Scenario: At the family medicine practice where you are a nurse, you are taking care of Nosmo King, a 76 year old African American, who has arrived for his annual check-up. After being evaluated by his physician, Mr. King asks you why his physician thinks that he might have cancer. You base your answer on what information and/or symptoms that may appear in the chart? 1. The physician explains to Mr. King the possible diagnostic tests that will be used to determine a cancer diagnosis. What explanations did the physician give for the following tests: Tumor Markers –PSA – CEA – AFP – X-ray – CT Scan – MRI – PET Scan – Ultrasound – 2. During a follow-up visit, the physician reports to Mr.
King that his tests indicate he has a malignant tumor on his left kidney. As he tries to internalize the troubling diagnosis, you are there to lend support and answer his information-seeking questions to the best of your ability. How would you address his question, “What could have caused this cancer? ” What questions would you ask Mr. King to help potentially identify the cause? 3.
How does the physician explain the difference(s) between malignant and benign tumors to Mr. King? 4. Mr. King has been told that his tumor is a T2, N0, M0. What does this mean? What is the purpose of the TNM system? 5. The physician tells Mr. King that the next step is to grade the tumor. What does this mean? How is grading done? 6. The physician tells Mr. King that surgery of the primary tumor is a possible treatment option. List and define the four types of surgery used for cancer. What type of surgery is most appropriate at this point for Mr. King?
1. 2. 3. 4. 7. After surgery, further evaluation determines that the tumor has metastized to his lungs. In your own words, explain the process of metastasis. 8. Mr. King is now facing treatment with radiation therapy and chemotherapy. Summarize both radiation therapy and chemotherapy. What are the nursing responsibilities with each treatment? What are the major side effects? 1. Radiation: 2. Chemotherapy: 9. 10 days following Mr. King’s hospital stay for chemotherapy, blood work is drawn in the office and the results are as follows: • Hemoglobin: 8.
5 g/dL • Hematocrit: 25% • Red blood cells: 2. 3 (x106/uL) • White blood cells: 2. 8 cells/mm3 • Platelets: 45,000 cells/mm3. What do these results indicate? What education should you give Mr. King at this time? Are there any possible treatments for these lab results? 10. What is Hematopoietic Stem Cell Transplant? When is it recommended? Is Mr. King a candidate for HSCT? 11. What is the purpose of targeted therapy? How does a biologic response modifier work? 12. After battling his cancer to no avail, Mr.
King is placed on hospice. How do you explain the concept of hospice to Mr. King and his family? 13. Mr. King’s family is concerned about being diagnosed with cancer after watching his difficult struggle. What are the levels of prevention? Which level is appropriate for the family at this point? What education will you provide the family about prevention strategies and what methods can you use to educate them? 14. What are Nursing Health Problems and associated interventions that can be applied to the client with cancer?