Nursing
Katerria1
2005-Cancerworksheet.docxMedical/ Surgical Simulation: Cancer
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Student Learning Objectives: SLO’s 1-8 9 10. Provide education specific to patients with Cancer. 11. Implement interventions for a patient on neutropenic precautions. I
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Preparation for scenario:
Pearson – Cellular Regulation Module 16.M Module 2 and 2C
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Cancer Simulation Student Worksheet
I. Data Collection
History of Present Problem: Julie Hammel, a 58 year old female, has just undergone chemotherapy and radiation therapy for stage II Breast Cancer, currently on Tamoxofen.
Patient presents to her oncologist’s office with lymphedema, was admitted to the hospital for monitoring.
PMH: Gravida 2; Para 2; full term uncomplicated vaginal deliveries. Breast Cancer with right mastectomy. No known allergies.
Personal/Social History: Married for 28 years. Has two adult children. Works as a dental hygienist part time.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
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RELEVANT Data from Present Problem: |
Clinical Significance: |
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- Stage II Breast Cancer - Right Mastectomy - Lymphedema
- Tamoxifen
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RELEVANT Data from Social History: |
Clinical Significance: |
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II. Patient Care Begins:
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Current VS: |
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T: (oral) 99.0 |
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P: (regular) 84 |
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R: (regular) 14 |
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BP:114/64 |
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O2 sat:97% on RA |
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Pain:0/10 |
What VS data is RELEVANT that must be recognized as clinically significant to the nurse?
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RELEVANT VS Data: |
Clinical Significance: |
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Current Assessment: |
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GENERAL APPEARANCE: |
Resting comfortably, appears in no acute distress |
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RESP: |
Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort |
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CARDIAC: |
Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks |
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NEURO: |
Alert & oriented to person, place, time, and situation (x4) |
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GI: |
Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants |
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GU: |
Voiding without difficulty, urine clear/yellow |
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SKIN: |
Unremarkable except for slight erythema in right upper extremity due to external radiation. RUE edema. Skin intact. |
What assessment data is RELEVANT that must be recognized as clinically significant to the nurse?
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RELEVANT Assessment Data: |
Clinical Significance: |
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Unremarkable. Patient needs to be prepared for limited contact with visitors and health care personnel for neutropenic precautions. Needs teaching about importance of neutropenia and lymphedema. |
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What interventions will you initiate based on this priority?
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Nursing Interventions: |
Rationale: |
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Foley output
Limit Visitors
Monitor Skin
Neurtropenic Precautions
Risk of stroke with Tamoxifen
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Medical Management: Rationale for Treatment & Expected Outcomes
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Care Provider Orders: |
Rationale: |
Expected Outcome: |
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Monitor neutrophils, temp and affected site (right arm)
Monitor skin
Limit Visitors
Monitor for signs and symptoms of stroke
I &O’s
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Medication Dosage Calculation:
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Medication/Dose:
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Mechanism of Action: |
Volume/time frame to Safely Administer: |
Nursing Assessment/Considerations: |
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Ondansetron (Zofran) 4mg IV Push prn q4 hours nausea
Tamoxifen
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Lab Results:
What lab results are RELEVANT that must be recognized as clinically significant to the nurse?
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Complete Blood Count (CBC:) |
Current: |
High/Low/WNL? |
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WBC (4.5–11.0mm 3) |
2.3 |
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Hgb (12–16g/dL) |
13 |
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Platelets (150-450 x103/µl) |
140 |
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Manual Diff: |
Current: |
Range: |
High/Low/WNL? |
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Neutrophil |
16 |
40-80 |
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Band Neutrophils |
12 |
0-5% |
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Lymphocyte |
54 |
20-50% |
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Monocyte |
19 |
2-12% |
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What lab results are RELEVANT that must be recognized as clinically significant to the nurse?
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RELEVANT Lab(s): |
Clinical Significance: |
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Situation: |
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Background: |
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Assessment: |
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Recommendation: |
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