Question

A 71-year-old man who is married and is still working as a farmer presents to the endoscopy suite clinic. He came to the outpatient clinic two weeks ago with complaints of a progressive cough and chest congestion. Despite a week of antibiotic therapy, he continued to worsen; he experienced progressive dyspnea, a productive cough, and began to have night sweats. He refused to be admitted to the hospital because, “There's no one to look after the cattle.” He agreed to go for a chest x-ray. The radiologist read the chest x-ray as ”left hilar lung mass, probable lung carcinoma.” He has a past medical history of hernia surgery in 1986 and prostate surgery in 2005 for benign prostatic hyperplasia. He does not drink. He has smoked for 40 years and the past three years he has smoked two to three packs per day. He is scheduled for a diagnostic fiber-optic bronchoscopy with endobronchial lung biopsy as an outpatient this morning to confirm the diagnosis.The client tolerates the procedure well. He returns to the outpatient clinic in four days to learn the result of his test. The pulmonologist tells the client and his wife that he has poorly differentiated oat cell lung cancer and explains that this is a very rapidly growing cancer with a poor prognosis. This kind of lung cancer is directly related to the client’s history of smoking. 4. List at least four nursing diagnoses that apply to this client and his family at the time of diagnosis. Which diagnosis might be most important to the client? Which diagnosis might be most important to the client’s wife? Which diagnosis might nurse consider as the top priority? The client undergoes a metastatic workup and is found to have disease in a number of lymph nodes. The physician tells him and his wife that surgery is not an option and schedules him to begin combination chemotherapy with cisplatin, etoposide. 5. The clients nursing care needs have changed since the focus of his care is now treatment with chemotherapy. List at least for nursing diagnoses that apply to the client and his wife during chemotherapy. Which diagnosis might be most important to the client? Which diagnosis might be most important to the client’s wife? Which diagnosis might nurse consider as the top priority? 6. The client plans to continue to work on his farm as long as possible and says his brother-in-law has promised to help him. The client needs to have an understanding of how to balance his treatment with his work. The nurse working in the chemotherapy center helps him to plan a daily work activity and rest schedule to accommodate his treatment and side effects. List at least four concepts the nurse should emphasize. One month following his first round of treatment, the client returns for his second round of chemotherapy. He complains of shortness of breath, chest tightness, and palpitations. He looks exhausted and his wife states, “he is a bit confused at times.” A chest x-ray suggests a large left lower lobe pleural effusion. The client is admitted to the hospital for supportive care. The pulmonologist performs a thoracentesis and drains 985 mL of fluid, immediately relieving some of the client’s dyspnea and chest discomfort. Following the thoracentesis the nurse makes the following assessments • there is a small amount of serosanguineous drainage on the dressing • the client complains of occasional chest pain when taking deep breaths • the client has a blood pressure of 90/50 mm Hg and some increasing dyspnea • the client states he has some burning and stinging at the thoracentesis site 7. Which of these assessments is a priority to report to the provider? His lab values on admission are as follows: WBC: 2500/mm3 Na: 129 mmol/L BUN: 30 RBC: 4.9 millions/mm3 K: 4.2 mmol.L Cr: 3 Hbg: 12.7 g/dL Cl: 89 mmol/L Platelets: 152,000/mm3 8. Considering his treatment and the side effects of the specific drugs he is receiving, what conditions do these lab values indicate? 9. What implications do these lab values have for nursing care while the client is hospitalized?

Answer 1

4, 4 nursing diagnosis:
1, impaired gas exchange
2, acute pain
3, Ineffective airway clearance
4,fear/anxiety
For client:
    patient having progressive cough and chest congestion,dyspnea and night sweats..so there is impaired gas exchange must be considered first to relieve dyspnea and chest congestion..
For wife:
   Fear and anxiety about disease..so education about disease and progress will eliminate fear..
Nurse must consider the impaired gas exchange and insufficient airway clearance..nursing intervention should focus on airway clearance to make him breath easy.
5, Anticipatory grieving for patient;
   loss of physiological well-weing and changes in life style during chemotherapy it cause potential cause of death..
Patient will experience intolerance to sideeffects:
    nausea,vomiting and acute pain will be there for 6hours..So analgesics and antiemetics can relieve those symptoms..
Lack of knowledge:
   education program regarding chemotherapy and side effects should be considered..pain management and nutrition modification should be expalined to the wife.psychological well being must be considered..
6, -Advice patient to avoid smoking completely.
   -Exposure to asbestos fibers can cause lung cance..so while working in farm he must be take care..
-Radon gas is natural radioactive gas that emits a tyoe of ionizing radiation..that can cause lung cancer..
   -Exposing to air pollution like dust may increase the lung cancer metastasis more.
7, First priority for the client hs a blood pressure of 90/50 mmhg and some increasing dyspnea..it shows there is impaired gas exchange and hypotension..
8, lab value shows infection and mild kidney dysfunction due to side effects of cisplatin chemotherapy..