Question

The client presents to the Emergency Room with complaints of fever and chills. She is a 57-year-old female with a past medical history of Stage 2 adenocarcinoma of the descending colon who had a bowel resection and creation of a colostomy 10 weeks ago. She has been receiving

intravenous chemotherapy with the last administration being 12 days ago. She has an implanted port in the left chest wall where she has been receiving her chemotherapy. The client states she has not been able to “eat much” due to nausea and sores in her mouth. Upon assessment, the nurse notes the client is very pale, with dry mucous membranes. An inspection of her oral cavity reveals scattered open lesions throughout the oral cavity. The implanted port to the left chest wall is not currently accessed. Lung sounds are diminished bilaterally, and the client has a persistent cough. Bowel sounds are hypoactive and the abdomen is soft. The stoma is pink and moist and there is a lack of stool in the colostomy appliance.

The client is admitted to the medical oor. The client is tearful and states she is concerned about her dog “Pookie” who is home alone. She didn’t realize she would have to “stay here”

Adult Vital Signs

Temperature 102.1 –oral

Pulse 122

Blood pressure 122/71

Respirations 22

Adult Diagnostics Results

Hemoglobin(13.5 -17.5 g/dL) 8.7

Hematocrit (40-45%) 28

WBC (4-11 x103/L) 0.1

Platelets (150-400 x103/L) 110

1. What are the relevant ndings in the case presentation?

2. What are your expectations from the collaboration with the

dietitian, case manager, oncologist, and pharmacist in your case study

Answer 1

1. From the history, vital signs and laboratory findings following interpretations can be made

• Thrombocytopenia (Platelet count: 110x103/L )
• Leukopenia
• Stomatitis
• Nausea
• Respiratory tract infections indicated by diminished breath sound, fever, and tachycardia
• Severe anemia represented by low hemoglobin and hematocrit levels (Hb: 8.7 g/dl, Hematocrit: 28 %)

2. Duty Roles

Dieticians

An immunocompromised diet also called a low-bacterial diet or neutropenic diet may be recommended if white blood cells are very low. This diet is thought to reduce your chances of getting germs from food or because of the way food is prepared.

Avoid raw vegetables and fruits in the diet.

High protein diet with Leafy greens, especially dark ones, are among the best sources of nonheme iron.

Small and frequent diet can be preferable to avoid nausea

Lean meats such as fish, chicken, and turkey are rich in protein, zinc, and Vitamin B12, all of which help increase the blood platelet count.

Case Manager

The patient should be kept in a Positive pressure isolation room to avoid infection

There should be allotted one caregiver at a time

Strictly avoid visitors in the patient's room and keep a board in front of the door to avoid unnecessary entry

Advice all nurses and other healthcare providers to use strict aseptic precautions while handling the patient

Oncologist

The oncologist should review the chemotherapeutic drugs which caused the side effects such as pancytopenia

He should stop the chemotherapy or postpone it if the symptoms continue to worsen

Administer immune booster drugs if needed

Remove the chemotherapy port implanted in the left chest to avoid an immune response

Advice to do culture and sensitivity test blood and sputum to start antibiotic therapy

Administer iron supplements to improve anemia

Administer blood transfusion if required when dietary management and medical management failed to manage the ongoing anemia

Pharmacist

Oncology pharmacists ensure safety in compounding, preparing, and dispensing chemotherapy.

They are responsible for minimizing drug waste, managing drug shortages, and decreasing exposure to hazardous drugs.

Review the drugs which causing following side effects like pancytopenia, nausea and stomatitis