An elective procedure is scheduled in advance so that all preparations can be completed ahead of time. The vital signs are the final check that must be completed before the client leaves the room so that continuity of care and assessment is provided for.

Option A: A signed consent is needed as soon as the client has consented to the procedure. General anesthesia is required. The patient is placed in the supine position, with the arms extended. The surgeon stands on the patient’s right side with the assistant opposite.
Option C: Name bands are given to the client upon admission. Sequential compression devices are used before the operation begins. Preoperative antibiotics are given within 60 minutes of the skin incision. The skin is prepared and draped with aseptic technique in the standard surgical fashion.
Option D: The client may empty the bladder prior to surgery, but it is not of the utmost importance. Before open splenectomy, a Foley catheter should be placed. An orogastric or nasogastric tube should be inserted during intubation and removed postoperatively as clinically indicated.

The peak incidence of Acute Lymphocytic Leukemia (ALL) is 4 years of age. It is uncommon after 15 years of age. It is diagnosed in about 4000 people in the United States each year with the majority being under the age of 18. It is the most common malignancy of childhood. The peak age of diagnosis is between two and ten years of age.

Option B: There are rare incidences of ALL between the ages of 20 to 30 years. Acute Lymphocytic Leukemia is more common in children with Trisomy 21 (Down syndrome), neurofibromatosis type 1, Bloom syndrome, and ataxia telangiectasia. All are common in children between two and three years of age.
Option C: Adults between 40 to 50 years old very rarely have cases of ALL. Acute Lymphocytic Leukemia is a disease with low incidence overall in population studies. The incidence of Acute Lymphocytic Leukemia is about 3.3 cases per 100,000 children. Survival rates for ALL have improved dramatically since the 1980s, with a current five-year overall survival rate estimated at greater than 85 percent.
Option D: Prognosis among older adults above 60 years old is poor. Prognosis is diminished in children when diagnosed in infants less than one year of age and in adults. It is more favorable for children. Association of the MLL gene in children at 11q23 chromosome is associated with poor prognosis.

Acute Lymphocytic Leukemia (ALL) does not cause gastric distention. It does invade the central nervous system, and clients experience headaches and vomiting from meningeal irritation. The primary care provider and nurse practitioner may be responsible for follow up after treatment and report back to the interprofessional team. These patients need close monitoring as they are prone to infections, coagulation dyscrasias, and relapse.

Option A: Some effects of radiation are nauseas, vomiting, and headaches. The pharmacist should educate the patient on chemotherapy medications, their adverse effects, and benefits. The dietitian should encourage a healthy diet. To prevent infections, the nurse practitioner should encourage hand washing, washing of fruits and vegetables and maintaining good personal hygiene.
Option B: Chemotherapy side effects include nausea, vomiting, and hair loss. Treatment options include prochlorperazine, haloperidol, metoclopramide, lorazepam, dexamethasone, ondansetron, granisetron, dolasetron, palonosetron, dronabinol, aprepitant, fosaprepitant, netupitant. palonosetron has a longer half-life, better efficacy, and higher binding affinity than granisetron.
Option C: Clients may experience headaches and vomiting due to meningeal irritation. Meningitis can have a varied clinical presentation depending on age and immune status of the host. Symptoms typically include fever, neck pain/stiffness, and photophobia. More non-specific symptoms include headache, dizziness, confusion, delirium, irritability, and nausea/vomiting.

Disseminated Intravascular Coagulation (DIC) has not been found to respond to oral anticoagulants such as Coumadin. Warfarin is contraindicated in patients with hemorrhagic tendencies (e.g., active GI ulceration, patients bleeding from the GI, respiratory, or GU tract; a cerebral aneurysm; central nervous system (CNS) hemorrhage; dissecting aortic aneurysm; spinal puncture and other diagnostic or therapeutic procedures with the potential for significant bleeding).

Option A: Heparin, an anticoagulant, is widely used during DIC treatment and in the prevention of thrombotic diseases. Heparin may also become necessary if a patient has extensive clotting as this medication may prevent further activation of the clotting cascade. Patients with DIC who are not actively bleeding should receive prophylactic anticoagulation with heparin or low molecular weight heparin (LMWH).
Option C: The DIC component will resolve on its own once the underlying disorder is addressed. The treatment for DIC centers on addressing the underlying disorder, which ultimately led to this condition. Consequently, therapies such as antibiotics for severe sepsis, possible delivery for placental abruption, and possible exploratory surgical intervention for trauma represent the mainstays of treatment for DIC.
Option D: Platelet and factor replacement should be directed not at simply correcting laboratory abnormalities but at addressing clinically relevant bleeding or meeting procedural needs. Platelet and plasma transfusions should only be considered in patients with active bleeding or a high risk of bleeding or those patients requiring an invasive procedure. A common threshold utilized for platelet transfusions in this patient population is less than 50 x 10^9 platelets per liter for actively hemorrhaging patients and 10-20 x 10^9 platelets per liter for those not actively bleeding but at high risk of future bleeding.

Urine output provides the most sensitive indication of the client’s response to therapy for hypovolemic shock. Urine output should be consistently greater than 30 to 35 mL/hr. Renal losses of salt and fluid can lead to hypovolemic shock. The kidneys usually excrete sodium and water in a manner that matches intake. Diuretic therapy and osmotic diuresis from hyperglycemia can lead to excessive renal sodium and volume loss. In addition, there are several tubular and interstitial diseases beyond the scope of this article that cause severe salt-wasting nephropathy.

Option B: Respiratory rate is not an indicator of adequate fluid replacement. Patients with volume depletion may complain of thirst, muscle cramps, and/or orthostatic hypotension. Severe hypovolemic shock can result in mesenteric and coronary ischemia that can cause abdominal or chest pain. Agitation, lethargy, or confusion may result from brain malperfusion.
Option C: Diastolic blood pressure is a less reliable indicator of adequate fluid replacement. Although relatively nonsensitive and nonspecific, physical exams can be helpful in determining the presence of hypovolemic shock. Physical findings suggestive of volume depletion include dry mucous membranes, decreased skin turgor, and low jugular venous distention. Tachycardia and hypotension can be seen along with decreased urinary output.
Option D: Systolic blood pressure is not a reliable indicator of fluid volume replacement. For hypovolemic shock due to fluid losses, history and physical should attempt to identify possible GI, renal, skin, or third-spacing as a cause of extracellular fluid loss. Symptoms of hypovolemic shock can be related to volume depletion, electrolyte imbalances, or acid-base disorders that accompany hypovolemic shock.