R.M is a 58 year old woman with stage 3 ovarian cancer. Her initial…

R.M is a 58 year old woman with stage 3 ovarian cancer. Her initial… R.M is a 58 year old woman with stage 3 ovarian cancer. Her initial treatment is an exploratory laparotomy with a total abdominal hysterectomy, an ileocecal resection and anastomosis, menotomy, and peritoneal biopsies. The postoperative CA-125 level is 69 units/mL. Family history analysis reveals a strong positive occurrence of breast and ovarian cancer. Her mother died of breast cancer at 56 years of age, and a maternal aunt died of ovarian cancer at 59. The oncologist recommends testing for the presence of the BRCA1 and BRCA2 genes and, if the results are positive, testing RM’s two daughters and son.  What is the association between cancer development and the BRCA1 and BRCA2 genes? Discuss the pros and cons of genetic testing for cancer.  In reviewing R.M’s family history, which factors are considered significant? Select all that apply.Aunt who died from ovarian cancer at age 59 Mother who died from breast cancer at age 56 Sister was diagnosed with cervical cancer at age 50 Grandmother who died from gastric cancer at age 84 Aunt was diagnosed with endometrial cancer at age 65 R.M tests positive for the BRCA2 gene. What implications does this have for her children? Why is ovarian cancer usually stage 3 or 4 when initially diagnosed? R.M begins a chemotherapy regimen of paclitaxel and cisplatin. After receiving the fourth course, she presents with SOB, complaints of nausea, and early satiety with a recent weight loss of 10 lbs (4.53 kg). Her abdomen is distended and her SpO2 is 86% on room air. Her current CA-125 level is 328 units/mL. You are admitting her directly from the oncologist’s office to the medical floor.  Explain the significance of R.M’s CA-125 level.Knowing the chemotherapeutic agents R.M has received, what lab tests will you expect the oncologist to order?You perform R.M’s admission assessment. Which finding must be immediately reported to the oncologist?Dark, amber colored urine A temperature of 100.3 F (37.9 C)Bleeding gums and mouth ulcerations Numbness in her lower legs bilaterally R.M’s chest x-ray film reveals bilateral pleural effusions. How do these relate to her underlying disease? How might they be treated? After performing a thoracentesis, the oncologist orders an MRI scan of the chest, abdomen, and pelvis, which reveals a mass in the left lower quadrant and a malignant bowel obstruction. He immediately schedules R.M for a tumor debulking and possible placement of an ostomy.  What does scheduling R.M for a debulking procedure imply?After this surgery, R.M will be cured of her cancer. R.M has advanced disease and the prognosis is poor. Chemotherapy will no longer be given after she recovers from surgery. R.M will now need to have radiation therapy in addition to chemotherapy. R.M is undergoing a palliative surgical intervention. How will you explain this to R.M and her family?What additional risks does surgery pose for R.M?Outline 4 topics to include in her preoperative teaching?Later in your shift, you find R.M’s daughter sitting in a chair at the end of the hall crying quietly. You pull up a chair and sit. She tells you “I had always thought mom was going to fight this. It is really just kind of hitting me that she is actually dying. You just think after surgery and all the chemo everything is going to be fine”. What is your best response?”Let’s talk about what is going on with your mother’s illness.””Don’t worry about her dying now. Focus on getting her through the surgery.””Your mother is receiving the best care available. Let’s talk about her surgery.””You are being rather pessimistic. You need to maintain hope for your mother.”How can you support R.M and her family at this time? Case study outcome R.M undergoes the debulking procedure. Because of the presence of multiple small tumors that were not detected on preoperative scanning, the oncologist elects not to place an ostomy. R.M. never fully recovers from surgery and does not resume chemotherapy. She has recurrent bowel obstructions and passes away in hospice care 3 weeks later.   Health Science Science Nursing BMS 300 Share EmailCopy link Comments (0)

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