Read the case and answer the following questions carefully. Nicole is a 13-year-old girl with leukemia. She lives at home with her parents and younger siblings and for the past 3 months has been receiving chemotherapy. She has a central venous access device (CVAD) that is cared for by her parents and herself. Nicole has experienced a number of absences from school as a result of her hospitalizations, chemotherapy, and the effects of her chemotherapy regimen, although she has had a tutor at home to keep her current with her studies. Nicole has alopecia and has been hospitalized with a line infection, stomatitis, esophagitis, and bleeding requiring platelet replacement. She refuses to see her friends although she speaks with them frequently on the phone. She tells them her refusal is based on the fact that she is prone to infection and doesn’t want to risk exposure and have to be hospitalized again.
Nicole is admitted to the pediatric unit of the local hospital with a temperature of 38.8C (101.8F) that did not respond to the acetaminophen that she has been taking every 4 hours since yesterday. Her admission assessment indicated that Nicole’s lung sounds are clear, heart sounds are strong and regular, she is in no apparent distress, has alopecia, and has evidence of white patches in her mouth. Her laboratory values include: hemoglobin 10.1 g/dL; hematocrit 25%; platelets 50,000/mm3; white blood cell count 2,000/mm3; neutrophils 20%.
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