The nurse is taking care of a patient who recently received an allogenic stem-cell transplant for acute lymphoblastic leukemia (ALL). The patient abruptly complains of right upper quadrant abdominal pain. Upon assessment, the nurse notes abdominal swelling and yellowing of the sclera and skin. The nurse anticipates the provider will prescribe which treatment?

Question

The nurse is taking care of a patient who recently received an allogenic stem-cell transplant for acute lymphoblastic leukemia (ALL).  The patient abruptly complains of right upper quadrant abdominal pain. Upon assessment, the nurse notes abdominal swelling and yellowing of the sclera and skin. The nurse anticipates the provider will prescribe which treatment?

Accepted Answer

Increase IV fluids. This patient who recently received an allogeneic stem-cell transplant for ALL presents with signs and symptoms of veno-occlusive disease, occlusion of the hepatic venules by thrombosis and phlebitis. This is a complication seen in stem-cell transplant recipients and is characterized by right upper quadrant pain, ascites, and jaundice. Early detection is key, and treatment is by fluids and supportive therapy. Reassurance is not appropriate, and immunosuppression will not be effective. Emergency surgery is not indicated as there is no known way to open the hepatic vessels.

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