Lung Cancer
The CXR results show a suspicious spot on Mr. Stringfellow's left lung. The HCP talks w/ Mr. Stringfellow about the findings and suggests a CT scan and a fiberoptic bronchoscopy to rule out lung cancer. Both are scheduled for the next day Mr. Stringfellow states, "I have already had a chest X Ray. Why do I need a CT scan? What is the nurse's best response?
"A CT scan can differentiate differences in tissue density"
When Mr. Stringfellow turns to his back at the nurse's request, fluctuation of the water seal chamber resumes What other nsg interventions should be included in Mr. Stringfellow's care?
- Assess the client's lung sounds - Record drainage according to facility policy - Encourage deep breathing exercises
Mr. Springfellow returns to the office in 2 days to learn the results of the bx. The HCP informs the client that he has non-small cell lung cancer (NSCLC). The nurse obtains a detailed hx from Mr. Stringfellow and enters the info in the clinic's electronic health record system. At his request, the nurse discusses the risk factors for lung cancer and answers his questions Which info in Mr. Stringfellow's hx places him at risk for lung cancer?
- Both of Mr. Stringfellow's parents were cigarette smokers - Twenty yrs of employment in a manufacturing plant
Mr. Stringfellow is scheduled to being external beam radiation. Which instructions should be included in the teaching plan
- Gently wash the area w/ mild soap and pat dry - Do not apply lotions, creams, or other products to the skin unless prescribed by the HCP
Despite the course of abx and other meds, Mr. Stringfellow never feels 100% better. He continues to work and interact w/ family and friends, but the cough persists. He assumes the sx's are r/t the chg in seasons. After 2 months, he decides to f/u w/ his HCP again. The HCP completes the exam and writes a prescription for lab work and a CXR While waiting to obtain the lab and XR, what info from the client's hx is priority for the nurse to collect?
- Have you experienced any hoarseness? - Do you currently, or have you ever smoked? - Tell me about your work hx
Following the 1st round of chemo, the following lab results are obtained: Hgb 12; WBC 3,000; Platelet 100,000; RBC 3.3; Glucose 86; Na+ 138; K+ 3 The nurse recognizes that Mr. Stringfellow is experiencing which conditions
- Leukopenia - Anemia - Thrombocytopenia - Hypokalemia
Mr. Stringfellow asks about common s/e of carboplatin (Paraplatin). Which common s/e should the nurse discuss w/ the client?
- Loss of taste - Ringing in ears - Nausea and vomiting
Mr. Stringfellow tolerates his txs, but has some decreased intake because of the effects of radiation and chemo. He lost about 15 #. The nurse determines a priority nsg dx is altered nutrition, less than body requirements r/t adverse effects of radiation therapy With which interdisciplinary team member should the nurse collaborate to dvp a POC?
- Registered dietician
Cedric Stringfellow Mr. Stringfellow is a 65-year-old American Indian who has developed a cough that comes and goes. He has not sought treatment, and the cough has never truly subsided. About a month ago, Mr. Stringfellow felt bad and went to a walk-in clinic. After an evaluation, the healthcare provider (HCP) prescribed a macrolide, azithromycin (Zithromax) and suggests an over the counter (OCT) cough medication. What important edu should the nurse provide to the client r/t this medication?
- Take medication on an empty stomach - Do not take antacids while on this medication - the medication may cause some abd'l discomfort and diarrhea
Which instructions should the nurse provide r/t the bronchoscopy?
- You must not eat or drink anything for 6-8 hrs prior to the procedure - You will receive a medication to dry up secretions and another medication to make you sleepy - The oral and nasal pharynx will be sprayed w/ a local anesthetic
The oncologist arrives to replace the central line. The left central line is removed after placing a new line in the right subclavian for continued IV access. A cx of the central line site is done and a course of ceftriaxone (Rocephin) is prescribed. Chemo is suspended until Mr. Stringfellow's infection is resolved. The prescription for ceftriaxone (Rocephin) is 1 gm IVPB every 12 hrs. The med is supplied as a powder in 500 mg bottles. The directions state "Add 4.8 mL of diluent for a resulting concentration of 100 mg / mL. Administer by infusion over 30 min in total of 100 mL of NS diluent" Each vial contains 100 mg/mL after reconstitution, and the prescription requires 1000 mg. How many mL of med should the nurse draw up after reconstitution
10
At what rate should the med be infused in mL/hr?
200
The nurse certified in chemo administration prepares to administer carboplatin (Paraplatin) 360 mg/m2 in 150 mL of NS via IV pump. The drug is prescribed to run over 30 minutes. At what rate should the nurse set the IV pump?
300
The next morning, the nurse enters the room and finds Mr. Stringfellow asleep on his left side. The nurse notices that the fluctuation in the water-seal chamber has stopped Based on this assessment finding, what action is indicated?
