case study: oncologic nursing!
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situation: Mrs. Brown, age 49, was admitted to the hospital with cancer of the left breast. A mastectomy was performed and seven lymph nodes were removed. three of these were found to contain cancer cells. mrs. brown was discharged with follow-up cobalt treatment. two years later, she developed shortness of breath and a bone scan showed metastasis to the left lung. the physician performed a bilateral oopherectomy and started mrs. brown on flouxymesterone, an androgen, 10 mg 3x a day.
two months later, mrs. brown reported that her shortness of breath was becoming more severe. a left thoracentesis was performed in which 500 ml of fluid was removed and 25 mg of Thiotepe was instilled. one week later a drug protocol was begun and mrs. brown received:
Doxorubicin HCl 50 mg/sq meter
Cyclophosphamide 500 mg/sq meter
5-fluorouracil 500 mg/sq meter
the physician planned to repeat this regimen every 22 days. following the first course of therapy, mrs. brown began to lose her scalp hair. Her WBC was 4400. there was little therapeutic response to this course treatment. two months later mrs. brown was strated on five drug protocol consisting of:
Cyclophosphamamide 100 mg O.D P.O
5-fluorouracil 12 mg/kg by IV daily for 4 doses then once a week
Methotrexate 25 mg IV once a week
Vincristine sulfate 1.5 mg by IV once a week
Prednisone 40 mg O.D P.O
Mrs. brown tolerated this drug treatment poorly and developed fever, loose stools, nausea, anorexia, mouth ulcers and a WBC of 14,000. After two-week trial, tis protocol was discontinued. Mrs. Brown continued to do poorly and expired two months following discontinuation of the five drug protocol.
QUESTIONS:
1. To what class of anti cancer drugs do each of the drugs received by Mrs. Brown?
2. Why was she initially placed on flouxymesterone following the bilateral oopherectomy?
3. What is the purpose of administering drugs according to a protocol or regimen of several drugs at a time?
4. What measure could have been used to decrease Mrs. Brown's loss of scalp hair?
5. What nursing measures are indicated while Mrs. Brown is receiving the five drug protocol?
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