A 65-year-old female patient with a history of breast cancer is found to have a suspicious lung mass, elevated serum calcium, and mild anemia. Given these findings, what is the most appropriate nursing intervention to address her hypercalcemia and associated symptoms?

A) Encourage increased oral fluid intake.

B) Administer supplemental oxygen as needed.

C) Provide a high-calcium diet to offset bone loss.

D) Restrict activities to prevent fatigue.

A 65-year-old female patient with a history of breast cancer presents with a newly identified lung mass, enlarged mediastinal lymph nodes, and hypercalcemia. Considering her low oxygen saturation despite supplemental oxygen, what should be the priority nursing intervention?

B) Administer supplemental oxygen and monitor respiratory status closely.

A) Encourage increased oral fluid intake to manage hypercalcemia.

B) Administer supplemental oxygen and monitor respiratory status closely.

C) Prepare the patient for immediate surgical removal of the lung mass.

D) Educate the patient about potential side effects of chemotherapy.

A patient with metastatic lung cancer presents with rapidly declining respiratory status and hypoxemia. After performing a thoracentesis, which immediate nursing intervention is most appropriate to monitor the improvement of the patient's respiratory function?

B) Monitor the patient's oxygen saturation and respiratory rate closely.

A) Assess the patient's pain level and administer analgesics as needed.

B) Monitor the patient's oxygen saturation and respiratory rate closely.

C) Encourage the patient to perform incentive spirometry exercises every hour.

D) Evaluate the patient's nutritional intake and provide high-calorie supplements.

A patient with metastatic lung cancer has undergone thoracentesis due to respiratory compromise. Following the procedure, her oxygen saturation improves from 85% to 90% on 2 liters of oxygen. Considering her current clinical status, what is the most appropriate nursing intervention to prioritize?

C) Monitor the patient for signs of re-accumulation of pleural fluid

A) Initiate high-flow oxygen therapy to further increase oxygen saturation

B) Educate the patient on deep breathing exercises to improve lung expansion

C) Monitor the patient for signs of re-accumulation of pleural fluid

D) Prepare the patient for immediate initiation of chemotherapy as per the oncology team's plan

A patient with metastatic liver involvement is being considered for immunotherapy due to worsening hepatic function. As the nurse, which intervention is most appropriate to prioritize in the care plan to mitigate the risk of hepatotoxicity?

B) Schedule frequent liver function tests to monitor enzyme levels.

A) Administer all medications orally to reduce liver workload.

B) Schedule frequent liver function tests to monitor enzyme levels.

C) Avoid providing high-protein meals to decrease metabolic demand.

D) Increase hydration to promote renal excretion of metabolites.

A patient with metastatic liver involvement presents with jaundice, increased abdominal discomfort, and elevated liver enzymes. As a nurse, what is the most appropriate initial intervention to manage the patient's liver dysfunction symptoms?

B) Initiate a low-sodium diet to manage fluid retention.

A) Administer lactulose to reduce ammonia levels.

B) Initiate a low-sodium diet to manage fluid retention.

C) Provide analgesics to manage abdominal pain.

D) Schedule frequent blood draws to monitor liver enzymes.

A patient with progressive liver dysfunction is exhibiting signs of coagulopathy, including prolonged prothrombin time and increased INR. Which nursing intervention is most appropriate to address the patient's bleeding risk?

A) Administering Vitamin K to promote synthesis of clotting factors

B) Encouraging increased fluid intake to improve circulation

C) Initiating a high-protein diet to support liver function

D) Applying warm compresses to bruised areas to reduce discoloration

A patient with progressive liver dysfunction and signs of coagulopathy is being managed with Vitamin K administration. Her prothrombin time (PT) is prolonged, and she exhibits easy bruising and petechiae. Which nursing intervention is most appropriate to prioritize at this time to minimize bleeding risks?

B) Educate the patient on avoiding activities that may cause injury.

A) Start the patient on low-dose aspirin therapy.

B) Educate the patient on avoiding activities that may cause injury.

C) Prepare the patient for a liver biopsy to assess hepatic function.

D) Initiate a high-protein diet to support liver regeneration.

A patient with hepatic encephalopathy is receiving lactulose therapy to decrease elevated ammonia levels. Which of the following nursing interventions is most critical in evaluating the effectiveness of this treatment?

C) Checking the patient's mental status and level of orientation regularly.

A) Monitoring the patient's blood pressure and heart rate for signs of dehydration.

B) Assessing the patient's bowel movement frequency and consistency.

C) Checking the patient's mental status and level of orientation regularly.

D) Monitoring the patient's serum electrolyte levels for imbalances.

A patient with hepatic encephalopathy is being treated with lactulose to reduce elevated ammonia levels. Upon assessment, the nurse notes that the patient has three loose stools in the past six hours and appears slightly lethargic. What is the nurse's best action to address this situation?