Ask Mr. Stringfellow to cough and chg positions
The oncologiest prescribes a CXR, a pre-chemo antiemetic, baseline lab work, and an IV infusion of NS at 75 ml/hr. While the nurse is assisting the HCP w/ the insertion of the subclavian triple lumen catheter, Mr. Stringfellow becomes tachypneic and agitated What is the priority action for the nurse?
Assess breath sounds
The nurse identifies a potential nsg dx of imbalanced nutrition: less than body requirements. Which meal recommendation is appropriate
Broiled chicken, greens, and cheese bread
After about an hour, Mr. Stringfellow becomes more dyspneic, tachypneic, and tachycardic. His temp has increased to 102 F What is the next priority action for the nurse at this time?
Call the Rapid Response Team
Following thoracotomy and left lung lobectomy, Mr. Stringfellow returns to his room. 2 chest tubes are in place, connected to a water-seal drainage system providing 15 cm of suction. During the initial assessment, the nurse notices that the suction-control chamber is bubbling continuously What intervention should be implemented by the nurse?
Continue to monitor drainage system regularly
Mr. Stringfellow discusses w/ the nurse that he often prefers to choose herbs and supplements when he feels out of sorts Which herbal supplement does the nurse anticipate Mr. Stringfellow will use for his current symptoms
Echinacea
The nurse notifies the HCP of the lab values. Pegfilgrastim (Neulasta) is prescribed Which nsg intervention has the highest priority when administering this med?
Evaluate the client's level of pain regularly
Mr. Stringfellow recovers from his episode and is d/c'd . He is able to finish his course of chemo over the next several wks. Following the completion of his course of chemo, he admitted to the acute care center for a left thoracotomy. The night b/f his scheduled surgery, the nurse observes that Mr. Stringfellow is unable to sleep and is moving around restlessly in his bed. He states, "What if I don't wake up after surgery?" The nurse suspects which etiologic factor is responsible for both the objective and subjective assessment data?
Fear
The results of the CXR confirm placement of the catheter in the superior vena cava The nurse obtains these X-Ray results b/f initiating fluids to prevent which complication?
Fluid infiltration
Mr. Stringfellow tells the nurse that he has never had surgery b/f, but has had a friend who had surgery and became unconscious and died. During further conversation, the nurse learns that Mr. Stringfellow participates in many practices of the American Indian cx, and he requests that a shaman visit him Which nsg action is most important to implement at this time?
Inquire more about process of contacting a shaman
On day 2, the LPN reports to the nurse that the water-seal chamber is continuously bubbling instead of fluctuating. The nurse goes to Mr. Stringfellow's room to assess the situation and finds constant bubbling What intervention should the nurse implement next?
Inspect the insertion site and tubing to check for air leaks
What nsg action should the nurse expect to implement following the bronchoscopy
Keep client NPO until the gag reflex returns
The HCP also orders epoetin alfa (Procrit). What nsg assessment is most important w/ this med?
Monitor for sudden onset of Chest Pain
After the assessment of breath sounds, which action should the nurse take next?
Notify radiology of the need for an X-Ray
The nurse also observes that the fluid level in the water seal chamber is fluctuating What assessment should the nurse perform?
Observe the client's respirations
Mr. Stringfellow remarks, "I am angry. I have tried to live a healthy life. Why is this happening to me?" What response by the nurse is most therapeutic?
Sit quietly w/ Mr. Stringfellow and allow him the opportunity to talk
Mr. Stringfellow's cancer is determined to be Stage 2 squamous cell type How would the nurse explain the purpose of cancer staging?
Staging helps determine the client's prognosis and best tx
The use of which venous access site reduces the risk for extravasation during chemo tx?
Subclavian vein
What is the best nsg response to Mr. Stringfellow's question?
Tell me what makes you feel afraid
Mr. Stringfellow is referred to an oncologist, who discusses tx options. Together, Mr. Stringfellow and the HCP decide on a combo of chemo and surgical mgmt to tx the cancer. He is scheduled to begin combo chemo w/ a platinum analogue carboplatin (Paraplatin) and etoposide (Toposar). When he arrives at the cancer center, which adjacent to the acute care center, a venous access device is initiated Mr. Stringfellow asks the nurse why 2 cancer meds are needed. What is the nurse's best explanation?
These 2 meds work during different phases of the cell cycle to increase the effectiveness of the therapy
1 wk later, Mr. Stringfellow calls the oncology office because he has a fever and feels bad. The nurse advises him to come in. His initial v/s are BP 100/60; HR 120; RR 28; T 101.5F orally. His SaO2 at 90%. the oncologist admits Mr. Stringfellow to the hospital. The HCP orders O2 via face mask at 60%, IVF of NS at 100 ml/hr, and a CBC. The lab results are : Hgb 13; Platelets 110,000; WBC 1500; absolute neutrophil count 1000 What is the priority nsg intervention?
Wash hands b/f and after caring for Mr. Stringfellow
Which instructions should the nurse provide to prepare Mr. Stringfellow for the XRay?
You will need to remove your clothes down to the waist and remove any jewelry on the neck or chest