TOPIC: PHARMACOLOGY Instructions: 1. Thoroughly review the clinical case presented below. 2. Formulate and discuss the nursing diagnosis. 3. Formulate and discuss the nursing care plan. 4. Using references from recently published peer-reviewed journal articles, discuss aspects of the pharmacology of the drugs of choice for treating this patient. HPI: 55-year-old J.D. male presents to the oncology clinic with severe pain in his lower back and right hip which started one week ago. He describes the pain as constant, dull, and achy, with intermittent sharp shooting sensations, which have significantly worsened over the past week. He rates the pain on a scale of 9/10, and is made worse with movement, especially walking and standing and has some relief with rest and changes in position. J.D. reports increased fatigue, reduced appetite, and disturbed sleep due to the pain. PMH: J.D. has a history of Stage IV Lung Cancer: Diagnosed a year ago with metastases to bones and liver and experiences episodes of pain intermittently, for which he usually takes over-thecounter pain medications. He has been attending regular clinic visits for disease monitoring and symptom management. PSH: radiation therapy to the chest for palliation Medications: underwent several cycles of chemotherapy with cisplatin and etoposide (anticancer medications) and acetaminophen for painful episodes. Allergies: none reported. Family history: Father – died of lung cancer, Mother – Diabetes, siblings – healthy Social History: previous 30-pack a year smoker, stopped smoking 10 years ago, does not drink alcohol, diet – balanced. Physical Examination: Vitals: Temp: 37.2 C (98.96 F), P 100 bpm, RR 18/min, BP 130/90 mmHg General Appearance: A middle-aged male is seen emaciated and appears significantly fatigued. He is grimacing and sweating profusely due to pain. Inspection: No visible deformities or skin changes noted in the lower back or right hip region. Palpation: Severe tenderness is noted over the lower lumbar spine and the right hip joint with limited range of motion due to pain, especially with hip flexion and extension. No palpable masses or lumps. Neurological Examination: Oriented x 3. Motor strength is preserved in all limbs. No sensory deficits are noted. Reflexes are normal. CVS: All peripheral pulses are regular. S1 and S2 heard. No peripheral edema. Abd: Flat abdomen. Bowel sounds active. Soft, non-tender. LS 9 cm. DRE deferred. Investigations: Laboratory Tests: Complete Blood Count (CBC): Hemoglobin: 11.5 g/dL (normal range: 13.5-17.5 g/dL) White Blood Cell Count: 6,200/mm³ (normal range: 4,500-11,000/mm³) Platelet Count: 210,000/mm³ (normal range: 150,000-450,000/mm³) Comprehensive Metabolic Panel (CMP): Serum Creatinine: 1.0 mg/dL (normal range: 0.7-1.3 mg/dL) Alanine Aminotransferase (ALT): 38 U/L (normal range: 7-56 U/L) Aspartate Aminotransferase (AST): 45 U/L (normal range: 10-40 U/L) Serum Alkaline Phosphatase: 320 U/L (normal range: 44-147 U/L) Serum Calcium: 10.5 mg/dL (normal range: 8.5-10.5 mg/dL) Imaging: CT Scan of the Spine and Hip: Ordered to evaluate the extent of bone metastases and assess for any pathological fractures.
TOPIC: PHARMACOLOGY
Instructions:
1. Thoroughly review the clinical case presented below.
2. Formulate and discuss the nursing diagnosis.
3. Formulate and discuss the nursing care plan.
4. Using references from recently published peer-reviewed journal articles, discuss aspects of
the pharmacology of the drugs of choice for treating this patient.
HPI:
55-year-old J.D. male presents to the oncology clinic with severe pain in his lower back and right
hip which started one week ago. He describes the pain as constant, dull, and achy, with
intermittent sharp shooting sensations, which have significantly worsened over the past week.
He rates the pain on a scale of 9/10, and is made worse with movement, especially walking and
standing and has some relief with rest and changes in position. J.D. reports increased fatigue,
reduced appetite, and disturbed sleep due to the pain.
PMH: J.D. has a history of Stage IV Lung Cancer: Diagnosed a year ago with metastases to bones
and liver and experiences episodes of pain intermittently, for which he usually takes over-thecounter pain medications. He has been attending regular clinic visits for disease monitoring and
symptom management.
PSH: radiation therapy to the chest for palliation
Medications: underwent several cycles of chemotherapy with cisplatin and etoposide (anticancer medications) and acetaminophen for painful episodes.
Allergies: none reported.
Family history: Father – died of lung cancer, Mother – Diabetes, siblings – healthy
Social History: previous 30-pack a year smoker, stopped smoking 10 years ago, does not drink
alcohol, diet – balanced.
Physical Examination:
Vitals: Temp: 37.2 C (98.96 F), P 100 bpm, RR 18/min, BP 130/90 mmHg
General Appearance: A middle-aged male is seen emaciated and appears significantly fatigued.
He is grimacing and sweating profusely due to pain.
Inspection: No visible deformities or skin changes noted in the lower back or right hip region.
Palpation: Severe tenderness is noted over the lower lumbar spine and the right hip joint with
limited range of motion due to pain, especially with hip flexion and extension. No palpable
masses or lumps.
Neurological Examination: Oriented x 3. Motor strength is preserved in all limbs. No sensory
deficits are noted. Reflexes are normal.
CVS: All peripheral pulses are regular. S1 and S2 heard. No peripheral edema.
Abd: Flat abdomen. Bowel sounds active. Soft, non-tender. LS 9 cm. DRE deferred.
Investigations:
Laboratory Tests:
Complete Blood Count (CBC):
Hemoglobin: 11.5 g/dL (normal range: 13.5-17.5 g/dL)
White Blood Cell Count: 6,200/mm³ (normal range: 4,500-11,000/mm³)
Platelet Count: 210,000/mm³ (normal range: 150,000-450,000/mm³)
Comprehensive
Serum Creatinine: 1.0 mg/dL (normal range: 0.7-1.3 mg/dL)
Alanine Aminotransferase (ALT): 38 U/L (normal range: 7-56 U/L)
Aspartate Aminotransferase (AST): 45 U/L (normal range: 10-40 U/L)
Serum Alkaline Phosphatase: 320 U/L (normal range: 44-147 U/L)
Serum Calcium: 10.5 mg/dL (normal range: 8.5-10.5 mg/dL)
Imaging: CT Scan of the Spine and Hip: Ordered to evaluate the extent of bone metastases and
assess for any pathological fractures.
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