When in doubt, the correct answer may be the low urine output (Urine output less than 30

mL/hr)

Strong indication of a hematologic disorder = Absence of hair on the legs

 Rationale: Thinning or absence of hair on the extremities indicates poor arterial

circulation to that area

Brachytherapy Treatment

 Procedure that involves placing radioactive material inside of the body

 Indication

o Commonly used to treat prostate cancer

o Cervical cancer

o Uterine (endometrial) cancer

o Brest cancer, lung cancer, eye cancer, and skin cancer

 Nursing Consideration

o Nurse needs to educate the client on the importance of remaining on bed rest

with limited movement while the radioactive implant is in place to prevent

dislodgment

o Nurse should wear a lead apron when providing direct care to provide

protection from radiation source and not turn their back toward the client

o Limit each of the client’s visitors to 30 minutes per day

o Instruct visitors to remain at least 6 feet from client receiving radiation at all

times

Indication of Pancreatitis

 Increased serum lipase level

o Rationale: due to the release of lipase into the pancreas and autodigestion

 Increased WBC count (because of the inflammatory process)

 Decreased albumin level (due to the inflammatory process)

 Increase in blood glucose levels (due to a drop-in insulin production)

Polycythemia Vera

 type of blood cancer that causes bone marrow to make too many red blood cells.

 Nursing Interventions

o Patient should elevate their legs when sitting

 Rationale: to avoid venous pooling with subsequent clot formation

o Patient should drink at least 3 Liters of fluid per day to help lower blood viscosity

o Patient should wear support hose/TED hose/SCD when awake

o Patient should use a soft toothbrush to clean their teeth (avoid flossing or

anything that increasing the risk for bleeding)