Case Study And A Oncology Health Assessment

Case Study And A Oncology Health AssessmentThis fount study concerns a patient, Mrs. Singh who is diagnosed with stomach mountaincer and is being managed with chemotherapy. Mrs. Singh, a 78yr. obsolescent female, presents to the oncology center with the chief complaint of feeling weak and hugging the sea fence while passing playing. Mrs. Singh is a known diabetic, and was accompanied by her daughter to the clinic.A thorough focused headness history accompanied by a focused physical examination was through with(p) to incur possible treat diagnosis related to to Mrs. Singhs presenting complaints, modern diagnosis, and treatment used presently.Health narrativeUsing COLDSPA, this information obtained provide forfeit for a focused health history of the presenting problem. (Weber Kelly 2007) Patients vital signs result be assessed temperature, pulse, relationship pressure, respiration and typesetters case O saturation. Blood pressure in lying, sitting and standing pass on be assessed. If needed, ( both nasal flaring, use of accessory muscle of respiration or fuss breathing) oxygen via nasal hindquartersnula forget be administered.The character of the flunkThe intrusion when did the weakness begin, is it better or worsened since it began?Location where exactly is the weakness, does it penetrate to other dampens of the body?Duration how long does the weakness last, does it regress?Severity how bad is it on a scale of 1-10?Pattern what makes it better, what makes it worse?Associated factors what other symptoms accompany the weakness, is it possible to do work or secure in other activities much(prenominal) as leisure/exercise during this? (Weber Kelly 2007)A biographical data is part of the health history, and would be obtained prior to get into the center (see Appendix). However, key features that the book takes into account allow be discussed. helplessness corporation be caused by a variety of medical exam conditions, such as d ehydration, stroke, myasthenia gravis (or other autoimmune dis dictates), electrolyte disturbances, anemia and infections. The obtaining of a current medical history and family history is vital in order to bind other possible complications directd. (McGraw Hill Medical 2010)Assessment impart be directed towards neurological (combining musculoskeletal and peripheral), cardiovascular, and gastrointestinal systems (including nutritional). (Merck Manual 2010)Health annalsMrs. Singhs chief complaint is a history of weakness, being unable to fling without hugging the fence in. This weakness, according to Merck Manual (2010), may be due to the disease process of stomach genus Cancer, diabetes mellitus as sound as from the chemotherapy that she is presently having.Mrs. Singhs age, is an property that she is postmenopausal, (Manson 2008), which back tooth besides contribute to her being weak as intimately as the possibility of hormonal treatment she may be receiving. (Nationa l found of Aging 2010)An inability to stand for long periods of time due to weakness is in any case a presenting symptomatology of menopause, according to Mayo clinic (2010)Mrs. Singh is a diabetic this can cause weakness, due to diabetic polyneuropathy. However knowing the type of diabetes Mrs. Singh has will also assist the nurse in verifying the drugs Mrs. Singh is presently taking. hypoglycemia can also present as weakness. These symptoms can be also related to an overdose of insulin (if insulin dependent) or other hypoglycemic agents as well as not eating on time. Blood glucose monitoring via a Diascan would be done at this point in time. Renal intimacy will also be assessed as this may be secondary to DM. Electrolyte blood values will be assessed (Merck Manual 2010)Mrs. Singh is diagnosed with stomach pubic louse. while of diagnosis as well as the management for the stomach cancer will be taken as part of the health history. This is truly important, as the patient with stomach cancer may have had various types of surgery done to treat this. Also the staging and grading of the cancer is important to verify the possible metastatic sites. Endoscopic mucosal resection, subtotal or total gastrectomy with or without lymph node removal may cause complications afterwards, such as abdominal pain, gastro esophageal reflux, weakness related to vitamin deficiencies and inabsorption. (American Cancer parliamentary procedure 2009)Another study showed postoperative complications for stomach cancer resulted in cardiovascular complications, hemorrhaging, septic shock, anastomotic leakage and abdominal and wound infections. (Japanese Journal of clinical oncology 2010)Dumping syndrome can also result in extreme weakness, which may result from surgery for stomach cancer. This occurs as there is a fast movement of nutrients directly into the small intestine. (Merck Manual 2010)The type of chemotherapy that Mrs. Singh is presently having as well as her compliance to it is also taken as part of the history. Chemotherapy drugs used for stomach cancer are FluorouracilDoxorubicin, Epirubicin, methotrexate, Etoposide, Cisplatin, Irinotecan, Paclitaxel, Docetaxel, Mitomycin C, Vinblastine, Cyclophosphamide, Cytarabine and Vincristine. Knowing the type of chemotherapy drug is relevant to assessing and monitoring possible side effects, even though most chemotherapy agents causes severe bone marrow depression tone downing to anemia. Methotrexate can lead to central neurotoxicity, Vincristine, peripheral neuropathy unneurotic with Vincristine can cause serious weakness.(BC Cancer do drugs Agency 2006)Cisplatin may lead to ototoxicity do problems with balance, which Mrs. Singh may have as she is holding on to the wall to walk. Neurotoxicity is also caused by this drug, and may also contribute to severe weakness. Doxorubicin may cause cardiovascular abnormalities which may present as myocardial infarctions, causing weakness, an inability to stand and w alk without assistance. This is treated as a medical emergency. Hence during cardiac assessment, a 12 lead ECG should be done to assess heart rhythm for pending supraventricular tachycardia, myocardial infarctions or other dysrhythmias.