Lung Cancer Evolve Case Study

1 January 2018

Notify the technician if you are allergic to shellfish. ” Feedback: INCORRECT This is only necessary if a diagnostic test involves the application of a topical iodine- based agent or the injection of an iodine-based dye. D) “You will be given a mild sedative to reduce any anxiety. ” Feedback: INCORRECT Sedatives are not generally administered before x-rays. Correct answer(s): B The chest x-ray results show a suspicious spot on Mr..

Priest’s left lung, and he is scheduled for a lung biopsy via operatic bronchus’s. 2. What nursing action should the nurse expect to implement following this procedure?A) Reinforce the pressure dressing over the biopsy site. The biopsy site is internal, which may be passed through the nose, mouth, or a stoma. B) Assess for return of the client’s gag reflex. Mr..

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Priest should remain NAP until the gag reflex has returned. Prior to the procedure, he will be given a topical anesthetic, both to gargle and through an aerosol mask to numb the back of the throat. C) Encourage Mr.. Priest to force fluids. There is no need to increase fluid intake. D) Maintain a chest tube drainage device as prescribed.

Chest tubes are not inserted during bronchus’s. Risk Factors Biopsy results confirm that Mr..Priest has demarcation of the lung. Mrs.. Priest is distraught upon hearing her husband’s diagnosis, and expresses to the nurse that she doesn’t understand how her husband could have gotten cancer since he never smoked cigarettes.

The nurse obtains a detailed history from Mr.. And Mrs.. Priest. 3. Which information in Mr.

. Priest’s history places him at risk for lung cancer? A) Lack of health insurance prior to becoming a U. S. Citizen ten years ago. Feedback: INCORRECT Lack of health insurance may influence early diagnosis and treatment, but is not a risk factor for the development of cancer. B) Both of Mr..

Priest’s parents were heavy cigarette smokers, and his father died of lung cancer. Feedback: CORRECT Although direct cigarette smoking is the leading cause of lung cancer, secondhand smoking is also a risk factor. In addition, heredity may play a role in the development of lung cancer, even in nonsmokers. C) Twenty years of employment in a high-stress, middle-management position. High stress is a risk factor for the development of some cardiovascular problems, but it is not associated with lung cancer. D) Lack of any of the routine childhood immunization due to family poverty in Mexico. Feedback: INCORRECTThere is no immunization for lung cancer, and the diseases prevented by immunization do not contribute to the risk for lung cancer.

Mrs.. Priest remarks, “l am so angry. My husband is a good man and doesn’t deserve this. ” 4. What action by the nurse is most therapeutic? A) Refer Mr..

And Mrs.. Priest to a cancer support group today. Feedback: INCORRECT This is a worthwhile action, but it is not the most therapeutic at this point. B) Tell Mrs.. Priest that this is a part of the grief process.

Feedback: INCORRECT Teaching about the grief process may be indicated, but it is not the most therapeutic at this point.C) Remind Mr.. ND Mrs.. Priest that there is always hope of a cure. Feedback: This is not the most therapeutic response and may be perceived as false reassurance.

D) Sit quietly with the couple and allow them the opportunity to talk. Feedback: CORRECT This allows Mr.. Priest and his wife time to grieve and formulate questions without feeling rushed by the nurse. Correct answer(s): D At the Priests’ request, the nurse discusses the risk factors for lung cancer and answers their questions. Cancer Staging Mr..

Priest’s cancer is determined to be Stage 2 demarcation. 5.How would the nurse explain the purpose of cancer staging? A) Staging systems track the overall incidence of types of cancers. Feedback: Staging does not track cancer incidence. B) Staging identifies the causative agent for the onset of the cancer. Feedback: Staging does not identify the causes of cancer. C) Staging helps determine the client’s prognosis and best treatment.

Feedback: Tumor staging incorporates assessment of the size, location, and degree of invasion of the primary tumor, the involvement of regional lymph nodes, and the presence or absence of distant metastasis.This assessment information is crucial in determining Mr.. Priest’s prognosis and the best possible treatment. D) Staging measures the number of nosecones in the tumor. Staging does not measure nosecones. Correct answer(s): C Chemotherapy The oncologist and Mr.

. Priest decide on a combination of chemotherapy and surgical management to treat the cancer. Mr.. Priest is scheduled to begin combination chemotherapy with topside (UP-16), an antibiotic, and captains (Palatial), an allocating agent. When he arrives at the Cancer Center, which is adjacent to the acute care, a venous access device is initiated. 6.

The use of which venous access site reduces the risk for extrapolation during chemotherapy treatments? A) Radial vein. The radial vein is located in the forearm. It is not the best choice for preventing infiltration of a visitant. B) Cephalic vein. The cephalic vein is a peripheral vein in the arm. It is not the best choice for preventing infiltration of a visitant. C) Sousaphones vein.

