Instructions: Read each case study and answer the following questions as if you are the nurse who is taking care of this patient. When finished please submit to the drop box.

I. Mr. V is a 65-year-old male with multiple myeloma. He also has a past medical history of smoking 2 packs per day for 20 years. He is widowed and estranged from his 2 children. Mr. V has had a persistent headache since admission. His initial cancer diagnosis was 18 months ago and he was placed on low dose dexamethasone treatment one year ago. Mr. V began lenalidomide and bortezomib 6 months ago. The lenalidomide and bortezomib had to be discontinued secondary to peripheral neuropathy and toxicity. A week later, the client accidentally ingested 8 tablets of his 20mg Lasix (instead of Decadron) and presented to the emergency department with severe headache. He is subsequently admitted.

Questions
1. What is the most important side effect for the nurse to know when chemotherapeutic medications and steroids are used together?
2. Why are steroids often used in conjunction with chemotherapeutic agents?
3.What does the term “nadir” mean
4. What are 3 nursing interventions to address nadir?
5. What labs signify dehydration?
6. What are three nursing interventions to address dehydration?
On day 2 of this treatment, Mr. V develops an S3 murmur and his blood sugar increases to 325.
7. What does an S3 murmur indicate with the administration of IV fluids?
8. What are nursing interventions to address fluid overload?
9. What interventions are needed for hyperglycemia?
10. What characteristics of an IV site are you assessing for?
11. If an IV site is infiltrated what are your nursing interventions?
12.What follow up care would you recommend for this patient addressing all of his issues?