A 25-year-old patient is admitted to the ambulatory surgery unit to receive two units of whole blood.

The patient has anemia, systemic lupus erythematosus, hypertension, schizophrenia, and primary hypothyroidism.

The patient’s vital signs are BP 100/68, P 110, R 24, T 99.1 °F, O2-97%. The patient reports experiencing shortness of breath with exertion, fatigue, dizziness when standing, and an intolerance to cold temperatures.

Initial labs indicate an Hgb of 6.8, an Hct of 21.2, a CRP of 38, an albumin of 14, and an iron level of 9. The patient’s current medications include hydroxychloroquine 200 mg one BID, amlodipine 10 mg one PO daily, Citalopram 20 mg one PO daily, Lisinopril 20 mg one PO daily, sertraline 50 mg one daily, levothyroxine 75 mg one PO daily, Ferrous sulfate 30 mg one PO TID, and quetiapine 100 mg one PO HS. Which patient assessment findings require immediate follow-up by the nurse at this time? (Select all that apply)

Choice A rationale:
While advancing age is a significant risk factor for cancer, it is not considered the single biggest risk factor. The risk of developing cancer does increase with age, primarily due to the accumulation of DNA damage over time. This damage can arise from various sources, including exposure to carcinogens, errors in DNA replication, and oxidative stress. With age, the body's ability to repair DNA damage also declines, making cells more susceptible to cancerous changes.
However, it's important to note that cancer can develop at any age, and even younger individuals can be affected if exposed to other significant risk factors.
Choice B rationale:
Exposure to tobacco is widely recognized as the single biggest risk factor for developing cancer. It is estimated to be responsible for about 25-30% of all cancer deaths worldwide.
Tobacco smoke contains over 70 known carcinogens, which are substances that can damage DNA and lead to cancer. These carcinogens can affect various organs in the body, including the lungs, mouth, throat, esophagus, stomach, pancreas, liver, bladder, kidney, cervix, and colon.
The risk of cancer increases with the amount and duration of tobacco use. Even exposure to secondhand smoke can increase the risk of cancer.
Quitting tobacco use is the most effective way to reduce the risk of cancer.
Choice C rationale:
Exposure to occupational chemicals is a known risk factor for certain types of cancer, such as lung cancer, bladder cancer, and leukemia. However, it is not considered the single biggest risk factor for developing cancer overall.
The risk of cancer from occupational chemicals depends on the specific chemical, the level of exposure, and the duration of exposure.
Workplace safety measures, such as using protective equipment and limiting exposure to hazardous chemicals, can help reduce the risk of cancer.
Choice D rationale:
Infection with certain viruses, known as oncoviruses, can increase the risk of developing certain types of cancer. For example, infection with human papillomavirus (HPV) can increase the risk of cervical cancer, and infection with hepatitis B virus (HBV) can increase the risk of liver cancer.
However, oncoviruses are not considered the single biggest risk factor for developing cancer overall. Vaccines are available to protect against some oncoviruses, such as HPV and HBV.

Choice A rationale:
Anaphylaxis risk: A history of allergy to bee and wasp stings indicates a potential risk for anaphylaxis, a severe and life- threatening allergic reaction. This information is crucial for the surgical team to be aware of, as it can influence their choice of anesthesia, medications, and other interventions during the surgery. They will need to be prepared to manage any potential allergic reactions promptly and effectively.
Cross-reactivity potential: Allergies to insect stings can sometimes cross-react with other substances, such as medications used during surgery (e.g., antibiotics, muscle relaxants, latex). It's essential for the surgical team to be aware of these potential cross-reactions to take necessary precautions and avoid triggering an allergic reaction.
Preoperative planning: Knowing about the patient's allergy to bee and wasp stings allows the surgical team to make informed decisions regarding:
Premedication: The patient may need to receive antihistamines or corticosteroids before surgery to reduce the risk of an allergic reaction.
Monitoring: The patient's vital signs and symptoms will be closely monitored during and after surgery for any signs of an allergic reaction.
Emergency preparedness: The surgical team will have medications and equipment readily available to treat anaphylaxis if it occurs.
Choice B rationale:
Lactose intolerance is not typically a significant concern during surgery. It's a digestive issue that can cause discomfort after consuming dairy products, but it doesn't typically pose immediate risks during surgical procedures. The surgical team may adjust the patient's diet after surgery to accommodate lactose intolerance, but it's not crucial information for the immediate surgical planning.
Choice C rationale:
Herb and supplement use is important to communicate to the surgical team. Some herbs and supplements can interact with medications used during surgery, increasing the risk of bleeding, heart problems, or other complications. However, it's not as immediately critical as an allergy to bee and wasp stings, which carries a risk of life-threatening anaphylaxis.
Choice D rationale:
While a patient's previous experience with surgery can be helpful for the surgical team to understand their anxiety levels and expectations, it's not as critical as information about allergies or potential medication interactions.