Scribd 020922 Case Study-Oncology A&k

Case Study, Chapter 15, Oncology: Nursing Management in Cancer Care
02/09/22
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. (Learning Objective 8)
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.
First, the nurse should assess the patient and obtain current vital signs. Next the nurse
should sit the patient up so they are able to breathe better. Then, it is very important to
collect the ABGs. Ensure the nasal cannula is correctly fitted and on 2L/min. Also, the
nurse needs to draw blood for the CBC and the renal/metabolic profile. The nurse should
make sure the lab received everything. The nurse should place a pulse ox to make sure the
02 is helping. Then the nurse needs to make sure they have an accessible IV line. If not, the
nurse needs to start an IV. Next, the nurse should read over the order for broad-spectrum
antibiotics. Then the nurse should perform the 6 rights of medication. (The right patient,
right medication, right dose, right time, right route, and right documentation.) The nurse
can now start the IV antibiotics. The nurse should check and make sure radiology has been
consulted to do the x-ray and KUB. Lastly, the nurse needs to keep monitoring vitals and
follow up with the doctor when they receive the results of the labs.
b. On what areas should the nurse focus the assessment to detect potential complications
for Mr. Jones?
The nurse should focus on the patient's temperature, respirations, heart rate, oxygen level,
and assessing how the patient looks, (i.e., making sure the patient isn’t hypoxic or
diaphoretic.) Continue to monitor his LOC (level of consciousness)The nurse should assess
the patient's temperature, blood pressure, and monitor if the patient is still coughing green
colored mucus. If they are, the nurse can hook up and suction the patient.
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?
Lung cancer can cause complications and you need to call 911 if you have any of the
following: shortness of breath, coughing up blood, pain or fluid in the chest (pleural
effusion). There are things you can do to reduce the recurrence of getting an infection such
as, quit smoking, drink lots of water, eat lots of fruits and veggies, get plenty of rest, wash
your hands frequently and before you eat, refrain from being around people who are sick,
when you do go out wear your mask and stay up-to-date on vaccinations. Additionally, you
can take multivitamins, eat a fresh, clean diet and ensure meat is cooked to the proper
temperature. Exercising can boost your immune system and help ease nausea and fatigue
during chemotherapy. However, chemo side effects can sometimes make exercising tough.
2. The oncology clinical nurse specialist (CNS) is asked to develop a staff development program
for registered nurses who will be administering chemotherapeutic agents. Because the nurses will
be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on
presenting an overview of agents, classifications, and special precautions related to the safe
handling and administration of these drugs. (Learning Objectives 6 and 8)
a. What does the CNS describe as the goals of chemotherapy? (1)CURE:The goal of
chemotherapy is to destroy cancer cells. Traditional chemotherapies work by killing cells
that divide rapidly. (2)CONTROL: Keep the cancer from growing. (3)PALLATIVE
CARE: Help keep the patient comfortable during their transition.
b. How should the CNS respond to the following question: “Why do patients require
rounds of chemotherapeutic drugs, including different drugs and varying intervals?”
Repetition of varying intervals helps give the patient a higher probability reaching a goal of
complete remission and aims to prevent relapse.
c. In teaching about the administration of chemotherapeutic agents, what signs of

extravasation should the nurse include? Extravasation is a term that describes a drug
inadvertently or accidentally leaking into surrounding tissue or the subcutaneous space
during IV infusions. Signs and of extravasation is redness around the site, swelling, puffy
or hard skin around the site, blanching (lighter skin around the IV site), pain or tenderness
around the site, IV not working, cool skin temperature around the IV site or in the scalp,
hand, arm, leg or foot near the site. If extravasation occurs, the infusion should be stopped
immediately.
d. What clinical manifestations of myelosuppression, secondary to chemotherapy

administration, should the CNS include in this program? Myelosuppression — also
referred to as bone marrow suppression — is a decrease in bone marrow activity resulting
in reduced production of blood cells. This condition is a common side effect of
chemotherapy. It can range from mild to severe. Severe myelosuppression, called
myeloablation, can be fatal.

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Case Study, Chapter 15, Oncology: Nursing Management in Cancer Care

c. In teaching about the administration of chemotherapeutic agents, what signs of

d. What clinical manifestations of myelosuppression, secondary to chemotherapy

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