The sousaphones vein is located in the leg. It is not the best choice for preventing D) Civilians vein. Chemotherapeutic agents are typically visitants which can cause extensive tissue damage if infiltration outside the vessel occurs.During chemotherapy administration, the nurse should monitor the client carefully for any indications of infiltration. Use of large central vein, such as the civilians vein, for the insertion of a venous access device reduces the risk of extrapolation of medication into the surrounding tissue. The oncologist prescribes a chest x-ray, a pre-chemo antithetic, and an IV infusion of 0. 9 Normal Saline at 60 ml/hour.

7. Which action should the nurse take first? A) Administer the IV antithetic. Another action should be completed before administering the antithetic. B) Notify radiology of the need for an x-ray.X-ray results to confirm the placement of the triple-lumen catheter should be obtained before administering fluids or medications through the catheter. C) Start the IV infusion. Another action should be completed before initiating IV fluids.

D) Instruct Mr.. Priest about possible nausea during chemotherapy. Feedback: Although this is important, it is of less priority than the other actions. The results of the chest x-ray confirm placement of the catheter in the superior even cave. 8. The nurse obtains these results before initiating fluids to prevent which complication? A) Air embolism.

An air embolism might occur if the line became disconnected, but it is not caused by the incorrect placement of the catheter. B) Mural thrombus. A mural thrombus is a blood clot that is formed in the wall of a cavity, often the heart. This is not caused by the incorrect placement of the catheter. C) Aspiration pneumonia. Aspiration does not result from the incorrect placement of the central venous catheter. D) Fluid infiltration.

If the catheter traveled through the vein wall during insertion, infiltration of the IV fluid into the surrounding subcutaneous tissue or thoracic cavity can occur.Continued Treatment Following the first round of chemotherapy, the following lab results are obtained: Hemoglobin: 16 g/del WEB count: 3,500/reran Platelet count: 200,000/mm RFC count: 4. Million/mm 9. The nurse recognizes that Mr.. Priest is experiencing which condition? A) Sepsis. An elevated WEB count would indicate sepsis.

The WEB is not elevated. B) Leukemia. Chemotherapy may cause suppression of the immune system, resulting in a reduction in the WEB count and placing the client at risk for infection. C) Anemia. A decreased hemoglobin would indicate anemia. The Hug is WIN for an adult male.D) Thermodynamic.

A decreased platelet count would indicate thermodynamic. The platelet count is WIN for an adult male. The nurse notifies the healthcare provider of the lab values. Filtrating (Unpaged) is restricted. 10. Which nursing intervention has the highest priority when administering this medication? A) Observe the injection site for pain and redness. Unpaged is administered subcutaneously, and a local inflammatory reaction may occur at the injection site.

The nurse should observe the site, but this is not the highest priority. B) Evaluate the client’s level of pain regularly.Unpaged may cause significant bone pain, so pain assessment is a high-priority nursing action. C) Encourage the client to eat a well-balanced diet. Maintaining an adequate intake of nutrients is very important, but there is another action of higher priority. D) Monitor the client’s fluid intake and output. Monitoring fluid balance is always important, but Unpaged has no specific impact on fluid balance.

A Complication Occurs Three days later at his scheduled chemotherapy visit, the nurse assesses that Mr.. Priest is dyspeptic, and his skin is warm and pale. His central line insertion site is inflamed.His wife tells the nurse that he began to “feel bad” the previous afternoon but didn’t want to bother the oncologist. Vital sign measurement indicates: BP 80/30, P 132, R 28, T 1030 F, 02 saturation 84%. While calling for assistance, the nurse lowers he head of the bed, elevates Mr.

. Priest’s feet, and applies oxygen. 11. What action should the nurse take next? A) Place cold, wet compresses on Mr.. Priest. This may help reduce Mr.

. Priest’s fever, but it is not the highest priority action at this time. B) Connect the previously prescribed intravenous fluid line (0. 9 NASA 60 ml/hrs) and increase the fluid rate.Feedback: CORRECT Mr.. Priest is experiencing severe sepsis.

It is critical to restore circulating fluid volume to restore his blood pressure and cardiac output. This action can be taken without leaving the room. C) Administer a prescribed PORN antipathetic. Mime. This action also requires leaving his room. Mr..

Priest should not be left alone at this critical time. D) Obtain a portable EGG monitor. It would be beneficial to monitor Mr.. Priest’s cardiac status, but it is not the highest priority action at this time. This action also requires leaving his room, and he should not be left alone at this critical time.Another URN comes to assist the nurse.

The second URN obtains the emergency cart, applies an EGG monitor, and begins to vigorously massage Mr.. Priest’s extremities using an emergency cold pack while the nurse continues to monitor and assess Mr.. Priest’s status. 2. A) Advise the other URN that vigorous cold pack massage may cause tissue damage.

