Transcript Here is the Original File - University of New Hampshire

Pharmacology Case Study
Thrombocytopenia, FTT, Metastatic Lung Cancer
Katie Rhoades
University of New Hampshire – Department of Nursing
Situation
Core Client Variables
Client Demographics
58 year-old Female
White/Caucasian
Height: 5’4’’
Weight: 213 lbs.
BMI: 36.6
DNI/DNR
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Assessment
VS
4/12/15 4/13/15
Temp.
37.0 C 36.2 C
HR
RR
BP
SpO2
95
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Smoker
Lives alone in disability housing
Obese
Divorced
Sedentary lifestyle
Maternal history of dementia
Paternal history of Coronary Heart
Disease
Lab Values
Client has stage IV breast cancer
Client has poorly differentiated non-small cell lung cancer in left upper lobe, stage IV
Client has completed 4/6 cycles of palliative chemotherapy **
Client was hospitalized two weeks prior for anemia, which required a blood transfusion;
client left hospital against medical advice
Sodium
142
Potassium
2.8 L
Chloride
100
Carbon Dioxide
34 H
Anion Gap
8.0
Glucose
83
BUN
6L
Creatinine
0.58
Magnesium
1.0 L
WBC
9.0
RBC
2.99 L
HGB
8.7 L
HCT
26.8 L
Failure To Thrive (FTT)
MCV
89.7
Decreased ability to adapt to change
Increased need for care or feelings of helplessness
Illness of chronic health problems
Side effects from certain medications
Decreased appetite
Lack of interest
MHC
29.1
RDW
17.3 H
HDW
3.7 H
PLT
51 L
MPV
10.5
Absolute NEUT Count
7.91
NEUT %
88 H
Lymph %
5L
Client presents to ED on 4/13/15 with weakness
Abdominal CT scan shows an adrenal mass and interval hemorrhage
Client required 7 units of platelets
Palliative radiation currently to stop bleeding
Medications
96
18
18
146/84 132/72
99%
Hospitalization
97%
Comorbidities/Past Medical
Hypertension
Hypothyroidism
Dyslipidemia
Anemia
Eczema
Left-sided sciatica
3 normal pregnancies
Post-Traumatic Stress
Disorder
Anxiety
Drug
Dose
Route
Frequency
Class
Docusate
Sodium
100 mg
PO
BID
Laxative
Folic Acid
1 mg
Daily
Vitamin
Levothyroxine
224 mcg
PO
Daily
Thyroid
Hormone
Ondansetron
Hydrochloride
8 mg = 4 ml
IV
Q8HRS
5-HT3
Receptor
Antagonist
Pantoprazole
Sodium
40 mg = 1 vial
IV
BID
Dose
Route
Frequency
Class
Acetaminophen
650 mg
PO
Q4-6HRS
Paraaminophenol
derivative
Albuterol Sulfate
180 mcg
Inhalation
Q4HRS
Bronchodilator
Diphenhydramine
HCl
25 mg
PO
Q6-8HRS
Antihistamine
Oxycodone
5mg or 10 mg
PO
Q4-6HRS
Opioid
analgesic
Tramadol
50 mg
PO
Q6HRS
Narcotic
Drug
Dose
Route
Frequency
Class
Potassium
Chloride
40 mEq
PO
Q4HRS
Magnesium
Sulfate
50 ml
IV
Once
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Proton Pump
Inhibitor
Drug
Thank You
A special acknowledgement to Mrs.
Nancy Doyle, the nursing staff on 3
West at SNHMC in Nashua, NH,
and my fellow peers of Cohort 12.
PO
Electrolyte
Supplement
Mineral
References:
1. Liebman, H.A. (2014). Thrombocytopenia in cancer patients. Thrombosis Research, 133(2), 63-9. doi: 10.1016/S0049-3848(14)50011-4
2.
Higgins, P.A. (2005). Adult failure to thrive in the older rehabilitation patient. Rehabil Nurs, 30(4), 152-9.
3. Aschenbrenner, D.S., & Venable, S.J. (2012). Drug therapy in nursing. Philadelphia, PA: Lippincott Williams & Wilkins.