Cancer Case Study Patient Profile: Mr. Miller is…

QuestionAnswered step-by-stepCancer Case Study Patient Profile: Mr. Miller is…​Cancer Case StudyPatient Profile:Mr. Miller is a 65-year-old patient who was recently diagnosed with metastatic bladder cancer. He began daily chemotherapy treatment with doxorubicin through a peripherally inserted central venous catheter (PICC) 5 days ago. Subjective Data:• States he has almost continuous nausea, which becomes severe and causes vomiting following his dose of chemotherapy• States he has no appetite• Expresses no hope that the chemotherapy will have a positive effectObjective Data:• Temperature: 99.4°F (37.4°C)• WBC: 3200/µl (3.2 X 109/L)• Platelets: 48,000• RBC: 2.8• Neutrophils: 500/µl (0.5 X 109/L)• Skin warm with decreased turgorOncology Critical Thinking Questions:1. What data indicates Mr. Miller is at risk for bleeding? A. Temperature 99.4°F (37.4°C)  B. WBC 3200/µl (3.2 X 109/L)C. Platelets 48,000D. Warm skin with decreased turgor 2. What puts Mr. Miller most at risk for infection? A. AgeB. PICC lineC. Poor appetiteD. Temperature     3. What should be included in the teaching plan for Mr. Miller and his family to prevent infection? Select all that applyA. Cook all vegetables before eatingB. Attend church services to see friendsC. Sip all day from the same water pitcher to stay hydrated.D. Let other family members change the litter boxE. Bathe daily with an antimicrobial soap 4. What should be included in the teaching plan for Mr. Miller to prevent bleeding?A. Take aspirin as needed for painB. Use a soft bristled toothbrushC. Wear tight fitting clothing to prevent edemaD. Use a straight blade razor for shaving 5. What intervention could be used to assist with Mr. Miller’s anemia? A. Avoid fresh flowers in his roomB. Increase fluids to 3 liters per dayC. Alternate rest with activityD. Encourage foods high in protein 6. What is the highest priority concern for Mr. Miller because of his chemotherapy induced vomiting? A. MucositisB. DehydrationC. InfectionD. Depression 7. What should be included in the teaching plan for mouth care and mucositis? Select all that applyA. Drink warm fluids to coat the mouthB. Apply a water based moisturizer on the lipsC. Brush the teeth and tongue every 8 hoursD. Use an alcohol based mouthwash to keep mouth cleanE. Drink 500ml per day to stay hydrated F. Avoid spicy and acidic foods      8. What should be included in the teaching plan to avoid injury related to neuropathy? Select all that applyA. Inspect your feet closely each weekB. Avoid temperature extremesC. Use scatter rugs to keep floors warmD. Use gloves when washing dishes or gardeningE. Use handrails when using a stairway 9. Mr. Miller comes to the emergency room with the following symptoms of fatigue, muscle weakness, abdominal discomfort and loss of deep tendon reflexes.  Which oncologic emergency should the nurse expect? A. Superior vena cava syndromeB. Tumor lysis syndromeC. HypercalcemiaD. Spinal cord compression 10. Based on the use of doxorubicin intravenously- what personal protection equipment (PPE) will the nurse need to wear during administration?  Fill in the blank______________________________________ 11. List in order how to don the required personal protectionequipment needed for the administration of the doxorubicin intravenously.  Fill in the blank (in the correct order) order________________________________________________________________ 12. The Oncology Clinical Nurse Specialist is preparing to administer the next dose of doxorubicin to Mr. Miller. Calculate the following dose for the client. Infuse 0.5mg/kg of doxorubicin over 90 minutes. The client currently weighs 180lbs.  How many milligrams will the client receive? Show your work- round to the nearest whole number.       13. What sign of extravasation should the nurse be alert for?A. BruisingB. HeadacheC. BlanchingD. Blood return 14. The nurse has assessed the IV site and found that it is leaking, painful and cool to touch. What should the nurse do first? A. Put a cool cloth on the siteB. Administer ordered pain medicineC. Call the healthcare providerD. Stop the infusion Mr. Miller’s health care provider decides to continue treatment with radiation brachytherapy.  15. The nurse caring for Mr. Miller during brachytherapy will utilize the following safety precautions. Select all that applyA. Let family visit whenever client requestsB. Keep a warning sign on the doorC. Ensure markings are not removedD. Never touch the radioactive sourceE. Wear a lead apron when providing care   16. What assessment tool can be used to evaluate physical and psychosocial problems for clients undergoing cancer treatment?  Fill in the blank______________________________ Patient Profile:Mr. Miller has had unsuccessful treatment for his cancer. He lives at home with his husband, a 15-year-old daughter and a 12-year-old son. He has been referred to hospice because of hisdeteriorating conditions and increasing pain. His husband is an accountant and tries to do as much of his work at home as possible so that he can help care of the family. Their children have become withdrawn, choosing to spend as much time as possible at their friends’ homes and in outside activities. Subjective Data:• Mr. Miller reports that he stays in bed most of the time because it is too painful to stand and sit.• He reports his pain as an 8 on a 10 point scale while taking oral Morphine extended release q12 hr.• He reports shortness of breath with almost any activity, such as getting up to go to the bathroom.• Mr. Miller says he knows he is dying, but his greatest suffering results from his children not caring about him.• The couple has not talked about dying with the children.• Mr. Miller’s husband reports that he does not know how to help anymore and that he feels guilty sometimes when he just wishes it were all over. Objective Data:• Height 5 ft 7 in; weight 120 lb • Skin intact• Vital signs: Temperature: 99°F (37.2 °C); HR 92: RR 30: BP 102/60 End of Life Critical Thinking Questions: 17. What physical care should the nurse include in a plan for Mr. Miller at this time?A. Experimental round of chemotherapy. B. Assistance with ADL’sC. Antibiotic therapyD. IV fluids  18. The client is ordered 80mg of Morphine extended release. The pharmacy has sent 15mg tablets. How many tablets will the nurse give the client? Round to the nearest whole number. Show your work.   19. When assessing Mr. Miller’s end of life wishes.  