A 7-year-old with Lymphoma is hospitalized for chemotherapy treatment. Her morning labs are as follows: WBC: 2235 Segs: 15% Bands: 3%. The ANC calculation for this patient would be

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. Given your nursing knowledge, would this patient need to be placed on neutropenic precautions at this time?

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.

Rationale:

A. We will make sure that we have enough metformin when we go on vacation: Metformin is an oral antidiabetic medication used for type 2 diabetes, not type 1. A child with type 1 diabetes will require insulin for glucose control.

B. We may have to check blood sugars more frequently when he is sick: Illness can raise blood glucose levels due to stress hormones, so more frequent monitoring helps guide insulin adjustments and prevent complications like diabetic ketoacidosis (DKA).

C. We should rotate insulin injection sites frequently to reduce scar tissue forming: Repeated injections in the same location can cause lipodystrophy (scar tissue or fat changes) which can impair insulin absorption. Rotating sites helps maintain consistent medication effectiveness.

D. We will check glucose levels once he starts to eat: Glucose monitoring for type 1 diabetes is often done before meals, not just after eating. Pre-meal checks guide insulin dosing and help maintain better blood glucose control.

E. We will always need to check ketones when his blood sugar is above 100: This is incorrect because ketone testing is not needed at such a low blood sugar threshold. Ketone testing is typically done when glucose levels are above 240 mg/dL or if the child is ill, to monitor for DKA risk.

Rationale:

A. Recommend immediate drug testing to confirm substance use: While drug testing may be part of the assessment process, it is not the first priority. Establishing trust and gathering history from the adolescent is essential before moving to diagnostic measures.

B. Reassure the parent that behavioral changes are a normal part of adolescence: Although moodiness and peer changes can occur in adolescence, the presence of multiple risk factors, withdrawal, irritability, poor academic performance, requires further assessment rather than reassurance.

C. Tell the adolescent that substance use can lead to serious consequences and should be avoided: Providing education about risks is important, but doing this before assessing the situation may shut down communication and make the teen defensive.

D. Ask the adolescent directly about substance use in a private, non-judgmental manner: This allows the nurse to gather accurate information in a confidential environment, promoting trust and honest disclosure which are critical for further planning and intervention.