Question

Eyes: no vision changes, no eye discharge, no redness, no edema Ears: no change in hearing, no tinnitus, no discharge Nose: + change in sense of smell, no nasal discharge or congestion Throat and mouth: dry mouth, very sore, food & drink makes it burn, having trouble swallowing secretions Lymphatic: no swelling, no tenderness Cardiovascular: no chest pain, no leg swelling, no palpitations, no sob, no orthopnea Blood Vessels: + leg cramps, no leg swelling Pulmonary: no difficulty breathing, no cough Gastrointestinal: + nausea, + vomiting, + abdominal cramping Genitourinary: no urinary burning, no urinary difficulty, no nocturia, no flank pain Musculoskeletal: + muscle cramps in legs, no present back pain, no joint stiffness Physical Exam/Findings: (Your findings) General: thin male in no apparent acute distress Weight-162lbs Height-5'8 Vital Signs: T-99.8, Pulse-110, RR-12, BP-92/53, 02 Sat-99% on room air, Pain-5/10 Skin: superficial burns noted to lower face and neck, no rashes, skin warm/dry, poor skin turgor, hair-unremarkable, nails-unremarkable Neurological: alert, confused at times to place & time, agitated, speech slow, hypereflexia, tremors in hands, facial movements symmetric, pupils equal and reactive, gait not assessed Head and neck: symmetrical, full rom of neck, no neck swelling Eyes: conjunctiva clear and free of erythema or exudate, pupils round, regular, equal and reactive, sclera is white Throat/mouth: dry mucous membranes, multiple open ulcers noted on gums, mucous membranes erythematous Cardiovascular: tachycardia, no edema, no JVD Pulmonary: respiratory rate slow, normal respiratory effort, lungs clear, equal expansion Abdomen: no distention, bowel sounds hyperactive x4, no guarding Musculoskeletal: hyperreflexia of upper & lower extremities reflexes Abnormal Laboratory Data: WBC-slightly elevated Urinalysis-specific gravity 1.030 EKG-T wave depression Hemoglobin-elevated Hematocrit-elevated Creatinine-1.8 Glucose-90 ABG- 7.52, CO2-36, HCO3-30 Sodium-120 Potassium-2.5 Magnesium-0.6 BUN-30

Answer 1

5) This complication is called chemotherapy induced nausea and vomiting ( CINV ).

Pathophysiology :-

Pathways of Nausea & Vomiting Chemotherapy Higher Cortical Memory, fear, anticipation Anesthetics Centers |--Sensory input (pain, smell, sight) Opioids Chemoreceptor Trigger Zone (Area Prostrema 4h Ventricle) Vomiting Center (Medulla) Stomach Surgery Small Intestine Radiotherapy – Chemotherapy Vomiting Reflex Labyrinths - Surgery