CASE SCENARIO

X.O. is a 3-year-old boy with no significant medical history. He is brought into the
emergency department(ED) by the emergency medical technicians after
experiencing a seizure lasting 3 minutes. His parents report no previous history
that might contribute to the seizure. Upon questioning, they state that they have
noticed that he has been irritable, has had a poor appetite, and has been
clumsier than usual over the past 2 to 3 weeks. X.O. and his family are admitted
for diagnosis and treatment for a suspected brain tumor. A CT scan of the brain
shows a 1-cm mass in the posterior fossa region of the brain, and X.O. is
diagnosed with a cerebellar astrocytoma. The tumor is contained, and the
treatment plan will consist of a surgical resection followed by chemotherapy.

CASE STUDY PROGRESS

X.O. returns to the unit after surgery. He is arousable and answers questions
appropriately. His pupils are equal and reactive to light. He has a dressing to his
head with small amount of serosanguineous drainage. His IV is intact and
infusing to a new central venous line as ordered. His breath sounds are equal
and clear, and O2 saturations are 98% on room air. You get him settled in his bed
and leave the room. You check the postop orders, which are listed below. Which
orders are appropriate, and
which would you question?

Chart View

Postoperative Orders
1. Vital signs every 15 minutes × 4, then every hour × 4, then every 4 hours.
2. Contact MD for temperature less than 36° C or over 38.5° C (96.8° F to 101.3°
F).
3. Maintain NPO until fully awake. May offer clear liquids as tolerated.
4. Maintain Trendelenburg's position.
5. Reinforce bandage as needed.
6. Neuro checks every 8 hours.

CASE STUDY PROGRESS

X.O.'s wound and neurologic status are monitored, and he continues to improve.
X.O. is transferred to the Oncology Service on postoperative day 7 for initiation of
chemotherapy with the combination of Cisplatin, Vincristine, Methotrexate and
Ondasetron IV.
On Day 10 after initiation of chemotherapy, you receive the following laboratory
results:
Outline a plan of care that addresses common risks secondary to chemotherapy,
describing
at least two nursing interventions that would be appropriate for managing risks
for infection,
bleeding, dehydration, altered growth and nutrition, altered skin integrity, and
body image.

■ Chart View
Laboratory Test Results
Hemoglobin (Hgb) 12.5 g/dL
Hematocrit (Hct) 36%
White blood cells (WBCs) 7.5/mm3
Red blood cells (RBCs) 4.0 million/mm3
Platelets 80,000/mm3
Albumin 2.8 mg/dL
Absolute neutrophil count (ANC) 75

Meanwhile, X.O. has a 5-year-old sister. She has been afraid of visiting at
the hospital because her “brother might die.”
CASE STUDY PROGRESS

Postoperatively, X.O. completed his initial course of chemotherapy and was

sent home after 5 days in the hospital.