C) Encourage increased oral fluid intake to prevent dehydration due to frequent stools.

A) Administer an additional dose of lactulose to further decrease ammonia levels.

B) Hold the next dose of lactulose and notify the healthcare provider of the patient's condition.

C) Encourage increased oral fluid intake to prevent dehydration due to frequent stools.

D) Perform a neurological assessment and recheck the patient's ammonia levels.

cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: Uncontrolled cell proliferation occurs when genetic mutations disrupt normal cell cycle regulation, leading to the excessive growth of abnormal cells that can form tumors. Mutations often affect oncogenes and tumor suppressor genes, such as p53, impairing their ability to regulate growth and apoptosis.

• Secondary mechanism: Angiogenesis is stimulated by cancer cells to support their rapid growth, involving the secretion of factors like VEGF (vascular endothelial growth factor). This process forms new blood vessels, providing the tumor with essential nutrients and oxygen, facilitating further expansion and the potential for metastasis.

• Key complication: Metastasis involves the spread of cancer cells from the primary site to distant organs via the bloodstream or lymphatic system. This is a significant cause of cancer-related morbidity and mortality, as metastatic tumors disrupt normal organ function and are often resistant to treatment.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, Type 2 Diabetes, Breast Cancer (Stage II, diagnosed 2 years ago)

• Current medications: Metformin, Lisinopril, Letrozole

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Shortness of breath and persistent cough

• Key symptoms: Fatigue, weight loss, intermittent chest pain, difficulty swallowing

• Vital signs: Blood pressure 145/90 mmHg, heart rate 110 bpm, respiratory rate 24 breaths per minute, temperature 100.4°F, oxygen saturation 89% on room air

Section 1

As the medical team continues to evaluate the 65-year-old female patient, a series of diagnostic tests are ordered to investigate her worsening symptoms. A chest X-ray reveals a suspicious mass in the right lung, raising concerns about potential metastasis from her previous breast cancer. A subsequent CT scan of the chest further delineates the mass, measuring approximately 4 cm in diameter, with irregular borders suggestive of malignancy. Additionally, the scan reveals enlarged mediastinal lymph nodes, indicating possible lymphatic spread. A PET scan is scheduled to assess the metabolic activity of the mass and to identify any other areas of metastasis throughout the body.

Laboratory results show an elevated serum calcium level of 11.5 mg/dL (normal: 8.5-10.2 mg/dL), which may indicate paraneoplastic hypercalcemia, a common complication associated with certain cancers. Her complete blood count reveals mild anemia with a hemoglobin level of 10.2 g/dL (normal: 12-15.5 g/dL) and a slightly elevated white blood cell count, suggesting a possible inflammatory or infectious process. These findings require careful consideration, as they may contribute to her fatigue and general malaise.

The oncology team discusses the possibility of performing a biopsy of the lung mass to confirm the diagnosis and to determine the appropriate course of treatment. In light of the patient's deteriorating respiratory status, with oxygen saturation persistently low despite supplemental oxygen, the team must weigh the risks and benefits of invasive procedures. The clinical picture suggests that the cancer may be progressing, necessitating a reassessment of her treatment plan, including potential changes to her oncological therapy and supportive care strategies to manage her symptoms and improve her quality of life.

Section 2

As the medical team continues to monitor the patient, new complications begin to emerge. The PET scan results return, confirming high metabolic activity in the lung mass and revealing additional areas of concern, including increased uptake in the lumbar spine and liver, suggesting further metastatic spread. This finding prompts a multidisciplinary discussion about the potential need for systemic therapy to address the widespread disease. In light of these results, the oncology team considers adjusting the patient's treatment regimen to include targeted therapies or immunotherapy, which may help control the cancer's progression and alleviate some of her symptoms.

Meanwhile, the patient's respiratory status deteriorates, presenting a significant clinical challenge. Her oxygen saturation levels continue to drop, now reaching 85% on 4 liters of supplemental oxygen via nasal cannula. Auscultation of her lungs reveals decreased breath sounds on the right side, and she exhibits increased work of breathing with the use of accessory muscles. This prompts the team to order an urgent arterial blood gas analysis, which shows hypoxemia with a PaO2 of 55 mmHg, and respiratory acidosis with a pH of 7.31. These findings suggest the possibility of a pleural effusion secondary to the malignancy, further complicating her respiratory function.

In response to these developments, the team initiates a thoracentesis to relieve the pressure from the suspected pleural effusion and improve her breathing. The procedure yields a significant amount of serosanguinous fluid, which is sent for cytological analysis to confirm the presence of malignant cells. Following the thoracentesis, the patient's respiratory status shows slight improvement, with oxygen saturation rising to 90% on 2 liters of oxygen. This temporary stabilization provides a window for the oncology team to reassess her treatment options, emphasizing the importance of balancing aggressive cancer therapy with supportive measures to enhance her quality of life.

