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JGH 8NW

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by

Diana Yang

on 9 April 2014

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Transcript of JGH 8NW

JGH 8NW - Medical/Oncology
CD's case

Physical Assessment
Strengths
- A lot of support from friends & family
- Very motivated to walk
- Positive outlook
- Very organized (journal, iPad)


Deficits:
- Lung cancer, mets to liver, right kidney & bones (Femur 7 pelvis)
- L side flank pain not well treated with Dilaudid




CD is at risk for poor quality of life related to chronic cancer & metastasis pain as demonstrated by her pain assessment; constant pain on lower back radiating to her Left thigh; difficulty mobilizing & disturbed sleep patterns


Nursing Interventions

Present Situation
Mrs. CD – 52 y.o. woman
Diagnosis: Lung Cancer (diagnosed: 6/13/13)
Admitted on January 10th, 2014
Reason for hospitalization: 2nd opinion about prognosis, chemotherapy & radiation therapy for cancer.
Confined to bed, 10/10 pain due to immobilization
PMH
Risks
- Decreased mobility
DVT, PE, atelactasis, hypercalcemia, hypotension, muscla atrophy, diminerialization & pressure sores
- Loss of autonomy & self-efficacy
depression & experience more pain
- Depressed respiration, sedation & constipation

Resources
- Her husband & family and friends
- Hospital staff
- Palliative care team
- Her iPad

Thank you for listening :)
Any questions?
Bilateral PE
Constipation
Multiple osteolytic bone metastasis (femur & pelvis)
Metastasis to the kidney and liver
Fracture of T12 & L5 vertebral bodies
Collapse of T7 vertebral body


Acetaminophen 1000mg po every 6hr
Bisacodyl 10mg po bid
Dalteparin
11000units every 24 hrs
Dexamethasone: 8mg po
Dilaudid contin long-acting
30mg po every 12 hr
Colace 100mg po bid
Domperidone 10mg po, 3 times a day
Metoprolol 25mg twice daily
Pantoprozole 40mg po
Scopolamine butylbromide
10mg sc 4 times a day
Dilaudid
8mg po or 4mg sc every 1hr
CNS:
- A&Ox3, PERRLA.
- Communicates effectively with staff

CV:
- HR: 93/min
- BP: 121/79mmHg L arm, supine
- T: 36.9˚C
- PPPx4, cap refill <2 sec on all peripheries. Butterfly on upper arms (for Buscopan & Dilaudid), PICC line on L upper arm

Resp:

- RR: 23/min
- O2 sat: 95% on RA
- GAEB, no advn. sounds
- short & shallow resp during pain.

GI/GU:
- Abdo soft & round, BS x4Q.
- Good appetite with no N/V
- Voiding & eliminating regularly in diaper

MSK:
- Pt turns independently.
- After last radiation Tx, L leg is slightly weaker than right.
- No pain (0/10) when not moving
- Ambulates with severe (7/10) pain if not given Dilaudid prior to mobilization.
mild (3/10) pain when mobilizing with Dilaudid relief


Skin:
- Pink & uniform, no pressure sores & areas of redness

Rest/Sleep
:
- Reports sleeping less since hospitalization.
- Mrs. CD believes pain is a major contribution to disturbed sleep


- Inadequate pain assessment = barrier
- Facial expressions indicate pain
- Pain is a subjective experience

Bone metastasis can cause pain by :
- Substances that demolish the bone and causes it to break
- Harden the bone and cause sclerosis
- Compress nerves

Unresolved pain can cause:
- Suffering
- Physical dysfunction
- Psychosocial distress
- Sleep disturbance
- Decreased mobility
- Further decrease quality of life



- Straightforward responding to thorough pain assessments
- Effective self-advocate (eg: requesting for Dilaudid)
- Enjoyed foot massage and used iPad as distraction
- Increased mobility
- Able to use commode instead of diaper
- CD was discharged and continuing her care with CLSC
References

Negotiated Goal
Medications
Hypothesis
Outcomes
Methodone
Health Issue
Clinical Instructor : Lisa Frick

Hanaa El-Hajj Shufang Liu
Marisa Kanellopoulos Catherine Wong
Rachael Lee Diana Yang
Sharon Liu

Proper pain management to maintain pain less than 3/10 when mobilizing during our shifts.
Full transcript