25TH CASE SCENARIO.(NURSING) CHEMOTHERAPY Side Effects.

THE WARNING SIGNS OF CANCER.

The change in the bladder and bowel behavior. Has the habit of your bowel or bladder change?.

Hoarse or a nagging cough.

Finding it difficult to swallow or indigestion.

A sore that have refused to heal.

Bleeding ,very unusual bleeding and discharge. For example unusual vagina discharge or bleeding. This is not your menstruation. (When I observed it in older adults. I get seriously worried because you cannot be menstruating at the age of 65years.Notify the doctor, provide emotional support, give needed supplies and document findings.) Younger adults it may be their menstruation.

Lump in breast or somewhere else.

A clear change in the mole.Watch the change of the mole or warts, that is change in size and shape.

And in taking care of cancer patients, it is very important to provide tender loving care,be compassionate, provide emotional support, accurate information, open communication, and help with your patients to cope.Remember that they have lives before hospitalization.

Below are case scenarios, questions and answers.

Age/Sex 30years old,Male.

Admitted 01/23/2001.

Attending doctor: Dr. Gardener, Love.

CODE STATUS: Full code.

Location: Med/Oncology.

Room 31134.

Diagnosis: Lung cancer.

Secondary Diagnosis: Diabetes, HLD,Hypertension.

(1)A 30years old man receiving Chemotherapy for cancer of the lung. Patient is placed on reversed Isolation. The patient tells the nurse. “I am really upset about missing my son’s fourth birthday “.The most appropriate way to address patient concern will be.

Correct answer:I know that you are upset.As soon as your treatment is completed,you will be able to return home to see your family.

Chemotherapy is medication that interferes with normal cell activities. Side effects are Nausea, vomiting, stomatitis(inflammation of the mucous membranes of mouth),bone marrow suppression, mucositis (inflammation of GI,GU)Mucous membrane,anorexia, alopecia (hair loss)

THE EPIDEMIOLOGY OF LUNG CANCER.

The epidemiology data on the lung cancer according to various studies out there.It includes small cell and non-small lung cell cancer. Small cell lung cancer accounts for about 10- 15%.The other percentage is non-small cells cancer. The second most cancer in women and men are lung cancer.Lung cancer is more common in older people 65years and above, and very few percentage in younger people.

RISK FACTORS:

Smoking cigarettes is the most factor associated with lung cancer but not the only factors. Having seen people who never smoked but was diagnosed with lung cancer.

Secondhand Smokers. That is you are in the same environment with people that smoke cigarettes.

THE OTHER RISK FACTORS

Lung disease and tuberculosis disease.

Exposure to radiation, and radioactive gas that occurs naturally in rocks and soils.

Asbestos exposure.

Chemical and mineral inhalation.

Exposure to certain air pollution for example combustion of diesel,coal and other stuff.

Previous lung cancer and previous history.

SIGNS AND SYMPTOMS OF LUNG CANCER.

Loss of appetite and weight loss.

Coughing that doesn’t go away.

Hoarseness.

Rust colored or bloody sputum.

Chest pain that get worse with deep couughing,breathing, or laughing.

Shortness of breath.

Wheezing. (New onset)

Recurring Pneumonia and bronchitis infections.

If lung cancer goes to other organs of the body. Patient might experience bone pain,and neurological symptoms such as dizziness, headache, weakness, numbness or some seizures and jaundice.

Some lung cancer can cause Paraneoplastic and Horner Syndrome.

SOME DIAGNOSIS/ IMAGING TEST I KNOW.

Biopsy to determine if you have lung cancer .

Chest Xray.

CT/PET SCAN.

MRI. Magnetic resonance images.

After learning about the diagnostic tests.

There are also stages of cancer. (Extend of disease)

Please read up more about diagnostic tests and stages of cancer research.

Reverse Isolation: Protection of patient from infection due to bone marrow depression, neutropenia (less than 500/mm3) from Chemotherapy.

Right Subclavian Mediport for Chemotherapy. Clean /Patent/ Dry.

MEDICATIONS:

Zofran 4mg IV Q4hours prn nausea/Vomiting.

Promethazine (Phenergan)12.5mg IV Q6hours prn nausea/Vomiting.

Tylenol 650mg po Q6hours prn temperature.

Morphine 2mg IV Q3hours prn pain.

Benadryl 25mg po/IV Q4hours prn itching.

Blood sugar check QAC +QHS.

Nursing Responsibilities:

Monitor temperature.

Monitor laboratory results.

PLAN:

Discharge home tomorrow if WBC is greater than 3.5.

