answer in number 11 and 12
SCENARIO
M.D. is a 50-year-old woman whose routine mammogram showed a 2.3 × 4.5 cm lobulated mass at the 3:00 position in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with infiltrating ductal carcinoma that was both estrogen and progesterone receptor positive. The staging workup was negative for distant metastasis. Her final staging was stage IIB. She had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 11 of 16 lymph nodes were positive for tumor cells. An implanted port was placed during surgery. She is prescribed a chemotherapy regimen of six cycles of CAF (cyclophosphamide [Cytoxan], fluorouracil [5-FU], and doxorubicin [Adriamycin]).
Describe the biopsy technique used to diagnosis M.D.'s cancer.
Discuss the implications of a positive sentinel node.
Using the TNM staging system, what would her classification be?
What is the significance of her hormone receptor status?
Surgical intervention is the primary treatment for breast cancer. Describe the surgical procedure that M.D. had.
M.D. asks you why she has to have chemotherapy with so many drugs if the surgeon removed all of the cancer. How would you respond?
Compare the drug actions of cyclophosphamide (Cytoxan), fluorouracil (5-FU), and doxorubicin (Adriamycin).
List any side effects and special considerations associated with the use of CAF.
M.D. is ordered doxorubicin at 75 mg/m2. Her height is 5 feet, 7 inches, and her weight is 155 pounds. Calculate the dose she will receive.
You have finished teaching M.D. regarding the effects of CAF. You know that she understands instructions regarding cyclophosphamide (Cytoxan) when she states:
“This medication should be taken with food.”
“I will drink 2000 to 3000 mL of fluids each day.”
“Taking this drug at nighttime will reduce nausea.”
“I will increase my intake of foods with potassium.”
CASE STUDY PROGRESS
M.D. has now completed three cycles of CAF. Her last treatment with doxorubicin, cyclophosphamide, and 5-fluorouracil was approximately 12 days ago. She comes to the emergency department with a 2-day history of fever, chills, and shortness of breath. On arrival, she is disoriented and agitated. Vital signs are 86/43, 119, 28, 103.6° F (39.8° C), Sao 2 85% on room air. Chest x-ray demonstrates diffuse infiltrates in the left lower lung. Her chem 14 is within normal limits, with the exception of BUN 28 mg/dL, creatinine 1.6 mg/dL, and lactic acid 2.4 mg/dL.
Chart View
Complete Blood Count
WBC 1200/mm3
Neutrophils 34%
Segmented (Polys) 30%
Bands 4%
Lymphocytes 60%
Monocytes 3%
Eosinophils and basophils 2%
Hct 24.9%
Hgb 8.7 g/dL
Platelets 85,000/mm3
Interpret M.D.'s CBC results.
Calculate M.D.'s absolute neutrophil count (ANC) and describe its significance.
What is the single most important nursing intervention for a patient with an ANC less than 500/mm3?
What are the probable causes of the abnormal laboratory findings listed previously?
What is the significance of the lactic acid level?
What treatment do you anticipate for M.D.?
The physician orders a 500-mL normal saline bolus now, with orders to infuse over 2 hours. You decide to use M.D.'s implanted port for IV access. After accessing the port and connecting the fluid, the infusion pump alarms that the line is occluded. What will you do?
CASE STUDY OUTCOME
M.D. requires endotracheal intubation and spends 3 days in the ICU receiving antibiotics and respiratory support. She is able to be extubated and returns to the oncology unit, where she remains for a few more days before being discharged to home.
