Alopecia (patchy baldness) may be noted with chemotherapy or radio-
therapy, so prepare child and family in advance when possible to allow
preparation for hair cover.
Refer family for counseling and provide referral to community agencies to
address resource needs for information or emotional or financial problems.CHAPTER 8/ Oncology Conditions^173
CASE STUDY
Adam, age 7, was admitted to the hospital with symptoms of fatigue and
fever and a “cold that keeps hanging on.” His mother states that Adam has
not been eating or drinking much and is unable to tolerate school activi-
ties. He has had to stay home for the past 3 days. In the admission history
the nurse learns that Adam lives alone with his mom. A diagnosis of
leukemia was made after lab results were reviewed.Assessment data:Laboratory values reveal below normal levels of red
blood cells (2.5 million/mm^3 ), platelets (70,000 mm^3 ), and white blood
cells (4000 mm^3 ). Immature lymphocytes are noted. What type of
leukemia would that indicate?Additional lab values reveal a protein level below normal (5.4 g/dL to
54g/L), and hematocrit of 40%, and Adam reveals a dry tongue and
mucous membranes, and poor skin turgor when the skin over the forehead
is pinched. The sample obtained for admission urinalysis is small in
amount (50 mL) and golden.Interpretation:What conditions should the nurse suspect from the his-
tory and lab value?Nursing intervention:Provide small high calorie meals every 3 hours,
after a rest during waking hours. Provide vitamins as ordered to stimulate
appetite. Weigh Adam every 24 hours using the same scale. Food and
oral fluids are offered (120 mL/hour) and within 24 hours Adam begins
to show increased energy. The sodium level was noted as 160 mEq/L
(160 mmol/L) in the admission labs, and the level was decreased to
142 mEq/L (142 mmol/L) after hydration. The nurse monitors intake
and output and continues to offer fluids between meals but with lesser
frequency (60 mL every 2 to 3 hours).