Case Stduy Med Surg

LIM, KEVEAN KIMI D.
CASE STUDY:
Situation:
Asher Millstone, 65 years of age, is male patient diagnosed with small cell carcinoma. He underwent surgery in the past to remove the right lower
lobe of his lung. He is receiving chemotherapy. Three 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 38 degree
celcius. Further assessment reveals decreased breath sounds in the left base of the 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 80% 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.
Provide answers to the following:
1. List the oncologist order related to the patient and give the rationale for each order.
● Blood, Sputum, and Urine Cultures:
Rationale:
The patient is complaining of fever, green-colored mucus from a productive cough, and diminished breath sounds, all of which are
signs of infection. In order to determine the right antibiotic therapy, cultures aid in identifying the causative organism.
● Chest X-ray:
Rationale:
By ruling out pneumonia or other lung complications, the oncologist hopes to evaluate the patient's lung health, particularly in light
of the decreased breath sounds and productive cough.
● X-ray of Kidneys, Ureters, Bladder (KUB):
Rationale:
The patient is ordered to have a KUB X-ray to evaluate the genitourinary system and rule out obstructions or other urinary issues due
to their history of BPH and complaints of burning and frequent urination.
● Arterial Blood Gas (ABG) on Room Air:
Rationale:
To assess the patient's acid-base balance and oxygenation status, particularly in light of the low pulse oximetry reading (80% SaO2 on
room air).
● CBC with Differential, Renal and Metabolic Profile:
Rationale:
These examinations offer a thorough evaluation of the patient's general health, encompassing blood cell counts, renal function, and
metabolic equilibrium. It assists in tracking the effects of chemotherapy and evaluating any possible side effects.
● Oxygen Therapy (Nasal Cannula at 2 L/min, titrated to keep SaO2 > 90%):
Rationale:
Oxygen therapy is started to increase oxygen saturation and avoid complications from inadequate oxygenation because the patient's
low SaO2 indicates hypoxemia.
● Levofloxacin 500 mg IV over 60 minutes (once daily):
Rationale:
For the treatment of the suspected infection, levofloxacin, a broad-spectrum antibiotic, is prescribed, which addresses a variety of
bacterial pathogens. Its intravenous administration guarantees a prompt and efficient response.
2. What is your nursing priority for this type of patient?
● Monitor Respiratory Status:
Our top priority is keeping a close eye on the patient's respiratory status because of the patient's history of small cell carcinoma,
recent surgery, and current infection symptoms (fever, cough, and decreased breath sounds). This includes assessing breath sounds,
respiratory rate, pulse oximetry, and response to oxygen therapy. Prompt intervention is crucial to ensuring adequate oxygenation.
3. How to prevent the reoccurrence of complications?
● Infection Prevention:
An infection's recurrence can be avoided by strictly adhering to infection control protocols, such as using aseptic techniques and
hand hygiene during procedures. Chemotherapy patients have compromised immune systems, which increases their risk of infection.
● Regular follow-up and surveillance:
It is crucial to have routine medical follow-ups and surveillance, which includes imaging studies and lab tests, to identify any new
problems or recurrences as soon as possible. It allows for prompt management and intervention.
● Patient Education:
Inform the patient of the significance of taking prescribed drugs as directed, making follow-up appointments on time, and reporting
any new or worsening symptoms right away. Early detection and prevention of complications can be facilitated by proactive
communication and awareness-raising.
● Supportive Care:
Administer supportive care measures, such as symptom management, nutritional support promotion, and psychosocial counseling,
to assist the patient in managing the side effects of chemotherapy. Comprehensive care requires a multidisciplinary approach
involving nurses, cancer specialists, and other medical professionals.
4. Create a simple NCP basing from the above situation.
Acute Pain related to surgical history and

FINAL DIAGNOSIS: respiratory distress. PROCEDURE PERFORMED:
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective Data: Acute Pain related to Short Term: Independent: After 8 hours of nursing
● Patient reports a surgical history and After 8 hours of 1. Obtain client’s assessment of 1. To rule out the intervention, the patient
temperature of respiratory distress. nursing intervention, pain to include location, worsening of the was able to report a
38°C. the patient will be able characteristics, onset/duration, underlying decrease in pain. Pain
● Productive cough to verbalize the frequency, quality, intensity, and condition/development of scale of 3/10, 10 as the
with decrease in pain. Pain precipitating/aggravating complications. highest.
green-colored scale of 3/10, 10 as factors. Reassess each time
mucus. the highest. pain occurs/is reported. 2. To distract attention and
● Shortness of 2. Instruct in/encourage use of reduce tension from pain.
breath. relaxation techniques, such as 3. To perceive their pain
● Urinary frequency focused breathing, imaging, management as more
and burning upon CDs/tapes/phone (e.g., “white” effective and more likely to
urination. noise, music, instructional). participate in therapy if
3. Ascertain client’s knowledge their expectations are
Objective Data: of and expectations about pain discussed.
● SaO2 of 80% on management. 4. To determine and
room air. 4. Determine factors in client’s assess if it affects
● Decreased breath lifestyle (e.g., alcohol/other responses to analgesics
sounds in the left drug use/abuse). and/or choice of
base of the lung. interventions for pain
● History of small Dependent: management.
cell carcinoma, 5. Administered medications as 5. To treat the underlying
right lower lobe ordered. condition.
lung surgery.
● BPH with urinary Collaborative:
symptoms. 6. Assist with treatments for 6. To improve awareness
underlying medical conditions of one's own needs and
general well being.

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LIM, KEVEAN KIMI D.

Provide answers to the following:

● Blood, Sputum, and Urine Cultures:

● X-ray of Kidneys, Ureters, Bladder (KUB):

● Arterial Blood Gas (ABG) on Room Air:

● CBC with Differential, Renal and Metabolic Profile:

● Levofloxacin 500 mg IV over 60 minutes (once daily):

2. What is your nursing priority for this type of patient?

● Monitor Respiratory Status:

● Regular follow-up and surveillance:

Acute Pain related to surgical history and

ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

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