Question

1. What pharmacologic interventions do you expect will be ordered for this patient? What routes of administration will be best indicated for this patient? (Include mechanism of action, indication for use and desired outcomes)
2. What are the nursing implications for the above listed pharmacologic treatments (teaching pearls, things to anticipate, adverse reactions)?

Gladys Young is a 68 year old female that resides in an Independent Living facility with her husband. She presents to her primary care physicians office with complaints of fever, chills, nausea and vomiting. She also states that she has had some mild hemoptysis occasionally with her persistent coughing. She has recently completed treatment with Chemotherapy for Breast cancer and is concerned that she may have an infection. You are the nurse caring for her.

You complete the following assessment:

Subjective Data:

She is able to complete a sentence in its entirety, but she is persistently coughing during the history. She is a former smoker, she smoked ½ pack of cigarettes per day for 30 years and quit when she was diagnosed with breast cancer 6 months ago. She denies shortness of breath or chest tightness. She has not yet gotten her influenza vaccine, but did receive the Pneumovax vaccine last year. She has had problems with persistent coughing at night which has prevented her from getting a good night’s sleep for the past two weeks. She also states that she has been waking up soaked in sweat in the morning.

Objective Data:

• Temp – 38.6 C; HR – 132 beats/min; RR—28; BP – 168/87; O2 sat – 90% on Room Air
• Auscultation: Lungs with faint crackles at bases bilaterally. No wheezing present.
• Patient is flushed and warm to touch.

Answer 1

1. PHARMACOLOGIC INTERVENTION:---

**Patient have complain of hemoptysis with persistent cough -

• Monitoring the vital parameters --- Registration of pulse oximetric o2 saturation.

• Sedation / anxiilysis -- calming of the patient , facilitation of diagnostic and therapeutic.

• Give oxygen-- improvement of oxygenation .

• Bleeding cessation.

• Aspiration prevention .

** Patient complain with nausea and vomiting--

• Drink or consume water, sports drinks, fluid and electrolytes.

• Start a BRAT diet--

B- Banana

R- Rice

A- Apolesauce

T- Toast

** For fever and chills--

• Sponging the body with lukewarm water or taking a cool shower may help reduce fever .Cold water however , may trigger an episode of chills .

• OTC ( over the counter ) medication can lower a fever and fight chills such as --

- Aspirin

- Acetaminophen

- Ibuprofen

** For the breast cancer --

• Its treatment depends on the stage of cancer. It may consist of chemotherapy , radiation, hormone therapy and surgery.

• Medical procedure -- chemotherapy, radiation therapy.

• Surgical procedure-- lupectomy, partial mastectomy, radial mastectomy.

• Medicine-- Estrogen modulators , chemotherapy, hormones based chemotherapy.

• Complementary therapy-- yoga, massage, acupuncture.

2. DISCUSSED OF CHEMOTHERAPY:--

• Route-- IV , some drugs can be taken in pills or capsule forms .

• Mode of action -- Chemotherapy is the use of drugs to destroy cancer cells . It works by keeping the cancer cells from dividing , growing more cells. Chemotherapy has more of an effect on cancer cells.

• Indication to use --

- To cure the cancer without other treatment .Chemotherapy can be used as the primary or sole treatment for cancer.

- To ease sign and symptoms.

- After other treatment to kill hidden cancer cells.

• Desired outcome-- chemotherapy drugs kill fast growing cells. But because these drugs travel throughout the body, they can affect normal, healthy cells that are fast growing.

3. NURSING IMPLICATIONS:--

• Patient specific information-

- Review what to expect the first day of treatment.

- Safety information about safe driving, no perfume or odorous foods .

-Verify height and weight.

- Confirm allergies.

• Treatment regimen--

- Review chemotherapy tip sheet.

- Review Chemotherapy regimen .

- Perform IV assessment.

- Common side effects.

• Adverse reactions--

- Fatigue

- Hair loss

- Infection

- Sores and pain with swallowing

-Easy bruising and bleeding