrhagic phase of his illness! The hallmark of performing care with these patients is the word "gentle". Putting the legs through nice and slow passive ROM by the nurse every 4 hours will reduce bleeding injury into knee, maintain its ROM and allay any anxiety (which is also being asked in the question) about it aggravating any further bleeding into the joint because you are going to explain all this to him as you are performing it. Most likely that low platelet count is going to get corrected with transfusions of platelets to the point that bleeding into the knee may eventually be resolved. You want to preserve whatever knee function there is for the future.