A patient with non-small cell lung carcinoma (NSCLC) has been found to have liver metastasis and presents with anemia and elevated liver enzymes. As the nurse on the oncology team, which is the most appropriate nursing intervention to address the patient's anemia and fatigue?

B) Administer prescribed erythropoiesis-stimulating agents as ordered.

A) Encourage increased physical activity to improve endurance.

B) Administer prescribed erythropoiesis-stimulating agents as ordered.

C) Provide a high-protein diet to support liver function.

D) Educate the patient about the benefits of a low-sodium diet.

A patient with newly diagnosed non-small cell lung carcinoma (NSCLC) and suspected liver metastasis presents with fatigue, pallor, and abdominal pain. Which nursing intervention is most appropriate to prioritize in this scenario?

B) Initiating dietary modifications to address anemia and weight loss

A) Administering oxygen therapy to improve respiratory function

B) Initiating dietary modifications to address anemia and weight loss

C) Educating the patient and family about the chemotherapy regimen

D) Coordinating with the oncology team to schedule a liver biopsy

A patient undergoing systemic chemotherapy presents with shortness of breath, fever, and an increased pleural effusion on a chest CT scan. Laboratory findings include an elevated white blood cell count with a left shift and worsened anemia. Which nursing intervention is the highest priority in managing this patient's current condition?

B) Provide supplemental oxygen to address hypoxemia.

A) Administer diuretics to manage the pleural effusion.

B) Provide supplemental oxygen to address hypoxemia.

C) Initiate intravenous antibiotics to treat suspected pneumonia.

D) Prepare the patient for thoracentesis to relieve respiratory distress.

A patient receiving chemotherapy presents with shortness of breath, persistent cough, fever, and hypoxemia. A chest CT reveals an increased pleural effusion, and laboratory tests indicate leukocytosis with a left shift. Based on this clinical presentation, which nursing intervention should be prioritized to address the patient's immediate respiratory distress?

B) Initiate supplemental oxygen therapy.

A) Administer intravenous antibiotics as prescribed.

B) Initiate supplemental oxygen therapy.

C) Prepare the patient for thoracentesis.

D) Administer diuretics to manage pleural effusion.

A patient with a history of cancer and recent thoracentesis for pleural effusion presents with ongoing fatigue despite improved respiratory status. His hemoglobin is 9.8 g/dL, and CRP levels are elevated. Which of the following nursing interventions is most appropriate to address the patient's current symptoms and underlying condition?

B) Educate the patient and family about energy conservation techniques.

A) Initiate a blood transfusion to address the patient's anemia.

B) Educate the patient and family about energy conservation techniques.

C) Increase the patient's oxygen flow rate to further improve oxygen saturation.

D) Request a change in antibiotic therapy to address persistent inflammation.

A patient with a history of cancer and current pleural effusion has undergone thoracentesis and is receiving intravenous antibiotics and oxygen therapy. Despite intervention, the patient exhibits fatigue and malaise. With a hemoglobin level of 9.8 g/dL and recent CRP of 18 mg/L, what is the priority nursing intervention?

B) Monitor the patient’s vital signs and oxygen saturation regularly.

A) Encourage the patient to increase physical activity to improve energy levels.

B) Monitor the patient’s vital signs and oxygen saturation regularly.

C) Initiate a transfusion of packed red blood cells immediately.

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

A patient with a complex medical history develops increased right-sided pleural effusion and Streptococcus pneumoniae pneumonia, with declining oxygen saturation despite increased oxygen therapy. As the nurse, what is the priority intervention to address the patient's respiratory status?

C) Prepare the patient for thoracentesis to relieve pleural effusion.

A) Increase the oxygen flow rate to 6 L/min via nasal cannula.

B) Position the patient in semi-Fowler's to promote lung expansion.

C) Prepare the patient for thoracentesis to relieve pleural effusion.

D) Administer prescribed broad-spectrum antibiotics immediately.

A patient with a known pleural effusion and confirmed secondary bacterial pneumonia is experiencing fluctuating oxygen saturation and worsening anemia. What is the priority nursing intervention to improve the patient's respiratory status?

C) Position the patient in high Fowler's position to facilitate lung expansion

A) Administer a blood transfusion to improve hemoglobin levels

B) Increase the oxygen flow rate to 6 L/min via nasal cannula

C) Position the patient in high Fowler's position to facilitate lung expansion

D) Administer prescribed broad-spectrum antibiotics immediately

A patient with advanced lung cancer is receiving treatment for a respiratory infection and is now showing signs of acute kidney injury. The healthcare team is adjusting the patient's fluid management to support renal perfusion while avoiding fluid overload. Which nursing intervention is most appropriate to address the patient's current condition?

B) Monitor the patient's daily weight and intake and output closely.

A) Increase the patient's fluid intake to 150 mL/hour to promote diuresis.

B) Monitor the patient's daily weight and intake and output closely.

C) Administer diuretics as prescribed to prevent fluid overload.

