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

Observing for 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.

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

•Incorrect: 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.

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

Normal 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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