Case Study, Chapter 14, Fluid and Electrolytes: Balance and Disturbance Objective: 11

Mrs. Dean is 55 years of age and is female patient who is admitted for chemotherapy that is vesicant, and for transfusion of red blood cells and platelets. She had a right radical mastectomy two months ago. The oncologist orders NS at 20 mL per hour as a continuous flush line for medications. The nurse needs to place two IV catheters for the patients treatment per orders from the oncologist and needs to begin the intravenous (IV) therapy. What are the theory/theories that will help explain the pathogenesis of breast cancer? Some theories that explain the patients pathogenesis of breast cancer can be genetic abnormalities, a family history of breast cancer, a nulliparity, early menarche, late menopause, exposure to ionizing radiation, and post menopausal estrogen therapy. THEORIES IS CELLULAT TRANSFORMATION AND DERANGEMENT THEORY AND FAILURE OF THE IMMUNE RESPONSE SYSTEM Explain the rationale for the size of the two cannulas the nurse will insert and the location for the cannulas based upon the patients needs. The patient needed two cannula, one for the transfusion of the red blood cells and other one for the chemotherapy agents. Sites should be different so that substance will not interfere with each other. THE SIZE OF TWO CANNULAS SHOULD BE G- 20 OR BIGGER INSERTED TO A GOOD AND BIG VEIN TO PREVENT COMPLICATIONS LIKE INFILTRATION OR ESCAPE OF FLUID TO THE TISSUES. Describe measures the nurse should take to prevent potential complications of IV therapy. 1 Check for the patients pulse, respiration, and level of consciousness and presence of cough, rales, or hoarseness to check for circulatory overload. If the following symptoms occur the nurse should: Notify the physician Reduce flow to keep open rate Raise head of bed to facilitate breathing. 2 Monitor the IV site and inspect for any decreased rate or cessation of flow, needle site cold, pale, swollen, and hard or presence of local pain. This could be signs of local infiltration. If there are local infiltration the nurse should: Apply moist heat at the site 3Watch for occurrence of pain, redness, warmth, edema along vein, a signs For Thrombophlebitis, if these are present nurse should Apply cold compress Elevate arm.

54 If the patient demonstrates fever, chills, general malaise, nausea and vomiting, hypotension it could be pyrogenic reaction and the nurse should Notify the physician Monitor vital signs