The nurse is performing an assessment of a client admitted with left sided heart failure. Which dinical manifestation(s) would the nurse expect to identify? SELECT ALL THAT APPLY)

A) Ascites
Ascites, the accumulation of fluid in the peritoneal cavity, is not a typical initial assessment finding in acute lymphocytic leukemia (ALL). While ascites can occur in some cancers or in cases of liver failure, it is not a hallmark or common finding in ALL. The focus in ALL would generally be on hematologic and immunologic symptoms rather than fluid accumulation in the abdomen.

B) Alopecia
Alopecia (hair loss) is more commonly associated with chemotherapy treatment for leukemia rather than the leukemia itself. While chemotherapy for ALL can lead to hair loss, it is not typically an initial symptom of the disease itself. Alopecia may appear later, as a side effect of cancer treatment.

C) Generalized edema
Generalized edema (swelling) is not a common or early sign of acute lymphocytic leukemia. While edema can occur in certain malignancies or complications (like in cases of renal failure or heart failure), it is not typically an initial presenting symptom of ALL. The key manifestations of ALL tend to relate to hematologic abnormalities, rather than fluid accumulation.

D) Petechiae
Petechiae (small, red or purple spots on the skin) are a common finding in ALL. They occur due to thrombocytopenia (low platelet count), which is a hallmark of leukemia. Thrombocytopenia impairs the blood’s ability to clot, leading to bleeding under the skin. Petechiae is often one of the first visible signs of blood dyscrasia in leukemia patients.

E) Epistaxis
Epistaxis (nosebleeds) is another common initial finding in ALL. Like petechiae, epistaxis occurs due to thrombocytopenia, which impairs normal clotting and leads to spontaneous bleeding. Nosebleeds are frequently observed in patients with low platelet counts, especially in leukemia.

A) Take this medication as needed for pain:
Baclofen is a muscle relaxant typically prescribed for managing spasticity associated with multiple sclerosis (MS), rather than for pain. It should be taken as prescribed, typically on a scheduled basis rather than on an as-needed basis for pain. Misunderstanding this could lead to improper use of the medication and ineffective symptom management.

B) Stop the medication if I experience dry mouth:
Dry mouth is a potential side effect of baclofen, but it should not be the reason to stop the medication abruptly. Stopping baclofen suddenly can result in withdrawal symptoms and could potentially worsen spasticity. If dry mouth or other side effects are bothersome, the client should consult the healthcare provider for management options rather than discontinuing the medication abruptly.

C) Taper this medication off over 1-2 weeks:
This statement demonstrates a correct understanding of the proper way to discontinue baclofen. Baclofen should not be stopped suddenly due to the risk of withdrawal symptoms, which can include increased spasticity, hallucinations, or seizures. A gradual tapering of the dose over a period of 1 to 2 weeks is recommended to avoid withdrawal. This is the most appropriate and safe response.

D) Feel an increase in energy with this medication:
Baclofen is not a medication designed to increase energy. Its primary purpose is to reduce muscle spasticity, not to provide a stimulant effect. If the client expects an increase in energy, this could indicate a misunderstanding of the medication's effects. Baclofen's focus is on reducing spasticity and muscle tightness, not improving energy levels.