The nurse receives report on the assigned team of clients on the oncology unit. All are receiving chemotherapy. Which client should the nurse check on first?

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A new-onset finding is more concerning than chronic or expected findings. There is a risk of spinal cord compression from a metastatic tumor in the epidural space. The classic symptoms are localized, persistent back pain; motor weakness; and sensory changes (eg, numbness, paresthesia). There can also be autonomic dysfunction, reflected by bowel or bladder dysfunction. Neurologic changes are a priority because the symptoms are subtle and time sensitive for permanent negative outcomes. Bone is a common site for metastasis due to its vascularity. This is the highest risk of the 4 options. (Option A) Cells with rapid turnover take up the chemotherapy and are most affected. Commonly expected findings are alopecia (loss of hair) and mucositis/ulcers in the mouth/gastrointestinal system. Comfort care and teaching will be given for these signs, but they are not a priority over a neurologic abnormality. (Option B) Chemotherapy suppresses bone marrow, commonly resulting in neutropenia (low neutrophil count), anemia (low hemoglobin), and thrombocytopenia (low platelets). This would be monitored but is not an emergency at this current level. (Option D) Nausea and vomiting are expected side effects of chemotherapy and/or radiation treatment. Potassium losses occur with vomiting or diarrhea. However, this potassium result is only slightly lowered. It should be monitored but is not the priority compared to the new neurologic assessment. Educational objective: The client with cancer who experiences a new unexpected neurologic complication is a priority. Acute symptoms of spinal cord compression are a priority over stabilized anemia, minor hypokalemia, mucositis, or alopecia.

The Nurse Receives Report on the Assigned Team of Clients