Question

E.J is a 63 year old retired homemaker with a history of lung cancer with metastasis of the liver. Patient states "feeling puffy and bloated" for a week. Pt states when lying flat feels SOB. Patient states having insomnia and begins to cry during assessment. VS 98.6 HR 78 BP 102/74 Resp 18. O2 Stat 95% on room air. Patient has gain 8lbs in 7days. BSx4, Lungs Upper Lobes Diminished. +4 Edema in Both Ankles.

A. Objective Data

B. Subjective Data

C. What is your analysis of this Patient?

D. What type of problem Focus Assessment would you do?

E. What type of Headache is he having?

F. Give 3 Nursing Diagnosis

G. Give 3 Nursing Interventions

H. Are you testing the Cranial Nerves? If so which ones would you test.

I. Critical thinking (Give 3 question outside the box)

J. Write a brief detail Nursing Note about this patient.

Answer 1

In the present scenario,

E.J is a 63-year-old retired homemaker with a history of lung cancer with metastasis of the liver. The patient states "feeling puffy and bloated" for a week. Pt states when lying flat feels SOB. Patient states having insomnia and begin to cry during the assessment. VS 98.6 HR 78 BP 102/74 Resp 18. O2 Stat 95% on room air. Patient has gained 8lbs in 7days. BSx4, Lungs Upper Lobes Diminished. +4 Edema in Both Ankles.

A)Objective data:

*Vital signs :

• Temp:98.6⁰F
• HR:72 beats/minute
• BP:102/74mmHg
• Resp:18breaths/mt
• Oxygen Saturation:95% on room air

*Physical Examination:

Patient has gained 8lbs in 7days

Abdomen: bowel sounds active in all four quadrants

Lungs: Upper lob diminished

Ankles: +4 edema in both ankles

B)Subjective data:

• Feeling of puffy and bloated for a week
• When lying flat feels SOB.
• insomnia

C)What is your analysis of this Patient?

In my view, there is a metastasis of cancer to the brain and other parts of the body and as well as result in ascites. When ascites is due to cancer, or if the fluid in the abdomen contains cancer cells, it is often called malignant ascites or malignant peritoneal effusion. Cancer that spreads to the liver can also cause ascites and shows the symptoms such as :

Symptoms of ascites include:

• feeling of bloating
• fatigue
• shortness of breath
• weight gain
• ankle or leg swelling

D)What type of problem Focus Assessment would you do?

We have to go for a review of systems to confirm the diagnosis for the presenting symptoms

E). What type of Headache is he having?

There is a metastasis of tumor to the brain and surrounding areas resulting in headache and resultant insomnia (Headache secondary to metastasis)

F)1.Acute Pain

2.Ineffective breathing pattern

3.Disturbed sleep pattern

G). Provide a calm, quiet and comfortable environment.

Place the patient in semi-fowlers position

Administer medications as prescribed

H)We will test all the cranial nerve function to know the cranial involvement in metastasis

I) Here is a need for support, both from mental health professionals and has been playing a critical role in their emotional well-being.

*What is really happened to this case?

*Why this case to be treat as giving more importance?

*Why this case is more significant to get the best medical and nursing care?

J)Here in the present scenario Mrs. E.J with a history of lung cancer with metastasis of the liver. The patient states "feeling puffy and bloated" for a week. Pt states when lying flat feels SOB. Patient states having insomnia and begin to cry during the assessment.

• VS: 98.6
• HR: 78
• BP: 102/74
• Resp: 18.
• O2 Stat 95% on room air.
• Patient has gained 8lbs in 7days.
• BSx4,
• Lungs Upper Lobes Diminished.
• +4 Edema in Both Ankles.

On assessment due to the metastasis of cancer to liver results in ascites and other symptoms such as :

• feeling of bloating
• fatigue
• shortness of breath
• weight gain
• ankle or leg swelling

We have done the review of the system and other relevant examination

Now the patient is on treatment as prescribed