Mr.. Priest is demonstrating manifestations of a systemic inflammatory response syndrome (SIRS) and resultant septic shock. He is at high risk for bleeding due to changes in clotting factors, and should be handled gently to prevent bruising.The use of antipathetic is considered more beneficial than cold applications to lower the body’s temperature, so antipathetic should be administered as soon as possible. B) Encourage the other URN to continue cold treatments while the nurse obtains an antipathetic. Feedback: INCORRECT This action increases Mr.

. Priest’s risk for injury. C) Continue to monitor vital signs. The nurse should continue to monitor Mr.. Priest, but action must be taken to decrease his temperature. D) Place Mr.

. Priest in a tub of cold water. There is a better action to lower body temperature without increasing the risk for injury.Correct answer(s): A The oncologist admits Mr.. Priest to the hospital, obtains a culture of the central line site, and prescribes a course of antibiotics. The left central line is removed after placing a new line in the right civilians for continued IV access.

Chemotherapy is suspended until Mr.. Priest’s infection is resolved and he is discharged from the hospital. Preoperative Care: Therapeutic Communication Following the completion of his course of chemotherapy, Mr.. Priest is admitted to the acute care center for a left tracheotomy. The night before his scheduled surgery, the nurse observes that Mr.

.Priest is unable to sleep and is moving around restlessly in his bed. He states, “What if I don’t wake up after surgery? ” 13. The nurse suspects which etiologic factor is responsible for both the objective and subjective assessment data? A) Fear. Mr.. Priest’s restless behavior and fertilization reflect fear.

B) Grief. Although Mr.. Priest may be experiencing anticipatory grief, his behaviors and fertilization reflect another problem. C) Pam. Restlessness may be a manifestation of pain, but Mr..

Priest’s overvaluations reflect another problem. D) Confusion. Mr..Priest does not exhibit manifestations of confusion. 14. What is the best nursing response to Mr.

. Priest’s question? A) “Facing a diagnosis of cancer is frightening. ” This statement makes an assumption that the diagnosis of cancer is the cause of Mr.. Priest’s fear, when that may not be correct. B) “You can cancel your surgery if you’re not ready. ” This statement does not provide an opportunity for Mr.

. Priest to discuss his fears. C) “Why do you feel frightened? ” Because the use of “why” is often perceived as challenging, it is not the best therapeutic response. D) “Tell me what makes you feel afraid. This open-ended statement provides an opportunity for Mr.. Priest to further verbalize the cause of his fear.

Mr.. Priest tells the nurse that he has never had surgery before, but when his father had surgery for lung cancer, he died in the hospital three days after surgery having never regained consciousness. He states he is afraid the same thing may happen to him and fears never seeing his wife and children again. During further conversation, the nurse learns that Mr.. Priest is a devout Catholic and would like to visit with a priest and receive communion and the Sacrament of the Sick.

15.Which nursing action is most important to implement at this time? A) Notify the surgeon of Mr.. Priest’s fears. This is an appropriate nursing action, but it is not the most important action at this B) Request a visit by the Catholic chaplain. The nurse should make every effort to meet Mr..

Priest’s request for spiritual support immediately to reduce his preoperative fear. C) Notify the social worker of the need to offer support to Mr.. Priest’s family. D) Offer to contact Mr.. Priest’s wife to share his concerns with her.

Feedback: Postoperative Chest Tube Management Following tracheotomy and left lung lobotomy, Mr..Priest returns to his room. Two chest tubes are in place connected to a water-seal drainage system providing 20 CM of suction. During the initial assessment, the nurse notices that the suction-control chamber is bubbling continuously. 16. What intervention should be implemented by the nurse? A) Apply pressure to the chest tube insertion site.

There is no reason to perform this action at this time. However, this intervention eight be implemented to prevent air from entering the thoracic cavity if the chest tube accidentally fell out.B) Use padded hemostats to clamp the chest tube. This action may actually cause harm by increasing intricacies pressure. C) Turn off the suction control device. There is no reason to perform this action at this time. D) Continue to monitor the drainage system regularly.

The purpose of a water-seal system is to promote a one-way flow of air and fluid out of the pleural space. Continuous bubbling in the suction-control chamber indicates that the desired level of suction is correct to promote removal of the air and fluid, so o action is required.The nurse also observes that the fluid level in the water-seal chamber is fluctuating. 17. What assessment should the nurse perform? A) Auscultative Mr.. Priest’s breath sounds.

This is not the best action to ensure the fluid level fluctuation is normal. B) Monitor Mr.. Priest’s blood pressure. C) Measure Mr.. Priest’s oxygen saturation.

D) Observe Mr.. Priest’s respirations. Fluctuation in the water-seal tube should occur with respirations. The absence of fluctuation with respirations may indicate that the tubing is obstructed or that the lung is re-expanded.

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