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Case 1 Dx : Small cell lung CA T4(SVC) N2M0 - Coggle Diagram
Case 1 Dx : Small cell lung CA T4(SVC) N2M0
Patient information
She is 69 year old. No underlying. Allergic of Tramadol. BW=54 kg. HT=158 cm. BMI=21 She had history about smoking since 13y. to 69y. (She stoped at last 3 month) 1 pack/day. No drinking alcohol. and Admitted on 21 Dec. 21 at 3.23pm. V/S are BT=36.4C, PR=98 bpm., RR=20 bpm. BP107/57
Chief complaint : Admit for chemical therapy.
Present illness : Last 2 month, patient has fatigue and chest pain. She went to Chonburi hospital and the doctor diagnosed to small cell lung CA. limited stage? T4 (SVC) N2M0 AxLN?
Pleural effusion-no malignancy (likely from atelectasis)
RUL mass with SVC obstruction (hx of ET tube)
The patient ever got treatment
RT to Rt chest Emergency 8 Gy (20/10/21)
Cis/etoposide x 2 (28 Oct.+15Nov./21) Then, came to Chonburi cancer hospital for receive continue treatment about RT+CMT.
Carbo/Eto + RT
Past illness : No U/D and drug allergic of tramadol.
Plan to treatment
Carbo AUC4/Eto+RT
Appointment follow up on 27/12/21
CBC+BUN+Cr+Elyte
Laboratory
on 21 Dec. 21
High
RDW-CV = 16.7%
BUN = 29 mg./dL
Cr = 1.3 mg/dL
Low
Na = 128 mmol/L
Cl = 94 mmol/L
Mg = 1.5 mmol/L
CBC
Hct = 30%
Hb = 10.3 g/dL
Doctor order
21 Dec. 21
-Pre-medication 30 min. before get chemical therapy
0.9 NSS 1000ml IV 60ml/hr.x1
-Elyte Mg Ca
DAY1
-Ondansetron 8 mg.+ D5W 50 ml. IV in 15 min.
-Dexamethasone 8 mg. + D5W to 20 ml. IV push
Chemical therapy
-Carboplatin (AUC4) 230 mg + 5% D/W 250 ml. IV drip 2 hr. in day1.
-Etoposide (80mg/m2) 120 mg + NSS 500 ml IV drip 4 hr. in day 1-3
Medicine per oral and home medicine
-Deamethasone 4 mg 1x2 per oral pc
-Plasil 10 mg 1x3 per oral ac
-Onsia 8 mg 1x2 per oral ac.
Nursing care plan
Electrolyte imbalance
Supportive data
O : The result of Electrolyte on 21 Dec. 21
-Na = 128 mmol/L
-Cl = 94 mmol/L
-Mg = 1.5 mmol/L
Nursing goal
To maintain electrolyte balance of patient.
Evaluation criteria
Electrolyte balance
-Na=136-145mmol/L
-Cl=98-107mmol/L
-Mg=1.6-2.6mmol/L
No sign of electrolyte imbalance such as fatigue, lethargy, nausea, vomitting and sweating.
V/S are normal range
-BT=36.5-37.5C
-BP=90/60 - 120/80 mmHg.
-PR=60-100bpm.
-RR=16-20bpm.
-O2sat >= 95%
I/O balance
Nursing activity
Assess sign of electrolyte imbalance such as fatigue, lethargy, nausea, vomitting and sweating.
Assess V/S every 4 hour.
Provide blood collection about electrolyte follow the doctor order.
Monitor intake and output for measure amount to loss of electrolyte every 4-8 hr.
Provide electrolyte such as MgSO4 10 ml with 0.9% NSS 1000ml IV rate 60ml/hr. follow the doctor order.
Encourage the patient eating more than half of each meal.
Provide information about food intake such as seafood, meat, egg and milk.
Analysis
Patients with cancer develop abnormally high levels of Antidiuretic Hormone (ADH), which results in an impaired renal excretion, resulting in lower levels of electrolyte in the blood.
Patient activity and relative activity
Patient activity
Observe her sign and symptom
Try to eating half of all meal.
Relative activity
Promote patient to eating more.
No Evaluation
Risk for renal dysfunction
Supportive data
O : The result of laboratory renal test
-BUN = 29 mg/dL
-Cr = 1.3 mg/dL
-CrCL = 34 ml/min
Nursing goal
To decrease renal dysfunction
Evaluation criteria
Normal range of laboratory renal test
-BUN = 6-20 mg/dL
-Cr = 0.51-0.95 mg/dL
-CrCL =97-137 ml/min
No pitting edema
I/O balance
No pale conjunctiva
Capillary refill <3 sec.
No sign of renal dysfunction such as weakness, fatigue, and confusion.