Section 3

New complications emerge as the patient develops symptoms suggestive of hepatic dysfunction, likely related to the metastatic spread to the liver. She begins to experience increased abdominal discomfort and distention. Her skin takes on a jaundiced appearance, and laboratory results reveal elevated liver enzymes: AST of 145 U/L, ALT of 160 U/L, and total bilirubin of 3.2 mg/dL. Additionally, an ultrasound of the abdomen confirms hepatomegaly with heterogeneous liver texture, consistent with metastatic involvement. This prompts the team to consider the implications of liver dysfunction on her overall treatment plan, particularly as it relates to drug metabolism and potential hepatotoxicity of systemic therapies.

The multidisciplinary team deliberates on the best approach to manage the patient's complex condition. Her deteriorating liver function necessitates a careful reassessment of the proposed treatment regimen. The oncology team evaluates the potential benefits of introducing immunotherapy, considering its relatively favorable side effect profile compared to traditional chemotherapy, which could exacerbate her hepatic impairment. Concurrently, the focus remains on optimizing supportive care, including managing her pain and nutritional status, to maintain her quality of life.

As the patient's clinical picture evolves, the team remains vigilant for signs of further complications, such as coagulopathy, which could arise from liver dysfunction. Close monitoring of her coagulation profile and other relevant biomarkers becomes essential. This phase of the patient's journey highlights the crucial interplay between aggressive cancer treatment and the management of metastatic disease complications, underscoring the importance of personalized, holistic care in oncology nursing practice. These developments set the stage for the next steps in her treatment journey, emphasizing the need for continuous reassessment and adaptation of her care plan.

Section 4

As the multidisciplinary team continues to monitor the patient's condition closely, a new complication emerges that necessitates further clinical attention. The patient begins to exhibit signs of coagulopathy, a known consequence of progressive liver dysfunction. Her latest laboratory results reveal a prolonged prothrombin time (PT) of 18.5 seconds and an increased international normalized ratio (INR) of 2.1, indicating impaired synthesis of clotting factors by the liver. These findings align with physical assessment observations, including easy bruising and petechiae on her extremities, which raise concerns about her risk for bleeding.

In response to these developments, the team initiates a series of interventions aimed at stabilizing her condition. Vitamin K is administered to address the clotting factor deficiency, and fresh frozen plasma is considered if her bleeding risk escalates. The patient's anticoagulation status is closely monitored, and any invasive procedures are postponed to minimize bleeding complications. Alongside these measures, the team emphasizes the importance of maintaining her overall well-being, adjusting her analgesic regimen to prevent hepatotoxicity while effectively managing her abdominal discomfort.

As the patient's journey progresses, the oncology team remains vigilant, continuously reassessing her treatment strategy to balance the benefits of cancer control against the potential for exacerbating hepatic issues. The possibility of introducing immunotherapy is revisited, with close collaboration among oncologists, hepatologists, and palliative care specialists to tailor an approach that aligns with her clinical needs and personal preferences. This phase underscores the dynamic nature of oncology nursing care, where clinical reasoning and adaptability are paramount in navigating the complexities of metastatic cancer management.

Section 5

As the multidisciplinary team continues to monitor the patient's evolving condition, a new complication arises. The patient begins to experience persistent fatigue and confusion, prompting investigations into her hepatic encephalopathy status. Her blood ammonia levels are found to be elevated at 85 µmol/L (normal range: 15-45 µmol/L), indicating an exacerbation of hepatic dysfunction contributing to her altered mental status. Vital signs reveal mild tachycardia with a heart rate of 102 beats per minute, and blood pressure is slightly reduced at 98/60 mmHg, both of which are consistent with her overall debilitated state. She exhibits asterixis during the physical exam, reinforcing concerns about her neurological function.

In response to these findings, the team initiates lactulose therapy to reduce ammonia levels and facilitate bowel movements, aiming to minimize the neurotoxic effects of accumulated ammonia. The patient's fluid and electrolyte status is closely monitored, given the diuretic effect of lactulose and her risk for dehydration and electrolyte imbalances. Nutritional support is also optimized to include sufficient protein intake without exacerbating ammonia production, striking a delicate balance crucial for her condition.

As the team implements these interventions, they remain acutely aware of the need to continuously evaluate her response, particularly in terms of mental clarity and overall energy levels. The patient's cognitive status and laboratory markers are reassessed frequently, ensuring that any adjustments to her treatment plan can be made promptly to support her recovery. This phase of care highlights the importance of diligent monitoring and coordinated efforts among healthcare providers, as the patient navigates the intricacies of managing both her cancer and its hepatic complications.