D) Encourage the patient to ambulate to improve respiratory status.

A 65-year-old patient with advanced lung cancer is experiencing respiratory compromise and signs of acute kidney injury following an antibiotic regimen and blood transfusion. The healthcare team is adjusting fluid management to prevent further renal impairment while avoiding fluid overload. Which of the following interventions should the nurse prioritize to address the patient's current condition?

C) Collaborate with the healthcare team to adjust antibiotic dosing based on creatinine clearance.

A) Increase the patient's oxygen flow rate to 6 L/min via nasal cannula to improve oxygen saturation.

B) Initiate a fluid challenge with normal saline to increase urine output and renal perfusion.

C) Collaborate with the healthcare team to adjust antibiotic dosing based on creatinine clearance.

D) Elevate the head of the bed and administer diuretics to manage potential fluid overload.

Lung cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: Genetic mutations in lung epithelial cells, often triggered by carcinogens such as tobacco smoke, lead to uncontrolled cell proliferation. These mutations disrupt normal cell cycle regulation, promoting tumor growth and malignancy.

• Secondary mechanism: Angiogenesis, the formation of new blood vessels, is stimulated by tumor cells to supply necessary nutrients and oxygen, facilitating further cancer growth and metastasis. This process is driven by factors like vascular endothelial growth factor (VEGF).

• Key complication: Metastasis occurs when cancer cells invade surrounding tissues and spread to distant organs, commonly the brain, bones, liver, and adrenal glands. This progression complicates treatment and significantly worsens the prognosis.

Patient Profile

Demographics:

65-year-old male, retired construction worker

History:

• Key past medical history: Hypertension, Chronic Obstructive Pulmonary Disease (COPD)

• Current medications: Lisinopril, Albuterol inhaler, Fluticasone/salmeterol

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent cough and shortness of breath

• Key symptoms: Coughing up blood, chest pain, fatigue, weight loss

• Vital signs: Blood pressure 150/95 mmHg, Heart rate 110 bpm, Respiratory rate 24 breaths/min, Temperature 100.2°F, Oxygen saturation 88% on room air

Section 1

As the medical team continues to evaluate the patient's condition, recent imaging and laboratory results reveal new diagnostic findings that provide further insight into the progression of his lung cancer. A CT scan of the chest shows a significant mass in the right upper lobe with evidence of lymph node involvement in the mediastinum. Additionally, there are suspicious lesions noted on the scan of his liver, suggestive of metastatic spread. This finding correlates with his recent complaints of dull abdominal pain and further weight loss. A biopsy of the lung mass confirms non-small cell lung carcinoma (NSCLC), a common type of lung cancer, which often presents with such systemic symptoms and complications.

Blood tests reveal elevated liver enzymes, including AST and ALT, which are consistent with possible liver metastasis. The patient's complete blood count shows anemia with a hemoglobin level of 10.5 g/dL, which may account for his increased fatigue and pallor. In light of these results, the oncology team considers adjusting his treatment plan to address the metastasis and manage his symptoms more effectively. The interdisciplinary team evaluates the need for systemic chemotherapy to target both the primary tumor and metastatic sites, alongside supportive care measures to optimize his respiratory function and quality of life.

These findings necessitate a thorough discussion with the patient and his family regarding the prognosis and potential treatment options. The healthcare team must weigh the benefits and risks of aggressive treatment versus palliative care, taking into account the patient's overall health status and personal preferences. This decision-making process highlights the importance of clinical reasoning in assessing the progression of disease, predicting potential complications, and planning an individualized care strategy to best support the patient's journey.

Section 2

Change in patient status:

Following the interdisciplinary team's decision to initiate systemic chemotherapy, the patient undergoes his first cycle. Initially, he tolerates the treatment reasonably well, but within a week, he begins to experience significant side effects. The patient presents to the clinic with complaints of increasing shortness of breath, persistent cough, and a new onset of fever reaching 38.5°C (101.3°F). Upon examination, his vital signs reveal a respiratory rate of 28 breaths per minute, heart rate of 110 beats per minute, blood pressure of 100/60 mmHg, and oxygen saturation of 88% on room air, indicating respiratory compromise.

A repeat chest CT scan shows an increase in pleural effusion on the right side, likely exacerbated by the tumor burden and possible infection. The healthcare team suspects a developing case of pneumonia, possibly due to immunosuppression from chemotherapy. Laboratory tests reveal an elevated white blood cell count of 14,000/mm³ with a left shift, supporting this suspicion. His anemia has worsened, with a hemoglobin level now at 9.8 g/dL, contributing further to his fatigue and dyspnea.

Given these findings, the medical team decides to admit the patient for closer monitoring and management. The treatment plan includes intravenous antibiotics to address the suspected pneumonia, supplemental oxygen to improve his hypoxemia, and diuretics to manage the pleural effusion. The team also considers a thoracentesis to relieve respiratory distress. This change in patient status prompts a reevaluation of his current treatment regimen, balancing the need to control the cancer's progression with the risks of chemotherapy-related complications. This phase of his care requires careful clinical reasoning to navigate the challenges of an evolving clinical picture and to tailor interventions that align with the patient's goals and preferences.

