Case Study, Chapter 15, Oncology: Nursing Management in Cancer Care

Emanuel Jones, 60 years of age, is male patient diagnosed with small cell carcinoma. He

underwent surgery in the past to remove the left lower lobe of his lung. He is receiving

chemotherapy. Two 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 101°F. Further assessment reveals

decreased breath sounds in the right base of the right 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 85% 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. (Learning Objective 8)

Case Study, Chapter 16, End-of-Life Care

1. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal

illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He

developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung),

which has compromised his lung expansion. He states that he is short of breath and feels anxious

that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an

invasive procedure used to drain the fluid from the pleural space so the lung can expand). The

thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing.

Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is

prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone

propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal

cannula as needed for comfort. (Learning Objective 9)

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