Acute Care iHuman Week 9 plan

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i-human Management Plan Patient: Betty Burns, 53 y.o., 5’6”, Primary Diagnosis: Metastatic Cancer (from breast) Familial and past medical history points to a strong likelihood of the pt’s bre... ast cancer metastasising to the bone. Further pointing to this are the pt’s complaints of fatigue, unintended weight loss, and night. Bone is the most common site of breast cancer metastasis reported in up to 70–80% of patients with metastatic disease. It is associated with significant morbidity, including bone pain, hypercalcemia, pathologic fractures and spinal cord compression—an oncologic emergency causing pain and potentially irreversible neurologic loss (Anderson et al., 2017). The cord compression is confirmed by spinal x-ray. Secondary Diagnosis: Radiculopathy Status/Condition: Critical Code Status: FULL Allergies: NKDA Admit to Unit: Telemetry Unit Activity Level: Diet: Balanced Critical Drips: Respiratory: 100% O2 Medications: HCTZ, Fluticasone/Salmeterol, Prednisone PRN severe asthma attack, Albuterol inhaler Nursing Orders: - Initiate Short-Acting Opioids in Opioid-naive patients - IV Bolus 2mg IV morphine sulfate - reassess effect at 15min - On assessment, if the pain score remains unchanged or is increased, administration of 50% to 100% of the previous rescue dose of opioid is recommended. - If the pain score decreases to 4 to 6, the same dose of opioid should be repeated and reassessment performed every 15 minutes. This study source was downloaded by 100000830772748 from CourseHero.com on 07-05-2022 04:22:46 GMT -05:00 https://www.coursehero.com/file/69058666/Acute-Care-iHuman-Week-9-plan-pdf/ Follow up lab tests: - Erythrocyte sedimentation rate (ESR) - C-reactive protein (CRP) - Alkaline Phosphate - Calcium level - CXR - AP and lateral views of lumbar spine - CBC, BMP, Fasting Glucose, TSH, Lipid profile - ECG - Urinalysis Diagnostic testing: • Spinal X-ray- Abnormal lumbosacral spine x-ray • L4 vertebral compression fracture Consults: Oncology referral for possible chemotherapy or other forms of therapy for treatment of metastases Patient Education and Health Promotion (address age appropriate patient education if applicable): Patient would be educated about when to seek help for sudden unexpected occurrence of circumstances like changes in physical or mental status, or a new symptom, such as severe pain, that affects a person's well-being and demands immediate action.If the pt is unable to control pain with medications prescribed by the doctor, pt should seek medical care in the ER. Regarding bone health pt should be educated that metastases are common in breast cancers, and circulating breast cancer cells have particular affinity for bone and thus bone health is a must. Treatment Goals. Reduce pain to a more manageable level. Slow the progression of metastases. This study source was downloaded by 100000830772748 from CourseHero.com on 07-05-2022 04:22:46 GMT -05:00 https://www.coursehero.com/file/69058666/Acute-Care-iHuman-Week-9-plan-pdf/ Discharge planning and required follow-up care: - If comfort and function is achieved and 24-hour opioid requirement is stable, consider extendedrelease opioid like transdermal fentanyl. - Routine follow-up of inpatients should be performed during each outpatient contact - References Anderson, B., Dvaladze, A., Ilbawi, A., Luciani, S., Torode, J. & Zujewski, J. (2017). Palliative Care for Metastatic Breast Cancer. Retrieved from https://www.fredhutch.org/content/dam/public/labsprojects/PHS/breast-cancer-initiative/KSPDF/ KS%20Palliative%20Care%20Metastatic%20030617.pdf Casamayor, M., DiDonato, K., Hennebert, M., Brazzi, L., & Prosen, G. (2018). Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe. Drugs in context, 7, 212524. doi:10.7573/dic.212524 Jin, X. & Mu, P. (2015). Targeting breast cancer metastasis. Breast cancer : basic and clinical research, 9(Suppl 1), 23-34. doi:10.4137/BCBCR.S25460 [Show More]

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