Oncologic and Hematologic Disorders



Oncologic and Hematologic Disorders



Case Study 88


Name______________________________ Class/Group__________________ Date___________


Group Members________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.




Scenario


You are a home health nurse who has been seeing P.C., who was diagnosed with small-cell lung cancer approximately 1 year ago. She has been treated with radiation and chemotherapy; however, her provider recently informed her that her cancer is no longer treatable because it has spread to her bones and liver and that the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat bewildered. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means.




Case Study Progress


P.C. confides that she has never formally written down her wishes concerning what types of treatments she would or would not want. You advise her to complete an advance directive and/or living will or to complete a medical durable power of attorney and/or a surrogate decision maker form. In current practice, it is very likely that a part of the home health intake process will be completion of a Physician Orders for Life-Sustaining Treatment (POLST) Paradigm form.




Case Study Outcome


P.C. discusses her wishes with her family and completes the documents describing what she would like her plan of care to be over the remainder of her life span. She passes away peacefully 7 weeks later in her home, supported by her family and friends, under her terms.



Case Study 89


Name______________________________ Class/Group__________________ Date___________


Group Members________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.



Scenario


G.C. is a 78-year-old widow who relies on her late husband’s Social Security income for all of her expenses. Over the past few years, G.C. has eaten less and less meat because of her financial situation and the trouble of preparing a meal “just for me.” She struggles financially to buy medicines for the treatment of hypertension and arthritis. Over the past 2 to 3 months, she has felt increasingly tired, despite sleeping well at night. When she goes to the senior clinic, the nurse practitioner orders blood work. G.C.’s chemistry panel is all within normal limits and a stool guaiac test is negative. Her other results include the following:



Chart View


Laboratory Test Results
















WBC 7600/mm3
Hct 27.3%
Hgb 8.3 mg/dL
Platelets 151,000/mm3


RBC indices































Mean corpuscular volume (MCV) 65 mm3
Mean corpuscular hemoglobin (MCH) 31.6 pg
MCH concentration (MCHC) 35.1%
Red cell distribution width (RDW) 15.6%
Iron (Fe) 30 mcg/dL
Total iron-binding capacity (TIBC) 422 mcg/dL
Ferritin 8 mg/dL
Vitamin B12 414 pg/mL
Folate 188 ng/mL



1. Which lab values are normal, and which are abnormal?


2. Explain the significance of each abnormal result.


3. What type of anemia does G.C. have?


4. What are some causative factors for the type of anemia G.C. has?


5. Which individuals are at risk?


6. Describe the signs and symptoms of this type of anemia.


7. Discuss some of the treatment options for her disease.


8. The physician starts G.C. on ferrous sulfate (Feosol) 325 mg orally per day. What teaching needs to be done regarding this medication?


9. Discuss some ideas that might help her with her meal planning.


10. You teach G.C. about foods she should include in her diet. You determine that she understands your teaching if she states she will increase her intake of which of the following foods?


11. What evaluative parameters could you use to determine whether G.C.’s nutritional needs are being met?



Case Study 90


Name______________________________ Class/Group__________________ Date___________


Group Members________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.



Scenario


You are a nurse working as a preoperative evaluation nurse. J.B., a well-known 62-year-old homeless alcoholic, is sent to you before a total laryngectomy with left radical neck dissection with placement of a permanent tracheostomy for squamous cell carcinoma. He has a long history of tobacco use, poor diet, and no dental care. Over the past several months, he has experienced increasing shortness of breath, hoarseness, and odynophagia. A piriform sinus mass was found on bronchoscopy. The large mass extends to and is fixed to the left true vocal cord. His chest x-ray is normal with the exception of changes related to chronic tobacco use. Past medical history includes reactive airway disease and hypertension. On examination, you find two palpable left-sided cervical nodes, which are firm and fixed.



1. Identify risk factors for head and neck cancer present in this case.


2. Name the warning signals listed on the American Cancer Society’s list of warning signs of cancer. Place a star or asterisk next to those J.B. has.


3. Describe the surgical intervention J.B. will undergo.


4. J.B. has several important postoperative needs. Identify two serious complications for which he is most at risk.


5. What type of follow-up therapy is J.B. likely to undergo after his initial wound heals?


6. J.B. will require placement of a percutaneous endoscopic gastrostomy (PEG) feeding tube postoperatively to maintain adequate nutritional intake. Discuss one immediate postoperative problem related to each of the following: nutrition, airway maintenance, and communication.


7. J.B. has several factors that make discharge planning especially problematic. Describe three specific discharge problems, and list possible solutions.



Case Study Progress


J.B. undergoes surgery, which ends up being complicated by pneumonia and poor wound healing. After being hospitalized for 6 weeks, he is discharged to a long-term care facility for care while recuperating and external radiation therapy. He is scheduled to receive 2000 cGy to the head and neck three times weekly for the next 8 weeks. As J.B.’s nurse, you are concerned about the effects of radiation therapy, particularly the development of mucositis and xerostomia, which are common in those receiving radiation to the head and neck.





Scenario


R.T. is a 64-year-old man who went to his primary care provider’s office for a yearly examination. He initially reported having no new health problems; however, on further questioning, he admitted to having developed some fatigue, abdominal bloating, and intermittent constipation. His physical examination was normal except for a stool positive for guaiac. A CBC with differential, BMP, and carcinoembryonic antigen (CEA) were ordered. R.T. was referred to a gastroenterologist for a colonoscopy. A 5-cm mass found in the sigmoid colon was diagnosed as an adenocarcinoma of the colon. The pathology report described the tumor as a Dukes’ stage B, meaning the cancer extends into the muscle or connective tissue and invades adjacent organs and lymph nodes. A distant metastatic workup is negative, and R.T. is being referred for surgery.





Case Study Progress


Four weeks after surgery, R.T. is scheduled to begin chemotherapy.





Case Study 92


Name______________________________ Class/Group__________________ Date___________


Group Members________________________________________________________________


INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as? and you will need to rewrite it.



Scenario


M.D. is a 50-year-old woman whose routine mammogram showed a 2.3 × 4.5 cm lobulated mass at the 3:00 position in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with infiltrating ductal carcinoma that was both estrogen and progesterone receptor positive. The staging workup was negative for distant metastasis. Her final staging was stage IIB. She had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 11 of 16 lymph nodes were positive for tumor cells. An implanted port was placed during surgery. She is prescribed a chemotherapy regimen of six cycles of CAF (cyclophosphamide [Cytoxan], fluorouracil [5-FU], and doxorubicin [Adriamycin]).



1. Describe the biopsy technique used to diagnosis M.D.’s cancer.


2. Discuss the implications of a positive sentinel node.


3. Using the TNM staging system, what would her classification be?


4. What is the significance of her hormone receptor status?


5. Surgical intervention is the primary treatment for breast cancer. Describe the surgical procedure that M.D. had.


6. M.D. asks you why she has to have chemotherapy with so many drugs if the surgeon removed all of the cancer. How would you respond?


7. Compare the drug actions of cyclophosphamide (Cytoxan), fluorouracil (5-FU), and doxorubicin (Adriamycin).


8. List any side effects and special considerations associated with the use of CAF.


9. M.D. is ordered doxorubicin at 75 mg/m2. Her height is 5 feet, 7 inches, and her weight is 155 pounds. Calculate the dose she will receive.


10. You have finished teaching M.D. regarding the effects of CAF. You know that she understands instructions regarding cyclophosphamide (Cytoxan) when she states:


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Jan 16, 2017 | Posted by in NURSING | Comments Off on Oncologic and Hematologic Disorders

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