Pt help!!!!!!

Nursing Students General Students

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HEY GUYS! I need some help!!!! I have yet to take care of a cancer pt and I just received a pt today who Dx is Epiglottis CA SCCA stage 4. Pt has a trach, PEG tube, and foley. I am just a little confused because this pt has been in the hospital for 5 days and has yet to receive a biopsy or any cancer Tx. Just pain and NV meds. Am I missing something here?

If this helps at all

LABS:

high WBC, MCV, MCH, RDW, neutrophils, Calcium

low RBC, lymphs.

No labs have been done besides CBC and chemistry

Can you tell me everything you know about epiglottis CA, apparently it is rare....

Along with nursing interventions and key problems to address....

ANY help is greatly appreciated! :bow:

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Specializes in Oncology.

Is the patient only on palliative care/hospice? If so, that is the reason why they are not having tx for the cancer. It sounds like it since you say they are only on pain and N/V meds which are mainly comfort measures.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I searched the website of the NCI and only found this information:

I've had cancer 3 times. My hospitalizations related to them were for surgery, radiation therapy, and a wound infection. Oncology is a specialty of internal medicine so this patient could be hospitalized for a complication related to the cancer or the treatment for the cancer. If this patient already has a trach and a PEG tube his cancer was diagnosed and treatment for it started some time ago. The trach and PEG tube were placed because either structures in the neck were resected and removed or the patient has refused treatment and these things were placed as palliative measures when the impinging tumor blocked the airway and food pipe.

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Is the patient only on palliative care/hospice? If so, that is the reason why they are not having tx for the cancer. It sounds like it since you say they are only on pain and N/V meds which are mainly comfort measures.

Not on pallative care or hospice... this isn't the floor for that. I think that is a big reason for my confusion because I thought the same with the pt not being ordered chemo or radiation. Even then, it isn't routinely done on the floor. Thank you both for the input... hopefully something else comes up tomorrow. Also, the pt had the PEG and Trach done after admission. Was admitted from the ER with persistent cough and trouble swallowing... This is a Charity hospital so maybe ER visit was a last resort.

As far as nursing Dx

Pain

Risk for infection

Adequate nutrition

Impaired physical mobility

Self care deficit

Confusion (From pain meds)

Any comments???

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Specializes in med/surg, telemetry, IV therapy, mgmt.

nursing diagnosing is done by use of the nursing process adapted to care planning (which is simply problem solving):

  1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
    • a physical assessment of the patient
    • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
    • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
    • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.

[*]determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.

[*]planning (write measurable goals/outcomes and nursing interventions)

  • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
    • improve the problem or remedy/cure it
    • stabilize it
    • support its deterioration

    [*]interventions are of four types

    • assess/monitor/evaluate/observe (to evaluate the patient's condition)
      • note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.

      [*]care/perform/provide/assist (performing actual patient care)

      [*]teach/educate/instruct/supervise (educating patient or caregiver)

      [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

[*]implementation (initiate the care plan)

[*]evaluation (determine if goals/outcomes have been met)

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms, pathophysiology and treatments.

  • epiglottis ca scca stage 4
  • tracheostomy
  • peg tube
  • foley

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data -

  • pain
  • nausea/vomiting
  • persistent cough
  • trouble swallowing
  • high wbc, mcv, mch, rdw, neutrophils, calcium
  • low rbc, lymphs

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use - is this man an alcoholic? the reason i ask is because of his anemia and b-12 deficiency which might indicate liver disease going on. of course, that could also be due to metastasis.

  • impaired gas exchange r/t ventilation perfusion imbalance (this man has a new trach and is coughing--they put a trach in because he was not able to breathe)
  • ineffective airway clearance r/t excessive mucous (new trachs cause an excessive amount of secretions to be generated and they need a lot of suctioning)
  • pain
  • adequate nutrition -
  • impaired physical mobility
  • self care deficit - will need mouth care because of the trach
  • impaired verbal communication r/t presence of tracheostomy
  • risk for imbalanced fluid volume (i think this man has anemia)
  • confusion (from pain meds) - how about using risk for acute confusion r/t opioid use instead
  • risk for infection r/t inadequate immune system (presence of foley, ivs, peg tube, trach)

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That is awesome help! thank you!

Can you explain the anemia, because I thought the same thing from looking at his labs I would say pernicious anemia because of the low RBC and high MCV... Is there anything else I should be aware of or monitor for with possible anemia? Im so excited now! I feel like im understanding the connections!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I think that this is going to turn into a complex patient. Collect as much data as you can find. This is probably a real sick dude. My guess is that he is probably very malnourished and he probably has metastatic disease going on. He's probably not real happy about the trach.

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