Name: Bobo, Lindy Jane

September 14, 2021

Section: A1

Case Study 1 The Case of the Patient with Cancer

1. What significant data will you collect from Fred during your initial assessment?
Answer:
Assessment
 Assess patient’s factors that may contribute to bleeding.
 Assess patient for infection, reduced white blood cell (WBC) count, bleeding skin
problems, nutritional problems, pain fatigue, and psychological stress.
 Assess patient’s nutritional status (weight, caloric intake, diet history, anorexia, changes
in appetite) and cachexia (wasting emaciation). Impaired nutritional status may
contribute to disease progression and a multitude of complications.
 Monitor common bleeding sites (intestinal, urinary, and respiratory tract).
 Assess the level (pain assessment sale), source, and site of pain and factors that increase
the patient’s perception of pain (fear and apprehension, fatigue, anger, and social
isolation).
2. There are three treatment options the healthcare provider described to Fred, along with the
advantages/disadvantages for each. Outline them in terms Fred can understand.
Answer:
Medical Management
 A variety of therapies may be used, including surgery (video-assisted endoscopic
surgery, salvage surgery, electrosurgery, cryosurgery, chemosurgery, or laser surgery).
Surgery could be for prophylactic, palliative, or reconstructive purposes. The goal of
surgery is to remove the tumor or as much as is feasible.
 Radiation therapy and chemotherapy may be used individually or in combination.
 Biologic response modifier (BRM) therapy may be used at various times throughout
treatment.
3. Due to the size of the tumor, Fred has decided to undergo radiation therapy (daily for 6
weeks) to reduce the size of the tumor, and then have surgery to remove the right kidney. He
is concerned about the radiation "hurting his grandkids." You notice that as he is talking to
you, he is trembling. What nursing diagnosis best describes Fred’s concern?
Answer:
Nursing Diagnosis
 Imbalanced nutrition: Less then body requirements related to anorexia, malabsorption,
and cachexia.
4. What interventions will you implement to help Fred overcome his anxiety?
Answer:
Nursing Interventions Promoting Nutrition
 Explain how to prepare foods so they look and taste appealing, also discuss ways to
avoid unpleasant smells.
  Assist in selecting foods that patient might eat despite altered sense of taste and smell
and decreased appetite. Relieving Pain
 Help patient and family play an active role in managing pain.
 Use a multidisciplinary team approach to determine optimal management of pain for
optimal quality of life.
 Provide education and support to correct fears and misconceptions about opioid use.
Decreasing Fatigue
 A positive approach is essential when caring for the patient with a disturbed body
image. To help the patient retain control and a sense of self-worth, encourage
independence and continued participation in self-care and decision making.
 Help patient and family to understand that fatigue is usually an expected and temporary
side effect of the cancer process and treatment.
5. About which lab values are you concerned? Why?
Answer:
Laboratory values
 Tumor marker identification may be beneficial for some cancers.
6. The nurse notes that Fred is underweight, and suspects anorexia-cachexia syndrome. What
further assessments of nutritional status will the nurse make?
Answer:
 Assess clinical and laboratory data related to nutritional status.
 Assess patient’s nutritional status (weight, caloric intake, diet history, anorexia, changes
in appetite) and cachexia (wasting emaciation). Impaired nutritional status may
contribute to disease progression and a multitude of complications.
 Assess situations and food that aggravate or relieve anorexia.
 Review patient’s medication history.
 Determine difficulty in hewing or swallowing and nausea, vomiting, or diarrhea.
7. Which lab values would the nurse check to help determine the degree of malnutrition? for
Fred? Why?
Answer:
Laboratory values
 Complete blood count, electrolytes, hormone levels, liver enzyme studies, as well as
other chemistry studies may help to identify effects of tumor.
8. What nursing interventions can assist Fred with his nutritional status?
Answer:
Promoting Health
 Used additional strategies as indicated (changing the feeding schedule, using simple
diet). Provide and encourage patient to eat small, frequent meals with supplements
between meals.
 Direct nursing are towards preventing trauma, infection, and other complications that
increase metabolic demands.
 Administer enzymes and vitamin replacement if ordered for malabsorption.
 Before invasive nutritional strategies are instituted, assess patient carefully and discuss
the option with patient and family.