Problem
You are the nurse on the oncology unit and Louis Daniels, a 50 y.o. man with colon cancer, is admitted. Medical history includes colon resection followed by combined chemotherapy approximately 18 months ago; recently diagnosed with recurrence of colon cancer; a single septum implanted port was surgically placed on the left, and chemotherapy was administered for 5 of the 8 scheduled cycles. Previous significant weight loss (current Ht 67 in., Wt 110 lb with pre-illness weight 185 lb); 50-pack-year (2 PPD × 25 years) smoking history. L.D. is admitted for acute nausea, vomiting, and dehydration. He also states that he has pain and swelling of the neck on the left, has a persistent headache, and has been feeling short of breath. He complains that he has "just not felt well." His wife adds that he has not been eating and sleeps all the time. An active man, he has not wanted to go fishing or engage in any activities. His wife also adds that during his previous treatment regimen 18 months ago, he was able to go to work and was relatively active during his chemotherapy treatments. Assessment findings include: serum albumin 3.0 mg/dL, serum transferrin 150 mg/dL. Vital signs are 150/90, P 130, R 26, T 100°F; bowel sounds absent, all four quadrants.
A. What physician orders would you anticipate for this patient?
B. What initial assessments of this patient would be important for his central vascular access device (CVAD) management?