<p> Oncology Case Study – Lung Cancer CONCEPT: Cellular Regulation</p><p>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. </p><p>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. </p><p>He underwent a bronchoscopy with biopsy. Further work-up revealed positive boney metastasis and the presence of paraneoplastic syndrome. </p><p>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. </p><p>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.</p><p>1.) What is your initial priority of care for this patient?</p><p>Knowing that fluid balance issues are of utmost concern – </p><p>2.) What types of fluid imbalance are you most worried he might develop?</p><p>3.) What signs and symptoms would you most likely find on this gentleman that would support your thoughts regarding the above fluid imbalance?</p><p>4.) Would you expect peripheral edema? Why or why not?</p><p>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</p><p>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?</p><p>6.) What acid- base imbalance might you expect to find? Why?</p><p>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]</p>