DrWhale3240
A 52 yr/old married mother of two was diagnosed with breast cancer…
A 52 yr/old married mother of two was diagnosed with breast cancer 6 months ago. She is a direct admit from her oncologist’s office with complaints of mouth sores, extreme fatigue, and weakness. Her mouth source has made it too painful to eat and she has not been out of bed except to go to the bathroom for 2 days. Her husband of 25 years is with her. They have twins, both of whom are in college out of state.
She had a left mastectomy with reconstruction for breast cancer 5 months ago and began chemotherapy and radiation 1 month later. She returned to work part-time as a paralegal 2 weeks after her first round of chemotherapy treatments. Ten days ago, she received her third round of chemotherapy treatment. Her admission diagnosis is to rule out neutropenia.
Initial assessment
1030: VS: T-99.5, P-98, R-24, B/P-112/52, O2-96% on RA. Pain 2/10 in both legs described as aching and intermittent. Pain of 6/10 in the mouth secondary to multiple inflamed areas of her tongue, gums, and hard palate. A&O x4. Lungs diminished in lower lobes, clear upper lobes bilaterally. SOB while wiling to the bathroom. Apical pulse 98 bpm. The abdomen is soft and flat with BS x4. No N/V. Moves all extremities equally. Denies difficulty with urinating or bowel elimination. Capillary refill is <3, pedal pulses 2+ bilaterally, slight edema and redness noted to right calf. She weighs 47kg and is 66 inches tall. She is a full code with an advanced directive in place. Braden's score is 21. The client's CBC is as followsAssessment Update 1843 - The client consumed less than 10% of her dinner and drank only 250ml if water with her meal. She explains that it hurts to swallow or put anything in her mouth. She is complaining of more pain (3/10), which has increased in consistency, in her right calf. She is on call for her ultrasound. The client's husband went home to feed the family dog and call their children to notify them of their mother's hospitalization. Lab results are as follows: CBC BMP WBC - 3000 Na - 138 mEq/L Hgb - 11 K+ - 4.2 mEg/L Hct - 32% Cl - 104 mmol/L Plt - 85,000 CO2 - 26 mmol/L ANC - 650 BUN - 18 mg/dL Blood cultures - pending Creatinine - 0.9 mg/dL Glucose - 72 mg.dL Pre-albumin - 12 mg/dL 11. There is a new graduate nurse orientating on your unit. He asks if you need to take chemotherapy precautions when caring for the client. Explain what hospital-based chemotherapy precautions involve and when they're necessary while caring for patients undergoing chemotherapy treatments.
