A client being treated with chemotherapy for cancer complains of ...

[Mr.Thesaxman]

A client being treated with chemotherapy for cancer complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which diagnosis should the nurse use as the priority when planning this client's care?
 
  A) Powerlessness
  B) Imbalanced Nutrition, Less than Body Requirements
  C) Activity Intolerance
  D) Ineffective Coping

Question 2

The nurse is caring for a client with metabolic acidosis. Which goals are appropriate for this client?
 
  Select all that apply.
  A) The client will maintain a respiratory rate of 30 or more.
  B) The client will describe preventative measure for the underlying chronic illness.
  C) The client will maintain baseline cardiac rhythm.
  D) pH will range from 7.25 to 7.35.
  E) The client will take potassium supplements to increase potassium levels.

[sierrahalpin]

Answer to Question 1

Answer: C

The symptoms (fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia) are caused by aplastic anemia from bone marrow suppression, which is a side effect of the chemotherapy drugs. Decreased red blood cells cause less oxygen to be delivered to body tissues, resulting in tissue hypoxia. Tachycardia is a compensation mechanism to speed up the delivery of oxygen that is available in the fewer number of cells that are present. Tissue hypoxia will result in muscle fatigue, and the symptoms that are related to aplastic anemia will decrease endurance and ability to perform activities. Thus, this NANDA diagnosis should be the first priority. Nutrition or iron deficiency is not the cause of the symptoms, which are related to tissue hypoxia. Powerlessness is the lack of control over current situations, but this is not the client's current problem. Her needs/symptoms are physical, and according to Maslow's theory must be met prior to emotional needs. Although the client might be having coping issues, the physical symptoms are her greatest complaints; therefore, coping is not the top priority in planning her care. Again, physiological needs must be met prior to self-actualization needs.

Answer to Question 2

Answer: B, C

Planning for the client with metabolic acidosis involves identification and treatment of the underlying cause and restoration and maintenance of acid-base balance. The client should be able to describe preventative measures for the underlying chronic illness that caused the metabolic acidosis to occur and maintain the baseline cardiac rhythm. The pH should be maintained between 7.35 and 7.45. The client's respiratory rate should be within normal range for age and condition. Taking a potassium supplement may cause hyperkalemia, which decreases cardiac output and worsens metabolic acidosis.