Medical/ Surgical Simulation: Cancer

Medical/ Surgical Simulation: Cancer

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 
Preparation for scenario:   Pearson – Cellular Regulation Module 16.M Module 2 and 2C  

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?

RELEVANT Data from Present Problem:Clinical Significance:
– Stage II Breast Cancer – Right Mastectomy                                   – Lymphedema   – Tamoxifen  
RELEVANT Data from Social History:Clinical Significance:
        

II. Patient Care Begins:

Current VS:  
T: (oral)  99.0
P:  (regular) 84
R: (regular) 14
BP:114/64
O2 sat:97% on RA
Pain:0/10

What VS data is RELEVANT that must be recognized as clinically significant to the nurse?

RELEVANT  VS Data:Clinical Significance:
    
Current Assessment:
GENERAL APPEARANCE:Resting comfortably, appears in no acute distress
RESP:Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort
CARDIAC:Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks
NEURO:Alert & oriented to person, place, time, and situation (x4)
GI:Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants
GU:Voiding without difficulty, urine clear/yellow
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?

RELEVANT  Assessment Data:Clinical Significance:
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.

What interventions will you initiate based on this priority?

Nursing Interventions:Rationale:
  Foley output     Limit Visitors     Monitor Skin     Neurtropenic Precautions     Risk of stroke with Tamoxifen    

Medical Management: Rationale for Treatment & Expected Outcomes

Care Provider Orders:Rationale:Expected Outcome:
    Monitor neutrophils, temp and affected site (right arm)     Monitor skin   Limit Visitors   Monitor for signs and symptoms of stroke   I &O’s      

Medication Dosage Calculation:

Medication/Dose:  Mechanism of Action:Volume/time frame to Safely Administer:Nursing Assessment/Considerations:
Ondansetron (Zofran) 4mg IV Push prn q4 hours nausea                       Tamoxifen                                                                       

Lab Results:

What lab results are RELEVANT that must be recognized as clinically significant to the nurse?

Complete Blood Count (CBC:)Current:High/Low/WNL?
WBC (4.5–11.0mm 3)2.3
Hgb (12–16g/dL)13 
Platelets (150-450 x103/µl)140 
Manual Diff:Current:Range:High/Low/WNL?
Neutrophil16 40-80 
Band Neutrophils12 0-5% 
Lymphocyte54 20-50% 
Monocyte19 2-12% 

What lab results are RELEVANT that must be recognized as clinically significant to the nurse?

RELEVANT Lab(s):Clinical Significance:
                    
Situation:
       
Background:
       
Assessment:
       
Recommendation:
         
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