Invasive procedures are minimized in patients with:

Rationale:

A. Filgrastim does not reduce GI toxicity. It specifically targets the bone marrow to stimulate white blood cell production and does not affect nausea, diarrhea, or mucositis caused by chemotherapy.

B. Filgrastim does the opposite of immune suppression. It stimulates the bone marrow to produce neutrophils, enhancing the patient’s immune function, especially after chemotherapy or surgery.

C. Filgrastim has no effect on nausea, vomiting, or appetite. Antiemetic medications, not filgrastim, are used to manage these symptoms.

D. Filgrastim (Neupogen) is a colony-stimulating factor that promotes the production of neutrophils in the bone marrow. After bowel resection and chemotherapy, patients are at risk for neutropenia, which increases susceptibility to infection. Administering filgrastim helps raise WBC counts, enhancing immune defense and reducing infection risk.

Rationale:

A. Bleeding is not a common side effect of opioids. While cancer itself or certain treatments (like chemotherapy or thrombocytopenia) may increase bleeding risk, opioid use does not directly cause bleeding.

B. Mucositis is inflammation and ulceration of the mucous membranes, commonly seen with chemotherapy or radiation therapy, not from opioid use.

C. Opioid medications generally cause the opposite effect—constipation, rather than diarrhea. Diarrhea may occur in some cancer patients due to treatment or disease, but it is not expected from opioid therapy.

D. Opioids slow gastrointestinal motility by binding to mu-opioid receptors in the gut. This can lead to constipation and, if untreated, fecal impaction, especially in clients who are immobile or have limited physical activity. Anticipating this effect allows the nurse to implement preventive measures, such as increasing fluid and fiber intake if tolerated, encouraging mobility as possible, and using stool softeners or laxatives.