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Breast Cancer and Pulmonary Emboli Case Study 2:30 pm shift report – Room 34 is a 35 year old white

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Breast Cancer and Pulmonary Emboli Case Study

2:30 pm shift report – Room 34 is a 35 year old white female with Stage IV metastatic breast and ovarian cancer which has metastasized to her liver. She was admitted yesterday with SVT and is on a Cardizem infusion and she is now having sinus tachycardia. Her main problem now is that she is SOB, and it has been getting progressively worse. She was admitted on Nasal Cannula 2L/min but now she is on a 60% venti-mask with saturations of 89%. Her CXR shows a pleural effusion to the right lung. She appears anxious & diaphoretic. Blood pressure 100/50, P 110, R 30, and temp 99. She finished palliative chemotherapy a few days ago and is in nadir right now. 

She is married and has 2 children, a son 5 and a daughter 2. Her husband is very supportive, and they live locally. She absolutely refuses hospice. Hospice nurses have discussed their services with her and her husband at length and she refuses. She is a full code. I have discussed her code status with the physician who feels he has to respect her wishes. I have asked the physician to consider transferring her to the ICU, but he said he would like to manage her on this unit so her family can be with her, and she can be taken care of by nurses she knows. 

Current orders 

Admit diagnosis – SVT and pleural effusion R/O PE 

      NKDA 

      Access port-a-cath 

      Hep lock 

      VS q 2 hrs. 

      Regular diet 

      Bedrest 

      Telemetry 

      STAT CT of the lungs 

Medications

 • Cardizem infusion—start at 5 mg/hr and titrate to keep heart rate < 120 beats/min     Diflucan 200 mg IVPB qd  • Cefuroxime 1 gram IVPB q6 hrs.  • Acyclovir 5mg/kg/day IVPB q8 hrs.  • Nystatin Suspension 500,000 Units swish and swallow PC and HS  • Morphine 2-4 mg IVP q1-2 hrs. prn pain  60% venti mask - check O2 Sat with VS  CXR in am  Lytes, BUN, creatinine, CBC with differential in am Current Diagnostic Tests  RBC - 3.4 Hgb - 8 g/dl Na - 144 Hct - 24% K - 4.0 Plts - 100,000 Cl - 100 mEq/L WBC - 1.3 ABG's BUN - 30 mg/dl pH 7.47 Creatinine - 3 mg/dl CO2- 30 Glucose -- 136 HCO3 20 CXR - large right pleural effusion. Chart Check 115 lbs.  5' 5'' Beginning of Shift Nursing Assessment  3 pm - Sitting upright in bed with 60% venti-mask on. Sats 91%. Breath sounds diminished in right lung. Bilateral well healed mastectomy scars. RR 32. States she is a little SOB but "doing ok". Nail beds pale with CRT 3 sec. S1S2 audible. Monitoring ST at rate of 118. BP 100/70 R arm. Cardizem 125 mg/100 D5W infusing at 5 cc/hr. via R hand IV. Site with good blood return. Skin diaphoretic. Easily palpable bilateral radial, dorsalis pedis, posterior tibial pulses. Abdomen soft non-tender with active bowel sounds. R subclavian port-a-cath accessed and hep locked. Husband and children present. Discussion: Discuss your thoughts on the role of the family in medical decision-making as it relates to this case. Do you believe the husband should be more involved by helping his wife explore her hesitation to address end-of-life care and planning? Support your thoughts with evidence-based literature. How can the patient be supported in obtaining a "good death?"   SCIENCE HEALTH SCIENCE NURSING NURN 400

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