P is a 71 year old married farmer, with a past medical history of hernia surgery in 1986 and prostat

P is a 71 year old married farmer, with a past medical history of hernia surgery in 1986 and prostate surgery in 2005 for BPH. CP does not drink, but he has smoked for 40 years; the past 3 years he has smoked two to three packs per day. Two weeks ago, CP visited the local rural health clinic with complaints of progressive cough and chest congestion. Despite a week of antibiotic therapy CP continued to worsen; he experienced progressive dyspnea and productive cough, and he began to have night sweats. CP refused to be admitted to the hospital because “there’s no one to look after the cows,: but he agreed to go for a chest x-ray. CP’s x-ray shows a “left hilar lung mass, probable lung cancer.” CP is schedule for a diagnostic fiberoptic bronchoscopy with endobronchial lung biopsy as an outpatient this morning to confirm the diagnosis.1. What information will fiberopitc bronchoscopy with endobronchial lung biopsy provide2. As the nurse who works with the pulmonologist, it is your responsibility to prepare CP for the fiberoptic bronchoscopy procedure. What will you include in your teaching plan?3. Outline the post procedure care you will provide for CP.Case Study ProgressesCP’s biopsy shows that he has poorly differentiated oat cell lung cancer. The physician explains to CP that this is a fast growing cancer with a poor prognosis and is directly related to his smoking history. CP undergoes a metastatic workup and is found to have disease in a number of lymph nodes. The physician tells CP and his wife that surgery in not an option and schedules CP to begin combination chemotherapy.4. What does poorly differentiated mean?5. How would you explain combination chemotherapy and how it works to CP and his wife?CP agrees to chemotherapy and is scheduled to receive cisplatin (Plantinol) 60 mg in 100 mL NS IV over 1 t o2 hours daily and etoposide (VePesid) 200 mg in 250 mL NS over 1 to 2 hours daily, both during the first 3 days each month.6. What is the mechanism of action for each of these drugs?7. List the most common side effects of each of the above medications?Case Study ProgressesA month later when CP returns for his second round of chemotherapy, he complains of shortness of breath, chest tightness, and palpitations. He looks exhausted. AN ECG reveals new onset of atrial fibrillation, and a CXR suggest a large left lower lobe pleural effusion. CP is admitted to the hospital for supportive care.The pulmonologist performs a thoracentesis and drains 985 mL of fluid, immediately relieving some of CPs dyspnea and chest discomfort. The following lab results are posted to CP’s chart:Laboratory Test Results·         WBC                                  2500/mm3·         RBC                                    4.9 millions/mm3·         Hgb                                    12.7 g.dL·         Hct                                     37.6%·         Platelets                            152,000/mm3·         Sodium                              131 mmol/L·         Potassium                          4.2 mmol/L·         Chloride                             90mmol/L8. Identify the abnormal lab values and discuss the significance.9.You assess CP 2 hours after the thoracentesis. Which one of the following should be reported to the physician?a. CP has a small amount of serosanguineous drainage on the dressinb. CP complains of occasional chest pain when taking deep breaths.c. CP has a blood pressure of 90/50 and some increase in dyspnea.d. CP states that he has some burning and stinging at the thoracentesis site.10. What is the rationale for your choice. PreviousNext   Health Science Science Nursing NURSING MED SURG14 Share QuestionEmailCopy link Comments (0)

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