What patient education does Mr. Jones need from the nurse to help prevent the reoccurrence of an infection and to get treatment for an infection promptly?

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1. Emanuel Jones, 60 years of age, is male patient diagnosed with small cell carcinoma. He underwent surgery in the past to remove the left lower lobe of his lung. He is receiving chemotherapy. Two weeks before a round of chemotherapy, a complete blood count with differential, and a renal and metabolic profile are obtained for the patient. The patient presents to the oncology clinic for chemotherapy with a temperature of 101°F. Further assessment reveals decreased breath sounds in the right base of the right lung, and a productive cough expectorating green colored mucus. The patient is short of breath and has a pulse oximetry reading that is SaO2 of 85% on room air. The patient has a history of benign prostate hypertrophy (BPH) and has complaints of urinary frequency and burning upon urination. The patient is admitted to the oncology unit in the hospital. The oncologist orders the following: blood, sputum, and urine cultures; and a chest x-ray. An x-ray of the kidneys, ureters, bladder (KUB) is ordered. An arterial blood gas (ABG) on room air, CBC with differential, and renal and metabolic profile are ordered. Oxygen is ordered to begin with nasal cannula at 2 L/min and titrate to keep SaO2 greater than 90%. A broad-spectrum antibiotic, levofloxacin 500 mg in 100 mL of NS is ordered to be administered IV over 60 minutes once daily.

  1. After examining the physician orders, in what sequence should the nurse provide the care to the patient admitted to the hospital? Give the rationale for the sequence chosen.
  2. On what areas should the nurse focus the assessment to detect potential complications for Mr. Jones?
  3. What patient education does Mr. Jones need from the nurse to help prevent the reoccurrence of an infection and to get treatment for an infection promptly?

2. The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs.

  1. What does the CNS describe as the goals of chemotherapy?
  2. How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?”
  3. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include?
  4. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program?

What nursing measures should the nurse use to manage the patient’s dyspnea?

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. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort.

  1. What nursing measures should the nurse use to manage the patient’s dyspnea?
  2. The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

2. Ms. Williams underwent a lobectomy for lung cancer 6 months ago, followed by treatment with radiation therapy and chemotherapy. On her most recent visit to the oncologist, she is told that despite the treatments, there is evidence of metastatic disease in her spine. The physician explains that there are no further treatment options, and refers Ms. Rogers to Hospice for continuing care.

  1. What are the underlying principles of hospice?
  2. To be eligible for Medicare and Medicaid Hospice benefits, what information needs to be provided by Ms. Williams’ physician?
  3. Ms. Williams has severe back pain and is concerned whether the hospice will assist with her pain management.

Explain the role of the nurse when implementing the immediate preoperative preparation the day before surgery and the morning of the surgery?

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. Joan Arnold, 67 years of age, is a female patient who underwent a coronary angiogram that diagnosed severe coronary artery disease in three of her coronary arteries, the left anterior descending, the left circumflex, and the right coronary artery. She is scheduled for a coronary artery bypass graft operation tomorrow. The nurse provides patient education for Mrs. Arnold and her husband, which includes watching a hospital video on the operation, the intensive care environment, what to expect after the surgery, the recovery period, and cardiac rehabilitation. The video also covered the importance of coughing and deep breathing, using an incentive spirometer, splinting, early ambulation, pain medication, and how to position oneself safely. The video stressed the importance of not rolling onto the side that the chest tube may be in place postoperatively. The video also discussed the preoperative preparation. The nurse also provided a booklet on the subject material. The nurse had a session with the patient and her husband to assess their understanding and to answer any questions they may have had.

  1. What specific preoperative nursing measures should the nurse review with the patient to help decrease the risk for postoperative complications?
  2. Explain the role of the nurse when implementing the immediate preoperative preparation the day before surgery and the morning of the surgery?

2. The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery.

  1. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?
  2. Why is it important to assess the patient for use of herbal products prior to surgery?

c.The patient asks how surgery could affect her blood glucose; how should the nurse respond?

Explain the role of the nurse in providing patient safety measures during the intraoperative period.

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1. Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years.

  1. What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age?
  2. Explain the role of the nurse in providing patient safety measures during the intraoperative period.

2. Mr. Bond is a 32-year-old Caucasian man who plays professional football. He was admitted for repair of a rotator cuff injury sustained in a game. In excellent shape, Mr. Bond has a muscular build and his body fat is 18%. Mr. Bond is transferred to the operating room, and the anesthesiologist begins to administer general anesthesia. During the induction of anesthesia, Mr. Bond develops tachycardia and dysrhythmias. His condition continues to deteriorate and he becomes severely hypotensive and exhibits decreased cardiac output. The anesthesiologist states that Mr. Bond is developing malignant hyperthermia.

  1. What risk factor does Mr. Bond have for malignant hyperthermia?
  2. What clinical manifestations of malignant hyperthermia does Mr. Bond demonstrate?
  3. Based on the patient’s condition, the surgical procedure is stopped and 100% oxygen is started. Additionally, a muscle relaxant and sodium bicarbonate are administered. What are the rationales for these medications?