NURS 106 Case Study—Oncology by whq15269


									                          NURS 106 Case Study—Oncology
                                    Colon CA

You are caring for John, a 56-yo male with colon CA. History includes colon resection
followed by combined chemotherapy approximately 18 months ago; recently diagnosed
with recurrence of colon cancer; previous significant weight loss; 50-pack-year (2
PPDx25yr) smoking history. John is admitted for acute N/V & dehydration. He is
nutritionally depleted. He is scheduled for diagnostic evaluation requiring exploratory
laparotomy. VS 150/90, 124, 26, 100F.

   1.      List at least 5 major risks & potential complications for John.

The surgery is performed, including lysis of adhesions small bowel resection, colectomy
& colostomy. John in admitted to the SICU with a large abdominal dressing. You roll
John side-to-side to remove the soiled surgical linen, and the dressing becomes saturated
with a large amount of serosanguineous drainage.

   2.      Would this drainage be expected after abdominal surgery? Explain.
           Traditionally the physician performs the 1st dressing change. Why is this

The surgical dressing is removed. Wound edges are well approximated, the suture line is
edematous, staples are intact. The transverse colostomy rosebud looks pink in the middle
and dark around the edges, & there are 2 Jackson-Pratt drains in the R abdomen.

   3.      Do any of these findings concern you? Why?

   4.      Within minutes of sitting in a chair, you note that John is becoming
           increasingly pale & diaphoretic. His pulse is rapid & irregular & he c/o being
           nauseated & dizzy. What actions should you take?

   5.      John looks at you & tells you that he knows he is never going to leave the
           hospital alive. He says he has lots of regrets. He confides that he used to
           drink a lot and wasn’t a good father to his children; his son hasn’t talked to
           him in 15 years. How should you respond?

   6.      John will be receiving 6 cycles of combination chemo. What are the major
           side effects you want to prepare him for?

   7.      Pre-chemo blood tests are performed, & John is diagnosed with
           thrombocytopenia & leukopenia. What manifestations do you need to watch
           for, and what precautions need to be taken?

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