Question

A client with Hodgkin’s disease is scheduled for a cyclophosphamide (Cytoxan) infusion. Which of the following manifestations causes the nurse the most concern? ? A. Blood in the urine ? B. Reports of a feeling of nausea ? C. White patches on the tongue ? D. Client weight gain

Short answer

Answer: A. Blood in the urine

Step-by-step solution

Understanding the Side Effects of Cyclophosphamide

Cyclophosphamide is a chemotherapy drug used to treat different types of cancer, including Hodgkin's disease. It works by suppressing the immune system and stopping the growth of cancer cells. Common side effects of cyclophosphamide include nausea, vomiting, loss of appetite, and temporary hair loss. Serious side effects may include infections, bleeding, kidney problems, and severe allergic reactions.

Analyzing Each Option

A. Blood in the urine: Cyclophosphamide can cause kidney problems, and blood in the urine is a potential sign of kidney damage or a urinary tract problem. This manifestation is concerning and requires further evaluation. B. Reports of a feeling of nausea: Nausea is a common side effect of cyclophosphamide, but it is typically manageable with anti-nausea medications. While it's essential to address, it's generally not as concerning as some other side effects. C. White patches on the tongue: This manifestation could indicate an oral infection, such as oral thrush, which is a fungal infection. It is a concerning symptom, and the patient may need treatment for this condition, but it does not typically pose a severe risk compared to some other potential side effects of the drug. D. Client weight gain: Weight gain is not a common side effect of cyclophosphamide. It could be related to other factors, such as fluid retention or changes in appetite. Although unusual, it is not the most critical concern among the options provided.

Identifying the Most Concerning Manifestation

Among the manifestations listed, blood in the urine (Option A) is the most concerning as it could indicate kidney damage or a urinary tract problem. Such conditions can have severe consequences and require prompt attention and evaluation. The correct answer is A. Blood in the urine.

Key concepts

Hodgkin's disease

Hodgkin's disease is a type of lymphoma, which is a cancer that originates in the lymphatic system. The lymphatic system is an integral part of your immune system, comprising a network of tissues and organs that help rid the body of toxins and waste. Hodgkin’s disease is characterized by the presence of Reed-Sternberg cells, which are large, abnormal lymphocytes found in lymph nodes. The typical signs and symptoms of Hodgkin’s disease include:

• Painless swelling of lymph nodes, especially in the neck, armpits, or groin
• Persistent fatigue and fever
• Night sweats and unintentional weight loss
• Itchy skin

Many of these symptoms can resemble other conditions, which makes early diagnosis crucial. Treatment options may include chemotherapy, radiation therapy, or stem cell transplantation, depending on the stage and specific characteristics of the disease. Understanding and recognizing the disease's signs can lead to early intervention and a more favorable prognosis.

Cyclophosphamide side effects

Cyclophosphamide is a chemotherapy drug that specifically targets rapidly growing cancer cells, but it can also affect normal cells, leading to a range of side effects. It's important for both patients and healthcare providers to be aware of these side effects in order to manage them effectively. Common side effects include:

• Nausea and vomiting
• Loss of appetite
• Temporary hair loss
• Increased risk of infection due to lowered white blood cell count

Serious side effects are less common but need immediate attention when they occur, such as:

• Blood in urine, indicating possible bladder or kidney damage
• Severe allergic reactions
• New signs of infection, such as fever or chills

With the right supportive care, many of these side effects can be minimized. For instance, anti-nausea medications can help reduce nausea, and patients are often advised to stay hydrated to help protect their kidneys.

Nursing assessment

Nursing assessment is a critical component of patient care, especially for those undergoing chemotherapy. An effective nursing assessment involves systematically collecting and analyzing a patient’s health information to provide the best possible care. For chemotherapy patients, nurses focus on:

• Monitoring vital signs and overall physical health
• Evaluating symptoms related to chemotherapy, such as nausea or signs of infection
• Assessing emotional and psychological well-being

Additionally, nurses are responsible for checking fluid and electrolyte balance, as well as any other signs of drug toxicity, such as abnormal lab results. Regular communication with patients helps in identifying any new or worsening symptoms, which is crucial for early intervention. Nursing assessments are vital for catching potentially serious side effects early, thereby preventing complications and ensuring that patients receive the necessary supportive care promptly.

Chemotherapy patient care

Caring for a patient undergoing chemotherapy requires a compassionate and comprehensive approach. Chemotherapy involves the use of strong drugs to destroy cancer cells, and while effective, these drugs can also impact normal, healthy cells. Key elements of chemotherapy patient care include:

• Ensuring patients receive adequate nutrition and manage their symptoms, like nausea
• Maintaining hydration to support kidney function and prevent complications
• Providing emotional support and addressing any anxiety or depression associated with the treatment

Patients may also experience fatigue, so encouraging rest and balanced activity is crucial. Education plays an essential role as well, informing patients about likely side effects and when to seek medical help. Good communication between healthcare providers and patients helps create a care plan that meets the individual needs of the patient, improving both their quality of life and treatment outcomes.