J.H. is a 52-year-old white man who comes to the emergency department complaining of shortness of breath. He has not seen a health care provider for many years.
• Has a 38 pack-year history of cigarette smoking
• States he has always been slender but has had 25-lb weight loss despite a normal appetite in the past few months
• Admits to a “smoker’s cough” for the past 2 to 3 years; recently coughing up blood
• Is married and the father of three adult children
• Thin, pale man looking older than stated age
• Height 6 ft; weight 135?lb (61.2?kg)
• Intermittently confused and anxious with rapid shallow respirations
• Vital signs: temperature 102.6° F (39.2° C), heart rate 120, respiratory rate 36
• Chest wall has limited excursion on right side; auscultation of left side reveals coarse crackles but clear with cough; right side has diminished breath sounds
• Arterial blood gases: pH 7.21, PaO2 58?mm?Hg, PaCO2 82?mm?Hg, HCO3? 33?mEq/L, O2 saturation 84%
• Chest x-ray: consolidation of the right lung, especially in the base with possible mass in the area of right bronchus; pleural effusion on the right side
• Bronchoscopy with biopsy of mass: small cell lung carcinoma
• Diagnosis: pneumonia with small cell lung cancer
• Follow-up with patient and family to consider treatment options
1. How would you classify J.H.’s pneumonia? Why is this important?
2. What is your analysis of J.H.’s arterial blood gas results?
3. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
4. Priority Decision: What are the priority nursing interventions for J.H.?
5. Delegation Decision: Identify activities that can be delegated to unlicensed assistive personnel (UAP).
6. You are planning a meeting with J.H. and his family to discuss their needs. The physician tells you that J.H. is terminally ill. Who will you include in this meeting?
7. Evidence-Based Practice: J.H.’s children tell you that they are worried they will get lung cancer, since their father has it and they grew up around his secondhand smoke. They want to know what kind of screening is available for them. How will you respond?
8. What is the goal if radiation therapy is used for J.H.?
9. What issues should be addressed in your teaching of J.H. and his wife as you prepare him for discharge and care at home?