Case study! please Help me!

Nursing Students Student Assist

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Case study:

Mrs. Jones is admitted to your unit following a simple mastectomy for breast cancer. The tumor was staged as a T2, N0, M0. Estrogen and progesterone receptors were negative. A bone scan was negative for metastasis. She is scheduled for four chemotherapy treatments, 3 weeks apart. The medications prescribed are high doses of doxorubicin and cyclophosphamide. A central line has been inserted for chemotherapy.

1. You enter the room to provide the discharge instructions and find Mrs. Jones crying. She says to you, "Do you think I should get a second opinion about treatment?" Your response is:

2. Ordered: Reglan 1.5 mg/kg po 30 minutes prior to beginning chemo.

Can you determine the amount to be given? If yes, how much will be given? Show your work.

If no, why not?

3. Time lapse: Mrs. Jones returns for her final dose of chemo therapy. Her CBC reveals: RBC 3.7 million/mm3; WBC 3,700/mm3; Plt 25,000/mm3. She is unable to receive her chemotherapy today. Explain the reason for this.

4. Given Mrs. Jones labs above, describe her risk for complications and methods/interventions to prevent these complications.

5. At this visit, Mrs. Jones is upset that she is unable to receive her chemo and states, "Maybe I need hospice." What is your reply?

Please help me! :(

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We are glad to help but would like to hear your thoughts first. What do you think?

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Specializes in Complex pedi to LTC/SA & now a manager.

What do you think? Post your thoughts and questions and we will be happy to guide you

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1. You enter the room to provide the discharge instructions and find Mrs. Jones crying. She says to you, “Do you think I should get a second opinion about treatment?” Your response is:

I would respond with "yes its always good to get a second opinion if you feel as though you would like to." (I know my explanation needs to be longer than this) this is the question im most stuck on because i know its a psychosocial question and i just dont know how to respond. I know it allows more independace for her to get a second opinion but i dont wanna guide her in the wrong direction.

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2. Ordered: Reglan 1.5 mg/kg po 30 minutes prior to beginning chemo.

Can you determine the amount to be given? If yes, how much will be given? Show your work.

If no, why not?

"There is no weight given to determine the amount given."

(Thats what i think for #2)

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Time lapse: Mrs. Jones returns for her final dose of chemo therapy. Her CBC reveals: RBC 3.7 million/mm3; WBC 3,700/mm3; Plt 25,000/mm3. She is unable to receive her chemotherapy today. Explain the reason for this

"she is more prone to infection n bleeding but her cells are also reproducing n chemo at that time could damage the marrow causing immature and messed up cells..her RBC is low and her WBC."

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5. At this visit, Mrs. Jones is upset that she is unable to receive her chemo and states, “Maybe I need hospice.” What is your reply?

"Hospice is for patients for are considered terminal and have a life expectancy of six months or less. You do not need hospice because you where unable to receive chemo."

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Specializes in Med Surg.
1. You enter the room to provide the discharge instructions and find Mrs. Jones crying. She says to you, “Do you think I should get a second opinion about treatment?” Your response is:

I would respond with "yes its always good to get a second opinion if you feel as though you would like to." (I know my explanation needs to be longer than this) this is the question im most stuck on because i know its a psychosocial question and i just dont know how to respond. I know it allows more independace for her to get a second opinion but i dont wanna guide her in the wrong direction.

Wrong. The nursing school answer always is "Tell me more about why you think you need a second opinion...."

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Specializes in Med Surg.
Time lapse: Mrs. Jones returns for her final dose of chemo therapy. Her CBC reveals: RBC 3.7 million/mm3; WBC 3,700/mm3; Plt 25,000/mm3. She is unable to receive her chemotherapy today. Explain the reason for this

"she is more prone to infection n bleeding but her cells are also reproducing n chemo at that time could damage the marrow causing immature and messed up cells..her RBC is low and her WBC."

Be more specific wrt to the lab results.

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Specializes in Med Surg.
1. You enter the room to provide the discharge instructions and find Mrs. Jones crying. She says to you, “Do you think I should get a second opinion about treatment?” Your response is:

I would respond with "yes its always good to get a second opinion if you feel as though you would like to." (I know my explanation needs to be longer than this) this is the question im most stuck on because i know its a psychosocial question and i just dont know how to respond. I know it allows more independace for her to get a second opinion but i dont wanna guide her in the wrong direction.

Expanding on my last brief answer. It appears you applied an intervention without doing any assessment. So what should you do?

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Specializes in Med Surg.
5. At this visit, Mrs. Jones is upset that she is unable to receive her chemo and states, “Maybe I need hospice.” What is your reply?

"Hospice is for patients for are considered terminal and have a life expectancy of six months or less. You do not need hospice because you where unable to receive chemo."

The information you gave about hospice does not appear to me to be the information the patient needs at this time - unless you are trying to terrify them. The problem appears to call for more assessment (always look for assessment vs intervention) and the intervention may need to be centered around why the pt isn't getting chemo that day.

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Always assess the patient first, before applying interventions. There always should be a weight in kg for chemo patients (well, for all patients). Palliative care consult, social work consult--patient needs to be assessed for risk. A "typical" response to chemo is shown in the labs. She would have a huge infection risk.

Otherwise fascinating, however, I am not that familiar with chemo, however, these are general nursing thoughts.

Oh, and the moment someone is frightened and asking for a "second opinion" you need to have the MD come and speak with the patient. I would not give anything without a consent. And it sounds as if the patient is not sure if she wants to proceed. Be mindful and careful of that.

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