Oncology Case Study Lung Cancer

Oncology Case Study – Lung Cancer CONCEPT: Cellular Regulation

J.D. is a 60 year old gentleman who was in his usual state of health until January 2012 when he first noted a persistent dry cough. Over the next several weeks, his cough became increasingly worse as well as accompanied by fever, chills, and shortness of breath.

He went to his primary care physician for evaluation and was given a ten day course of antibiotics. Upon completion of the antibiotics, his symptoms had not improved. He therefore returned to his PCP at which point a chest x-ray was performed. Chest x-ray results showed a suspicious density in the RUL along with rib lesions consistent with metastatic disease. A subsequent CT scan of the neck and chest revealed a 4 cm lesion in diameter extending into the pleura and chest wall consistent with malignancy. Hilar lymphadenopathy suspicious for metastatic disease was also noted.

He underwent a bronchoscopy with biopsy. Further work-up revealed positive boney metastasis and the presence of paraneoplastic syndrome.

J.C. was admitted to the oncology unit for chemotherapy and radiation. PMH is significant for a 58 pack year history and a 10 year history of alcohol abuse and DM.

On arrival to the floor his vital signs were: T: 37.8, P: 120, BP: 140/96, RR: 32, O2 sats: 87% on RA. CBC, BMP, Ca, PO4, Albumin, and Mg are pending.

1.) What is your initial priority of care for this patient?

Knowing that fluid balance issues are of utmost concern –

2.) What types of fluid imbalance are you most worried he might develop?

3.) What signs and symptoms would you most likely find on this gentleman that would support your thoughts regarding the above fluid imbalance?

4.) Would you expect peripheral edema? Why or why not?

Developed by Carol Thorn, RN, MS May use with permission for the purposes of nursing education If questions/comments, please contact Carol Thorn at [email protected] 4.) Would you expect the following results to be increased, decreased, or WNL? Please provide rationale for your answers.  CBC  BMP  Ca  PO4  Mg  Albumin  Urine Na

5.) What signs and symptoms would you expect to accompany each imbalance and what is the medical management of each imbalance? What would the nurse need to assess/monitor related to each imbalance noted above?

6.) What acid- base imbalance might you expect to find? Why?

Developed by Carol Thorn, RN, MS May use with permission for the purposes of nursing education If questions/comments, please contact Carol Thorn at [email protected]