The diagnosis of acute lymphoblastic leukemia (ALL) is confirmed. The hematologic values include white blood cell count of 6,000 cells/ml with a low blast cell count, a platelet count of 50,000, hemoglobin of 6 g/dl, and hematocrit of 16%. Which of the following measures should be included in the patient's plan of care?

Observe for dyspnea on exertion

Explanation

•Bone marrow suppression results in anemia from decreased RBC production. The patient's hemoglobin and hematocrit are abnormally low, likely causing symptoms of anemia such as fatigue, pallor, tachycardia, and dyspnea on exertion.

•With ALL, bone marrow overproduces immature lymphocytes and soon becomes unable to continue normal production of other blood components. ALL is the most common type of leukemia in children.

Incorrect options:

•Vitamin K injection is not indicated because the patient has a low platelet count (thrombocytopenia). Vitamin K affects the synthesis of clotting factors, not platelets.

•Reverse isolation and the restriction of fresh fruits and vegetables are interventions for a patient that is leukopenic. The patient's WBC count is within normal limits.

Normal lab values:

•WBC: 4,000-10,000 cells/ml
•Hemoglobin: 14-18 g/dl (men), 12-16 g/dl (women)
•Hematocrit: 42-52% (men), 37-47% (women)
•Platelets: 150,000-400,000

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