Section 3

The patient is admitted to the hospital, and the initial interventions begin with the administration of intravenous antibiotics and supplemental oxygen therapy via nasal cannula to improve his oxygen saturation, which now reads at 92% with 3 L/min of oxygen. The medical team conducts a thoracentesis, successfully draining 800 ml of clear yellowish fluid from the right pleural space, which provides the patient with some relief from his dyspnea. Post-procedure, his respiratory rate decreases to 22 breaths per minute, and his heart rate stabilizes at 98 beats per minute. However, despite these improvements, the patient continues to exhibit signs of fatigue and malaise.

New laboratory results reveal a C-reactive protein (CRP) level of 18 mg/L, indicating significant inflammation, and blood cultures are pending. A repeat chest CT scan post-thoracentesis shows partial resolution of the pleural effusion with no new significant findings, but the underlying tumor mass persists. The patient’s anemia remains a concern, with a hemoglobin level steady at 9.8 g/dL, prompting the team to consider a transfusion if his symptoms of fatigue worsen or his hemoglobin levels drop further. Renal function tests are monitored closely, given the administration of diuretics, and remain within normal limits at this time.

As the patient starts to stabilize, the healthcare team engages in a discussion regarding the next steps in his treatment plan. They consider adjusting the chemotherapy regimen to reduce the risk of further immunosuppression while ensuring adequate oncological control. The patient's family is brought into these discussions to align the treatment approach with his preferences and quality of life considerations. The team also emphasizes the importance of vigilant monitoring for potential new complications, such as further infections or renal impairment, as they navigate the delicate balance of managing both cancer progression and treatment-related side effects. This phase of care underscores the need for dynamic clinical reasoning and adaptability in response to the evolving clinical picture.

Section 4

As the hospital stay progresses, the patient begins to exhibit new complications. Over the course of a few days, the patient's oxygen saturation starts to fluctuate, dropping to 88% despite increasing the oxygen flow to 4 L/min via nasal cannula. A repeat clinical examination reveals diminished breath sounds on the right side, prompting the medical team to suspect a recurrent pleural effusion or possible pneumonia. The patient also develops a low-grade fever of 100.5°F (38.1°C) and a productive cough with yellowish sputum, raising concerns about a potential infectious process.

In response to these new developments, a follow-up chest X-ray is ordered, which shows an increase in the right-sided pleural effusion compared to the previous imaging. Concurrently, the pending blood cultures return positive for Streptococcus pneumoniae, confirming a secondary bacterial pneumonia. Given the bacterial nature of the infection and the patient's compromised immune status, the healthcare team decides to escalate antibiotic therapy to a broader spectrum regimen and consults with infectious disease specialists to optimize treatment.

The patient's anemia has also progressed, with his hemoglobin level now at 8.5 g/dL, accompanied by increased pallor and worsening fatigue. After a thorough discussion with the patient and his family, a decision is made to proceed with a blood transfusion to address his symptomatic anemia. This complex interplay of cancer progression, infectious complications, and anemia highlights the need for the healthcare team to continuously reassess and adapt the treatment plan, balancing aggressive management of complications with the patient's overall prognosis and quality of life considerations. As the team addresses these new obstacles, they remain vigilant for further potential complications, such as sepsis or renal impairment, which could significantly impact the patient's recovery trajectory.

Section 5

As the healthcare team implements the broader spectrum antibiotic regimen and completes the blood transfusion, they closely monitor the patient's clinical status. Over the next 48 hours, the patient's oxygen saturation stabilizes slightly, maintaining around 90-92% on 4 L/min of oxygen via nasal cannula. However, his respiratory rate remains elevated at 24 breaths per minute, and his breath sounds continue to be diminished on the right side with crackles present, indicating ongoing respiratory compromise. The patient's productive cough persists, although the volume of sputum begins to decrease gradually.

Despite these interventions, the patient starts to exhibit signs of renal stress. His latest laboratory results reveal a rising creatinine level of 2.1 mg/dL, up from a baseline of 1.2 mg/dL, suggesting acute kidney injury possibly secondary to the infection or medication effects. Urine output has decreased to less than 30 mL/hour, raising concern for potential renal impairment. These findings prompt the team to adjust the patient's fluid management and consult nephrology to prevent further deterioration in kidney function.

This new complication adds another layer of complexity to the patient's care. The team must carefully balance fluid resuscitation to support renal perfusion while avoiding fluid overload, which could exacerbate the pleural effusion and respiratory status. The patient's condition necessitates frequent reassessment and adjustment of the management plan, emphasizing the importance of an interdisciplinary approach in addressing the multifaceted needs of a patient with advanced lung cancer and its complications. As the team navigates these challenges, they remain vigilant for additional signs of systemic instability, such as hypotension or altered mental status, that could indicate progression to sepsis or other critical issues.