Nursing activity
Assess sign of renal dysfunction such as weakness, fatigue, and confusion.
Assess physical eamination about pale conjunctiva, pitting edema and capillary refill.
Monitor I/O every 4-8 hr.
Provide blood collection for repeat laboratory renal test follow the doctor order.
Patient and relative activity
Patient activity
Observe sign of renal dysfuction such as weakness, fatigue, and confusion.
Observe her physical about pale.
Relative activity
Observe sign of renal dysfuction such as weakness, fatigue, and confusion of patient.
Observe pale of patient.
Analysis
The renal has filtration wast. But chemotherapy it make renal dysfunction and remove drug and wast not well. So, wast is accumulated in the body make high BUN and Cr.
No Evaluation
Risk for side effect of RT+CMT
Supportive data
O : Anemia
-Hct = 30%
-Hb = 10.3 g/dL
Physical
-Dry skin around her chest
Analysis
Chemotherapy works on active cells. Active cells are cells that are growing and dividing into more of the same type of cell. Cancer cells are active, but so are some healthy cells. These include cells in your blood, mouth, digestive system, and hair follicles. Side effects happen when chemotherapy damages these healthy cells.
Radiotherapy causes DNA break and subsequent cell death. This affects the cancer cells more severely than the normal cells.
Nursing goal
To prevent side effect of RT+CMT
Evaluation criteria
No hair loss
No nausea, vomitting and fatigue.
No enemia, Hct=40-54%
Hb=13-18 g/dL
No dry skin at her chest
No loss appetite, can eat more than half all meal.
Nursing activity
Promote patient to rest on the bed to decrease nausea and vommitting.
Provide information to caring skin of patient such as -Not apply lotion on skin that radiotherapy area.
-Can showering but not applt shower cream on area for radiotherapy and used towel to clean.
-Wear soft clothes and airy fabric easy to ventilated.
Promote patient to eating more than half of meal.
Provide medicine to prevent nausea and vomitting follow the doctor order that are Plasil 10 mg 1x3 per oral ac
and Onsia 8 mg 1x2 per oral ac.
Provide blood collection to check Hct and Hb follow the doctor order.
Patient and relative activity
Patient activity
Patient can caring herself and do daily life correctly such as showering and changing clothes
Observe nausea and vomitting
Relative activity
Mental support about patient's image
Promote patient to rest and eating more.
Observe nausea and vomitting.
D-METHOD
Supportive data
O : Plan to discharge if clinical stable
Analysis
The doctor order patient to discharge. Preparing of patient to caring him at home is important because if patient misunderstand to caring, it can make her to worse.
Nursing goal
Patient can caring herself correctly.
Evaluation criteria
She can tell about how to manage and cleaning area that give radiotherapy.
She can tell about how to taking medicine.
She can tell about manage environment
She can tell about cause and complication of
her illness and disease.
She can tell about treatment such as how to do when receive radiotherapy and chemotherapy
She can tell what day is next appoinment and sign of patient come to hospital.
She can tell the diet that appropriated with her illness.
Nursing activity
D (Diagnosis) = She has small cell lung CA limited stage T4(SVC)N2M0, provide information about his disease such as cause and complication of CA lung.
M (Medicine) = Provide information about medicine that patient getting such as dosage, properties, indication, contraindication and side effect.
-Deamethasone 4 mg 1x2 per oral pc to treat allergic
-Plasil 10 mg 1x3 per oral ac to treat nausea and vomitting.
-Onsia 8 mg 1x2 per oral ac. to treat nausea and vomitting.
E (Environment) = Provide information about well ventilation and not have dust or air pollution.
T (Treatment) = Provide information about radiotherapy and chemotherapy such as What are RT and CMT? Why patient must receive that?
Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors.
Chemotherapy is a cancer treatment where medicine is used to kill cancer cells. There are many different types of chemotherapy medicine, but they all work in a similar way. They stop cancer cells reproducing, which prevents them from growing and spreading in the body.
H (Health) = Provide information about caring after treat with RT and CMT
-Not apply lotion on skin that radiotherapy area.
-Can showering but not applt shower cream on area for radiotherapy and used towel to clean.
-Wear soft clothes and airy fabric easy to ventilated not wear bra with frame
-Try to rest more after giving RT and CMT for reduce nausea and vomitting
O(Out patient) = Provide information about next appointment and suggest her come to hospitl follow appointment.
D (Diet) = Provide information about appropriated diet such as she should eat more protein such as Lean meats such as chicken, fish, or turkey. Eggs. Low fat dairy products such as milk, yogurt, and cheese or dairy substitutes. Nuts and nut butters. Beans. Soy foods.
No information about physical examination.