Question

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 SaO2 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. a. 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. b. On what areas should the nurse focus the assessment to detect potential complications for Mr. Jones? c. 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?

Answer 1

a.The following order has to be carried out by the nurse to provide care to this patient

• Prop the patient to high or semi Fowler's position to improve the lu g capacity and increase oxygenation
• Administer oxygen via nasal canal to relieve breathing difficulties
• Insert an IV cannula and collect blood samples before starting antibiotics and IV fluids(because blood culture sample has to be taken prior to administration of antibiotics, a collection of sample after this can give false report.Collection of blood samples during insertion of IV line can minimize the number of pricks in patient)
• Administer antibiotics if patient has no allergic history (if not known check for allergy by injecting a small portion intra-dermally)
• Provide rapid sponge and medication as per order to reduce temperature
• ABG can be done down to rule put acid base imbalances
• Patient can be done with chest X ray and other investigations
• KUB needs bowel preparation, so it has to e carried at last

2.The potential complications which can be expected and assessment from a nurse can be done on

• Acid base imbalance (Respiratory acidosis or reports failure due to imbalance) Respiratory assessment can track the baseline
• Neurological assessment to prevent complications die to hyperthermia
• Risk for urinary problems and infection can occur leading to ITI

3.The following education to be done

• Take medication as prescribed
• Follow perineal hygiene to prevent UTI
• Hygienic practices as chemotherapy patient will have low immunity during the therapy
• Limit visiting crowded places ,unhygienic environment
• Practice simple breathing exercises
• Eat healthy and nutritious
• Meticulous hand washing
• Regular follow up