CASE STUDY 11,12,13,14,15 - Ellie Long, a 55-year-old patient, presents to the pain clinic
11. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of fibromyalgia syndrome. The nurse at the clinic obtains a history and physical assessment of the patient.
a. On what areas should the nurse concentrate when interviewing the patient during the history process?
b. On what areas should the nurse concentrate when assessing the patient?
c. What diagnostic tests are used with fibromyalgia syndrome?
12. Julie Walker, a 22-year-old patient, is newly diagnosed with systemic lupus erythematosus (SLE). She presented with extreme fatigue; muscle and joint aching and swelling; a butterfly-shaped, flat, red rash across the bridge of the nose; patchy alopecia; a low-grade fever; and loss of appetite. Further workup revealed a positive antinuclear antibodies (ANA) titer, anemia, leucopenia, and mild thrombocytopenia. She has an abnormal lipid profile, proteinuria, and hypertension. The liver and renal profiles are within normal range. The physician ordered over-the-counter ibuprofen as needed for joint discomfort, but not to exceed 1,200 mg/day; hydroxychloroquine sulfate (Plaquenil) before meals at the same time each day; and prednisone in tapering doses over the next month. The physician also started the patient on lisinopril, an ACE inhibitor for the hypertension and a statin for the elevated lipids. The clinic nurse is asked by the physician to provide patient and family education.
a. What teaching-plan topics should the nurse provide for the patient?
13. John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple myeloma. He present with a spinal fracture of the fifth lumber vertebrate. The patient is schedule for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolystic lesions are seen in x-ray skull, vertebrae, and ribs. The patient has hypercalcemia.
The patient's uric acid level is elevated. The patient has orders for zoledronic acid (Zometa), thalidomide (Thalomod), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin.
a. What nursing management should the nurse provide the patient?
b. Explain the indication and of the various medication ordered to treat the patient's symptoms.
14. Susan Clare, age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last two months and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation.
a. What laboratory results would you anticipate due to her ecchymosis and petechia?
b. Why would it be important to inspect her gums and teeth?
c. Why is her liver enlarged?
15. George Smith is 55 years of age and is a male patient who is admitted to the intensive care unit after a thoracotomy approach was used for an esophagectomy to remove an early stage adenocarcinoma of the distal esophagus and gastroesophageal junction. The patient has a history of GERD and Barrett’s esophagus. The patient sought medical treatment for dysphagia with solid foods and feeling that there was a lump in his throat and substernal pain with swallowing and subsequent regurgitation of undigested food and the development of hiccups. The patient has no other medical problems.
a. Describe the esophageal cancer that Mr. Smith has and how it relates to his history of GERD and Barrett’s esophagus.
b. Explain the rationale for the early symptoms and late symptoms of esophageal cancer.
c. What course of cancer treatment should you, the nurse anticipate that Mr. Smith would have?
d. What nursing care should be provided for Mr. Smith in the intensive care unit in the early postoperative period?
e. Explain the care the nurse should provide when Mr. Smith begins to eat.