Case Study – Lung Cancer
You are taking care of Mr. W.B. He is a 48-year-old male who has been admitted to the medical-surgical unit three days ago. His primary admitting diagnosis is pneumonia. He has a past medical history significant for stage 4 lung cancer with metastasis to the liver and spine, hypertension, coronary artery disease, type 2 diabetes, and COPD. His past surgical history includes a total knee replacement of the right knee. Mr. W.B. receives chemotherapy and radiation therapy treatments every two weeks at the local cancer treatment center. His last treatment was eight days ago. He was doing well until 4 days ago, when he began running a fever at home and experiencing a cough. His wife took him to the emergency department, where a chest x-ray showed pneumonia to the left lower lobe. He is now receiving IV antibiotics. His oncology team has determined he will need to pause his cancer treatment regimen until further notice. Subjective
He reports a pain level of 9/10 to the skin on his chest. He reports back pain at a 7/10. He reports shortness of breath and finds it difficult to speak full sentences without having to take a break.
He reports feeling chilled and fatigued.
He states, “I don’t know if I can do this anymore.”
Objective
Vital signs:
Temperature: 101.3
Heart rate: 98
Respiratory rate: 26
Blood pressure: 88 / 54
Oxygen saturation: 78% on room air
Laboratory findings:
WBC: 15.6
HGB: 5.7
Platelets: 124
Upon assessment, you notice he is pale, diaphoretic, and exhibits labored breathing. He is sitting in tripod position on the edge of his bed. You hear crackles in all lobes upon auscultation. He has second degree radiation burns to his anterior chest wall with serous exudate draining from the site. You note a 20 gauge IV catheter to the left forearm with Vancomycin infusing via IV pump. His wife is at bedside.