LABS in at 05am 01/24/2001.

CBC WITH DIFFERENTIAL

CHEM 7( Comprehensive Metabolic Panel)

LFT PANEL.( Liver Function Panel)

(2)The doctor ordered phenergan 12.5mg IVP . The most important action to be taken by the nurse before administering this medication intravenously would be to check patency of the vein(Saline lock).It is absolutely important to determine absolute patency of the vein.Extravasation will cause necrosis.

25TH CASE SCENARIO .B

(3) A 34years old female is diagnosed with a malignant brain tumor focused in her left frontal lobe.She undergoes a craniotomy for removal of the tumor. In caring for the patient postoperatively, the nurse would expect neurological changes such as

Correct answer:Personality Changes from the frontal lobe surgery.

Craniotomy is a surgical opening into the skull.

Complications are atelectasis,pneumonia, Cardiac dysthymia, increased, intracranial pressure, fluid and electrolyte imbalance.

25 TH CASE SCENARIO C.

Age/Sex 63year Man.

Admitting Diagnosis: Cancer of the Larynx.

Admitted 09/13/2002.

Admitting Doctor: Dr. DON’T HATE.

CODE STATUS Full Code.

LOCATION: Med/Oncology.

MR: Q0000999224.

Allergy: NKDA.

A 63years old man is diagnosed with cancer of the larynx and comes to the hospital for a total laryngectomy.When the nurse is assessing this patient laryngeal nerve functions.It is very important for the nurse the check patient for Ability to Swallow.

S/P: Laryngectomy.

02 2L NC.

MEDICATIONS

Zofran 4mg IV Q4hours prn nausea/Vomiting.

D51/2NS with 20mEqkcl at 125ml/hr.

Morphine 2mg IV Q3 prn pain.

Dilaudid 0.5mg IV Q3hours prn pain.

Question:

(3)A patient with terminal cancers tells the nurse, I feel so tired. I don’t know what is happening to me.Am I dying?

Correct Answer: What do you think is happening to you?.

(4)A 62 years old woman is admitted to the hospital with end stage cancer of the Pancreas. As her condition worsen her family visit less frequently. To reduce the loneliness experienced by the patient.Which action should be taken by the nurse.

Answer: Establish a schedule for members of the nursing staff to spend time with the patient.

(5)Joseph Robinson 24years old is taken to the hospital by her parents because he complains of weight loss and tiredness. The doctor examination reveals pallor and multiple bruises on his arms and legs.He is admitted to the hospital for blood work and bone marrow aspiration. In preparation for the bone marrow aspiration, the nurse places Joseph in a prone position. Joseph was placed in this position because:

Answer:

(A)Bone marrow samples are commonly taken from the posterior iliac Crest.

(B)Joseph actually ask for that position.

(C )All of the above.

(D )None of the above.

Correct answer A.

(6) Prior to the bone marrow aspiration, the nurse checks Joseph chart to make sure that informed consent is obtained. The nurse understands that informed consent means that?.

Answer:

All of the potential risks and benefits of the procedure have been explained to Joseph by his doctor.

(7) The results of Joseph’s blood tests reveal a platelet count of 40,000 per mm3 and a granulocyte count of 350 per mm3.Joseph receives a diagnosis of acute lymphocytic leukemia. Joseph is thrombocytopenic,the nurse determines that which of the following nursing diagnosis most accurately reflects his condition?.

(A)Potential for injury.

(B)Potential lack of love.

(C)He will be fine.

(D)All of the above.

Correct answer A.

(8) Joseph is placed in a private room. The nurse expects the outcome of this action to be that :

Answer:

Joseph will not be infected by the other patients and the healthcare workers.

(9) Oncovin (Vincristine) and allopurinol ( Zyloprim) are prescribed are prescribed by Joseph. The nurse would explain to Joseph that patients who are receiving Vincristine,also receive Zyloprim to:

Answer :

( A)Prevent uric acid nephropathy .

(B )Prevent nausea and Vomiting.

(C) You cannot receive both together.

(D)All of the above.

Correct answer: A.

(10) Which statement if made by Joseph, would indicate to the nurse that patient teaching about Zyloprim has been effective.

Answer:

Nurse ,I know that I must drink at least 8glasses of water a day.

Joseph begins Chemotherapy. The nurse should recognize that an early side effect of Chemotherapy is?.

Answer:

Mouth ulcerations.

(11) Joseph asks the nurse if he is going to be bald as a result of the Chemotherapy.

Answer:

Assess Joseph’s understanding about Alopecia. Alopecia is a complete or partial loss of hair from the areas of the body that hair normally grows.