Wendy Johnson is a 48 year-old female patient who comes to the clinic for her annual exam. The patient is a married woman with three children, ages 15/12/8. She works in the IT industry as a systems analyst.
Her heath history includes para 3 gravida 3. She had a T&A when she was 5 years old. She broke her wrist playing volleyball when she was 16 y/o. She has some arthritis in her knees as she was an avid runner until she had her second child.
No allergies to medications. Medications include:
Multivitamin
Vitamin D
During her health assessment interview, she complains of frequent constipation and weakness. She tells the nurse, "I just feel so run down. I know that I started menopause, and that should make me tired, but gee, I tell you, some days, I rather just lay in bed all day that do another load of laundry! I suppose that is not helping my constipation. But it's just so hard to get motivated to eat right or exercise when you feel like poo all day."
What questions would the nurse ask the patient as part of her health assessment in regards to her health assessment? List at least five questions with the rationale for the questions.BP: 134/86 Pulse: 86 Respirations: 22
Temperature 98.6 F
The patient is assessed by the NP. She finds the patient has had a weight loss of 10 lbs over the past six months without change in diet or exercise. The patient complained of chronic constipation and hemorrhoids. She also has noticed some shortness of breath with walking upstairs. Physical assessment is normal with no acute findings other than external hemorrhoids, most likely secondary to the patient's frequent constipation. The provider orders labs. The results are posted later that day. The nurse sees the following values:
WBC 5.2 Hgb 7.5 Hct 26%RBC 3.5Platelets 650Creat 1.1BUN 15Na 134K 4.0Mg 1.8Ca 9.2Glu 124Which lab values would cause the nurse the most concern? Why? How could these lab values be related to the patient's complaint? (3 points) In order to educate the patient on proper nutrition during her cancer treatment, list at least three nutritional educational points would the nurse tell the patient with rationale.
The patient reports she does not understand what "neutropenia" means. How would the nurse best educate the patient on neutropenia and self-care with this side-effect of chemo? List three neutropenic "precautions".
The patient returns to the clinic for following up six weeks into her chemo treatment. She tells the nurse that her Hgb has improved to 10 - 11 since she started therapy. However, she asks the nurse why she continues to be tired and have no pep. The patient starts to cry during the interview. The nurse knows that many patients with cancer will experience depression during their cancer journey, and unfortunately, many cancer patients go undiagnosed with depression.
List five things the nurse could recommend to this patient with probable depression. Include the rationale for these recommendations.