Ellie Smith

Lung Cancer Case Study 1

Patient profile: Mr. M is a 65-year-old patient who was recently diagnosed with metastatic lung cancer.
He began treatment with chemotherapy through a peripherally inserted central venous catheter 5 days
ago.

Subjective data:

 States he has almost continuous nausea, which becomes severe and causes vomiting following
his dose of chemotherapy
 States he has no appetite
 Expresses no hope that the chemotherapy will have a positive effect

Objective data:

 Temp: 99.4
 WBC: 3200
 Neutrophils: 500
 Skin warm with decreased turgor

Critical thinking questions:

1. What factors may be responsible for Mr. M’s decreased WBC and neutrophil count?
WBCs, specifically Neutrophils, help to protect us from infections. Mr. M has been receiving
chemotherapy. Chemotherapy slows down the bone marrow’s production of healthy WBCs.
Therefore, his chemotherapy treatment is likely responsible for decreasing his WBC and
Neutrophil levels.
2. What assessment data indicate that Mr. M may be experiencing an infection?
Mr. M’s WBC counts are low, which make him more susceptible to infection as evidenced by
his WBC and Neutrophil levels.
3. What additional assessment data should be collected from Mr. M to determine the presence of
an infection?
The nurse should assess Mr. M for other symptoms such as a fever, chills and sweating,
inflammation and edema around the insertion site, shortness of breath, chest pain or
discomfort, and hemoptysis.
4. What factors may contribute to Mr. M’s negative attitude toward the chemotherapy?
Mr. M is experiencing severe nausea and vomiting, and no longer has an appetite. He may also
be experiencing fluid and electrolyte imbalances, acid-base imbalances, and malnourishment
due to the continuous nausea and vomiting. In addition, Mr. M’s WBC levels are low, putting
him at risk for infection. The chemotherapy is an effort to treat his lung cancer, but in his mind
it has “made things worse.” He must weigh the pros and cons of chemotherapy to determine
how he wishes to continue his plan of care.
5. Identify nursing measures that could be instituted to help control his anorexia, nausea and
vomiting.
The nurse should teach Mr. M to eat a light meal before chemotherapy treatments. After
treatments, he should be instructed to take a nap or rest quietly. If the smell of food causes

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 Ellie Smith

nausea, he should be instructed to avoid strong smelling foods such as tuna, cabbage, or
onions. With a doctor prescription the nurse could administer an antiemetic such as
Aprepitant (Emend) or Ondansetron (Zofran). The patient can also receive a prescription to
take a drug at home.
6. What should be included in the teaching plan for Mr. M and his family to prevent infection?
The nurse should educate the patient’s family on the importance of maintaining a strict aseptic
technique while caring for the individual. As always, the nurse should reinforce handwashing
before and after each activity. In addition, the family should be instructed to use PPE as
appropriate, limit visitors to prevent infection, and alert the doctor if the patient experiences
pain, redness, or swelling at the injection site.
7. Based on the assessment data presented, write 5 appropriate nursing diagnoses.
a. Risk for dehydration related to persistent fluid loss and vomiting AEB decreased skin
turgor.
b. Risk for fluid-electrolyte imbalance related to persistent fluid loss and vomiting AEB
decreased skin turgor.
c. Imbalanced nutrition related to decreased intake AEB patient statement “I have a
decreased appetite.”
d. Risk for infection related to chemotherapy treatment AEB low WBC count.
e. Coping impairment related to chronic illness AEB patient statement “I have no hope
that the chemotherapy will have a positive effect.”

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