(BC Cancer Drug Agency 2006)Neurological assessment aim of consciousness, posture and body movement will be assessed. A pip will then be obtained (G.C.S) in order to ascertain Mrs. Singhs neurologic status. Cranial nerve assessment will then be performed together with posture, all reflexes, mood, speech, facial expression and cognitive status. (Weber Kelly 2007)This will allow the nurse to ascertain whether the weakness is due to a neurological problem, as Mrs. Singh is a known diabetic. The use of the chemotherapeutic drugs can also affect her neurological status as well, hence the importance of this assessment. Observations for any stroke or history of same will be done. Drooping of face or any side of the body will be assessed for.Since Mrs. Sin ghs balance is affected, a thorough assessment for balance, using the Rombergs test would be done. (BC Cancer Drug Manual 2006)Gait and balance, together with strength of muscle and tone will be assessed. Nutritional assessment Patient will be assessed for anorexia, dyspepsia, freight loss, abdominal pain, constipation, anemia, nausea and vomiting as these may all be related to the weakness she is experiencing. The daughter will be asked to answer as well as Mrs. Singh. (Weber Kelly 2007)Cardiovascular assessmentObservation of the jugular veins for venous pulse and pressure would be done. Carotid arteries would be ascultated for bruits and palpated to determine the pulse. This can indicate hypovolemia, if the pulse is weak and may be associated with weakness. (Health Medicine 2010)The precordium will be inspected for any pulsations. Any heaves, lifts observed on the precordium, and abnormal pulsations palpated, may be an indication of an enlarged ventricle from an overload of work . This can be caused by chemotherapy agents such as doxorubicin (cardiotoxicity). Mrs. Singh being a diabetic as well could develop cardiac complications secondary to the diabetes. (Cecil 2002)Auscultation of heart rate, rhythm, heart sounds and duplicate heart sounds may be an indication of cardiac abnormalities such as aortic regurgitation. (Weber Kelly 2007)Nutritional status will be assessed, which will involve what is her daily intake food and fluid, her weight will be assessed and compared to her service line weight. Mrs. Singhs intake and output will be assessed in the last 24 hours with any supplements/ vitamins taken. For a vitamin deficiency can lead to peripheral neuropathy. Patients blood values as per laboratory chart will be assessed haemoglobin levels, WBC count platelet levels for any abnormalities. Can pt. tolerate a full diet or what is the intake, what food can she eat or any changes in eating habits as well as comportment of mucositis. Skin, hair and nails w ould also be assessed for dehydration. The patient will be asked if any bleeding was observed in stools. The nurse will assess secluded blood in laboratory reports. (Weber Kelly 2007)Observation of body build, muscle stilt and fat distribution will be taken in accordance of rights to weight and height. (Body mass index). Assessment of Mrs. Singhs skin for turgor, moisture and venous fill will show fluid volume status. Observation of the neck veins will also nominate fluid volume status. The tongue will be observed for hydration (furrows), as well as, the eyes position and coloration for signs of dehydration. palpation of the eyeball will verify any dehydration. Auscultation of lung fields will identify any fluid present in the lung. (Weber Kelly 2007)Inspection of stomachThe abdomen will be observed for colour. A purple discoloration of the flanks will indicate bleeding within the abdominal wall. Abdomen will be inspected for jaundice (yellowing),paleness, swelling, hernias, abdominal movement, contour, symmetry, striae, vascularities, scars, lesions and rashes as well as, aortic palpations and peristaltic waves. Umbilicus will be inspected for colour, deviation from midline, contour. (Weber Kelly 2007)Auscultation of bowel sounds, vascular sounds and friction rubs over liver-colored and spleen will be done. Absence of bowel sounds can ascertain any abdominal surgery being done or can be an emergency. Bruit over abdominal aorta, renal, femoral or iliac arteries may indicate an aneurysm. Friction rubs heard over liver or spleen may indicate metastases. (Weber Kelly 2007)Percussion of the abdomen is done for tone. dullness over the liver or spleen may indicate megalohepatia or splenomegaly. Measuring the span of liver and spleen will also allow the nurse to assess any decrease or gain in size from the normal. Light and deep palpation of the umbilicus, liver, aorta, spleen and kidneys would allow any masses to be verified which may be related to tumor growth or presence, aneurysms or metastases. Shifting dullness and fluid wave test will be done. (Weber Kelly 2007)Possible Nursing diagnoses helplessness related to diabetic polyneuropathy and side effects of chemotherapy (anemia) as evidenced by displayed weakness.Imbalance related to chemotherapy side effects as evidenced by pt. inability to stand.Nutritional imbalance less than body requirements related to chemotherapy or G.I. surgery as evidenced by displayed weakness.Impaired physical mobility related to impaired balance as evidenced by Mrs. Singh hugging the wall to walkPowerlessness related to chemotherapy and inability to perform activities of daily donjon as evidenced by inability to maintain balance and walk (RN CENTRAL 2010)ConclusionA thorough health assessment of Mrs. Singh was done which included a focused health history as well as a focused physical assessment in order to formulate nursing diagnoses for appropriate nursing interventions and referrals to be made as immediate as possible. This allowed for the chief complaint to be logically canvas for a plan of care to be developed for Mrs. Singh. A framework was provided (COLDSPA) as well as, scientific literature to validate all assumptions made.