What should the nurse include in the plan of care?A. Consult with rehab for mobilityB. Case manager to assist with family involvementC. Attorney to prepare financial documentsD. Ethics committee Patient Profile: Mr. Miller has been receiving hospice care for the past 2 months and is now completely bedridden and has beenuncommunicative for the past 4 days. Prior to this change in his status, he had become increasingly confused and seeing visions of Jesus. The hospice aide has been in the home the past week assisting with ADL’s. The hospice nurse has increased her visitsto daily since the change in his level of consciousness. The husband has continued to work more at home, but is falling behind with his work since his spouse is now totally dependent on others for self care. His pain has been controlled with fentanyl patches and oral morphine tablets, but the oral morphine was discontinued and replaced with hydromorphone elixir due to his inability to swallow. The hospice nurse has stopped taking blood pressures on Mr. Miller because it was becoming more painful. The children have been staying at home more for the past week assisting their father with care.  Subjective Data: • Mr. Miller’s husband reports that he is not sleeping much and is falling behind with his job.• Mr. Miller’s husband has discussed the dying process with the children and they have been expressing feelings of guilt about helping with the care of their father.  Objective Data: • Respirations irregular (6/minute), frequent periods of apnea.• Breath sounds loud and gurgling • Skin cool to touch with areas of mottling to upper and lower extremities• Foley intact draining dark urine; urine output 20ml total inpast 24 hours  20. What clinical manifestations indicate that a client is actively dying?Select all that applyA. Increased appetiteB. Intact urinary catheterC. Irregular breathingD. Warm extremitiesE. GurglingF. Confusion   21. The healthcare team will work together to manage which symptom?A. Risk for catheter infectionB. AgitationC. Decreased appetiteD. Memory loss   Mr. Miller passes away peacefully surrounded by his family. The hospice nurse arrives to pronounce Mr. Miller. The daughter asks the hospice nurse if there is anything else she can do to save her father.   22. What is the appropriate response to the daughter who asks if there is anything else to be done to save her father? A. “We will call 911 and start CPR immediately.”B. “Don’t worry; your father is in a better place now.”C. “God only sends us as much as we can bear. You’ll get through this”D. “This must be very difficult for you, let’s spend some time with your father.”  23. What are the signs the nurse recognizes that death has occurred? Select all that applyA. Breathing is shallowB. Eyes are openC. Pupils are fixed and dilatedD. Body temperature is warmE. Heart stops beating  24. What intervention will the nurse provide for physical care of the body at death?A. Keep the family in the hallway for privacyB. Place waterproof pad under the clientC. Send dentures to funeral home in a cupD. Ensure head of bed is at 45 degrees    Clinical judgment activity continues on the next page.   The following dosage problems are the final part of this clinical judgment activity. We will utilize this to help you practice dosage and it will allow faculty to help identify if you are making an incorrect step and point this out to you. Whichever way you use to answer dosage (desired over have, ratio & proportion, dimensional analysis) should be what you use. Please utilize this as you would for computerized testing (working out the problem only on the document instead of onpaper and then transferring it to the document and using only a four-function calculator).  25. Calculate the intake and output for client during the nurses shift from 0700 to 1500. At 0700, the client has an IV infusing at 35 mL/hr via pump. For Breakfast, the client consumed 4 oz. of orange juice, and 1 cup of coffee. During medication administration at 0900, the client drank 8 oz. of Sprite. At 0930, the client received an IV antibiotic with 100 mL. At 1000, the client voided 550 mL. During lunch, the client consumed 12 oz. of Sprite and 8 oz. of jello. The client received another antibiotic at 1400 with 50 mL. At 1430, the client voided 750 mL.  Intake _______ mLOutput _______ mL 26. Your client complains of a pain level of 8 out of 10 on a 0-10 scale after abdominal surgery. The surgeon orders fentanyl citrate 75 mcg IV push every 2 hours prn pain > 8. The vial of fentanyl citrate contains 0.1 mg/2 mL. You may give a single dose of no more than 100 mcg over 5 minutes. How many mL(s) will you draw up? Round to the nearest tenth. _____ mL   27. The client has a new order for levetriacetam 500 mg. The pharmacy sends a bag of 500 mg in 100 mL. The levetiracetam is ordered to be given in 15 minutes. How many mL/ hr will you set the pump? Round to the nearest whole number.  ______ mL/hr    28. The heparin protocol states to start the heparin drip at 18units per kilogram per hour. The client weights 158 lbs. The bag pharmacy sends up contains 25,000 units in 500 mL of 0.9% Normal Saline. How many mL/ hr will you set the pump? Round to the nearest tenth. ______ mL/hr   29. A client is ordered oxycodone-acetaminophen syrup 7.5mgoral solution every 6 hours as needed for pain. The client is reporting a pain level of 6/10. The pharmacy sends oral solution where 15 mL contains oxycodone-acetaminophen 5mg. How many mL would the nurse administer to the client for the prescribed order? Round to the nearest tenth. ______ mL    30. A client in DKA is receiving regular insulin intravenously at 22 mL/hr. The bag hanging has 100 units regular insulin in 250 mL 0.9% Normal Saline. How many units is the client receiving each hour? Round to the nearest whole number. ________ units/hr   Health ScienceScienceNursingShare Question