Case Study Week 1 Nursing Process Worksheet
Scenario:
H.L is a 65-year-old Caucasian male diagnosed with Hodgkin’s Lymphoma (NHL) 4 months ago. He just finished receiving his third of six chemotherapy courses 5 days ago. Yesterday morning, he was seen at his oncologist’s office for malaise, muscle weakness, and palpitations. He had splenomegaly on examination. A computerized tomography (CT) scan of the abdomen showed metastatic disease in the liver and spleen. He is admitted to the hospital with progressive disease.
LABS: Basic Metabolic Panel (BMP)
| NA | 136mEq/L | (136mmol/L) | |
| K | 6/1mEq/L | (6.1 mmol/L) | |
| CL | 97mEq/L | (97mmol/L) | |
| CO2 | 28 | (28mmol/) L | |
| Glucose | 98mg.dL | (5.4 mmol/L) | |
| Blood Urea Nitrogen (BUN) | 54mg/dL | (19.28 mmol/L) | |
| Creatinine | 2.7mg/dl | (239mcmol/L) | |
| Ca | 6.3 units/L | ||
| Total Protein | 5.4g/dL | (54g/L) | |
| Albumin | 2.8g/dL | (421 mcmol/L) | |
| Phosphorus | 4.8mg/dL | (1.55 mmol/L) | |
| Uric Acid | 20.7mg/dL | (1.23mmol/L) | |
| Total Bilirubin | 0.8mg./dL | (13.7 mcmol/l) | |
| Alkaline Phosphatase | 172 units | (2.87ukat/L) | |
| Aspartate transaminase (AST) | 254 units | (4.23ukat/L) | |
| Alanine transaminase (ALT) | 74 units | (1.23ukat/L) | |
| Lactate dehydrogenase (LDH) | 214 IU/L | (3.57mckat/L) | |
- Interpret H. L’s admitting BMP panel.
- Based on the values, which common oncologic emergency is H.L. experiencing?
- Describe the pathophysiology of this condition.
- What assessment findings related to this diagnosis would you expect in H.L.?
Complete Blood Count
Chart View:
White Blood Cells (WBC) 1500/mm
Neutrophils 66%
Lymphocytes 16%
Monocytes 15%
Eosinophils 5%
Hemoglobin (Hgb) 8.3g/dL
Hematocrit (Hct) 23.6%
Platelets 21.000/mm
Based on lab values, name three additional problems for which H.J. is at risk.
6.What are your nursing priorities right now?
Chart View:
Medication Record:
I.V. 0.9 % Normal Saline @ 150ml/hr.
100 mEq Sodium Bicarbonate in the first liter of IV fluid
Rasburicase 6 mg IV now.
Allopurinol 500mg BID PO
Furosemide 40 mg IV now and every 6 hours
Sodium polystyrene sulfonate 15 g PO every 6 hours
Albumin hydroxide 2 capsules PO with meals
Case Study Progress:
The oncologist confirms a diagnosis of acute tumor lysis syndrome (TLS) and writes several orders for H.L.
- What is the expected outcome associated with each medication H.L. is receiving?
8.After giving sodium polystyrene sulfonate, it is important for you to monitor
- J.’s:
- Urine output
- Bowel sounds
- Peripheral pulses
- Level of consciousness
- What major complication of TLS is H. J. at risk for and why?
- Name three signs and symptoms of this complication you will assess for in H.J.
- List four independent nursing interventions that you would include in H. J’s plan of care and the rationale for each.
- the best way to prevent infection in a patient with H. J’s diagnosis is
- Giving prophylactic antibiotics.
- Placing him in reverse isolation.
- Limiting his intake of fresh fruit and vegetables with skins.
- Practicing good handwashing by all who are in contact with him.
Case Study Progress:
24 hours after admission, H.J.’s lab tests are repeated.
Chart View:
Basic Metabolic Panel:
Na 138 mEq
K 4.8 mEq
Cl 109 mEq/L
Co2 26 mEq/L
Glucose 148 mg/dL
BUN 34 mg/dL
Creatinine 2.4 mg/dL
Ca 7.3 units/L
Total Protein 5.4 g/dL
Albumin 2.8 g/dL
Phosphorus 3.8 mg/dL
Uric Acid 0.5mg/dL
Total Bilirubin 1.0mg/dL
Alkaline Phosphatase 96 units/L
AST 49 units/ L
ALT 48 units/ L
LDH 224 IU/L
Interpret H.J.’s lab results. Is his condition improving?
Case Study Progress:
Because H. J.’s condition has stabilized the oncologist orders another round of chemotherapy.
- Because the TLS is just resolving, what interventions would you include in your plan of care and why?
- What precautions should you take when administering H.J.’s chemotherapy to reduce the risk for injury? Select all that apply.
- Independently verify the completeness of the drug order and infusion rate.
- Dispose of any equipment that held the drug in special biohazard containers.
- Scrub the skin that comes into contact with the drug for 5 minutes with a surgical brush.
- Wear goggles, powdered gloves, and a disposable, fluid, resistant, long sleeved gown.
- If using a peripheral site, place a disposable drape under the arm where the drug will be infused.
- Use a Luer-Lok connector to attach the drug tubing to the main IV line, using the IV port closet to H.J.
- The UAP you are working with states she is unfamiliar with caring fir patients receiving chemotherapy. What instructions do you give to the UAP to reduce her risk for injury?
- which tasks can you delegate to the UAP? Select all that apply.
- Giving IV fluids as prescribed.
- Assisting H.J with oral hygiene.
- Practicing good hand washing technique
- Determining the need for antiemetic therapy.
- Reporting the amount and type of oral fluid intake.
- Taking vital signs and recording them every 4 hours.
Case Study Outcome:
H.J does not experience any acute kidney injury. He is discharged home 3 days later after finishing this round of chemotherapy. He will follow up with the oncologist in 1 week.
Week One:
This scenario will be used for your week 1 for the Patient Profile Database and your Nursing Process Worksheet. You will be divided into groups. You will be expected to work through the scenario together and will discuss this during post conference.
