Question

Mr. DeVito is a 48 old male who presents to his Primary Care Provider with left upper abdominal pain and complain of weakness and fatigue. The nurse immediately notes how pale his skin. A full set of vitals reveals the following: HR 82bpm, BP 142/90 mmhg, RR 16bpm, Spo2 94 on room air, Temp 101.0 F

What further Nursing Assessment would you perform at this time?

Upon further assessment, the nurse notes a palpable mass in the left upper quadrant, possible an enlarged spleen that is tender on

palpation. THe nurse also notws perechia and bruising to the patient’s arms and legs. When questioned the patient says “I seem to bruise so easily these days”. The patient also reports slight headache.

What laboratory or diagnostic tests do you anticipate the provider ordering?

Mr DeVito will start on high dose chemotherapy.

What education topics should be included in teaching for Mr. DeVito and his wife?

Answer 1

1. The initial assessment reveals that the patient has fever. Mostly fever occurs as a result of any underlying infections in the patients body. So the priorty at this stage should be given to reduce the fever. Fisr of all, the patient sould be given a comfortable possition. Since he has fever, and complaints of upper abdominal pain, the nurse should suspect that, about the enlargement of any of the organs which is present on the left side. So, immediately, the nurse should inform the doctor about the conditions of the patient. Then she can focus on mesures to reduce fever, such as tepid sponging and checking of the temperature frequently.Careful observation and monitoring of the patient should be done and detailed examination of the patiet should be done.

2. In this stage, sincepatient was noticed to have spleenomegaly, This enlargemet may be due to various contributing factors such as infections(viral, bacterial, parasitic etc)diseases affecting the liver,blood cancers, various types of hemolytic anemia etc.Patient compaints all symptoms assosciated wth this spellenomegaly.Snce an enlarged spleen,reduce the umber of heathy cells and trap too may platelets, the nurse should sent blood tests such as complete blood count to check RBCs, WBCs and platelets. In addition ULTRASOUND OR CT to know the size of the spleen and to know wheter it is crowding other organs and MRI to know the blood flow to the spleen. Sometimes liver function test and bone marrow examination is also done.

3.Since patient will stat chemotherapy, before that the patient should be made aware about the chemotherapy regimen and how it works. The nurse will expalin about the medications prescribed for this patient and explan about the purpose, side effects etc.Side effects managemnt tools to be provided to minimise the issues during treatment. The nurse should explain about the importance of self care- while they are under the treatment.Educate the patient that during the treatment time the patient should eat nutritiously and to do exercise Some relaxation techniques can be also taught to the patient to overcome the side effects that they experience.