Oncology case study PDF

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Case Study Assignment 1

Case Study, Chapter 15, Oncology: Nursing Management in Cancer Care 1. Emanuel Jones, 60 years of age, is male patient diagnosed with small cell carcinoma. He underwent surgery in the past to remove the left lower lobe of his lung. He is receiving chemotherapy. Two weeks before a round of chemotherapy, a complete blood count with differential, and a renal and metabolic profile are obtained for the patient. The patient presents to the oncology clinic for chemotherapy with a temperature of 101°F. Further assessment reveals decreased breath sounds in the right base of the right lung, and a productive cough expectorating green colored mucus. The patient is short of breath and has a pulse oximetry reading that is SaO2 of 85% on room air. The patient has a history of benign prostate hypertrophy (BPH) and has complaints of urinary frequency and burning upon urination. The patient is admitted to the oncology unit in the hospital. The oncologist orders the following: blood, sputum, and urine cultures; and a chest x-ray. An x-ray of the kidneys, ureters, bladder (KUB) is ordered. An arterial blood gas (ABG) on room air, CBC with differential, and renal and metabolic profile are ordered. Oxygen is ordered to begin with nasal cannula at 2 L/min and titrate to keep SaO 2 greater than 90%. A broad-spectrum antibiotic, levofloxacin 500 mg in 100 mL of NS is ordered to be administered IV over 60 minutes once daily. (Learning Objective 8)

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After examining the physician orders, in what sequence should the nurse provide the care to the patient admitted to the hospital? Give the rationale for the sequence chosen.  First I would obtain, per the oncologist order, the ABGs on room air and it is done before providing oxygenation to ensure accurate reading.  I would then ensure that the blood and CBC with differential, as well the renal and metabolic profiles are done. These are done before the medications to ensure that the blood results are accurate and not compromised by the antibiotics.  Next I would begin oxygenation at 2 L/ min to make the patient comfortable and maintain the SaO2 at 90% . This will also make him more comfortable to breath and making it easier for the patient to provide sputum without running out of breath  I would then do the sputum and urine cultures after the blood tests are drawn because these specimen will not be compromised with the other test done before hand  Lastly I would give the patient his antibiotics administered through an IV because all labs have been done and the medication would not compromise anymore tests.  Once all that is done, I would ensure that his chest and KUB x-rays are done all at once so that the patient is comfortable and ready to rest after the the x-rays.

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On what areas should the nurse focus the assessment to detect potential complications for Mr. Jones?  I would assess the color of the urine to monitor for any blood. I would also assess his chest expansion as well as his lung sounds. I would monitor his SaO2 constantly to make sure that it is above 90% along with the oxygenation. I would also make sure to monitor his fever temper and take necessary interventions to ensure it does not increase, and if it does notify the doctor.

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What patient education does Mr. Jones need from the nurse to help prevent the reoccurrence of an infection and to get treatment for an infection promptly?  The nurse should teach the patient about hand washing with soap and water often, especially if he is sneezing or coughing in his hands/arms.  If he is to touch surface areas, to make sure that he does not touch his face, eyes, nose or other potential portals of entries.  The nurse should remind him to stay away from friends or family members that may be sick, and if he has to be around them to wear a mask.  He should also be instruct to finish his antibiotics if he is to be discharged with a prescription to ensure the infection is completely gone.  The patient should be taught the signs and symptoms of an infection so that if they are to occur he can seek help immediately.  The nurse should also try and educate the family members so that they can know what to look for and to take precautions to avoid infecting the patient.

Case Study, Chapter 16, End-of-Life Care 1. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9)

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What nursing measures should the nurse use to manage the patient’s dyspnea?  The nurse should raise the HOB to make it easier for the patient to breath as well as constantly assessing his breathing to make sure he is provided with the oxygenation when needed.  The nurse should also try and ease his anxiety which can make him feel that his dyspnea is worsening. The nurse can implement complementary and alternative therapies.  Administer the patient’s medication, which would be his Flovent or his Proventil which is a bronchodilator.  Keep everything within reach so patient can conserve energy.

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The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?  The nurse should first provide oral care which will hopefully make him find foods more appealing.  Helping the patient ease his anxiety may also make it easier for him to eat. The nurse can ease his anxiety by using complementary and alternative therapies, such as guided imagery or playing music for the patient.  Offering cold foods as sometimes they are more often tolerated than warm foods  The nurse should also maintained his room clean without foul orders in the environment as it may make him nauseous and without appetite  Offering the patients his meds before a meal, if possible, to alleviate respiratory issues and making it easier for him to eat.  Suggesting smaller and more frequent meals  Scheduling meals around family member schedule  The patient may be offered fluids such as broths, jello, or puddings, or would ask him what he feels like eating or drinking and it can be anything he finds appetizing....