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Pharmacology Case Study Thrombocytopenia, FTT, Metastatic Lung Cancer Katie Rhoades University of New Hampshire – Department of Nursing Situation Core Client Variables Client Demographics 58 year-old Female White/Caucasian Height: 5’4’’ Weight: 213 lbs. BMI: 36.6 DNI/DNR • • • • • • • Assessment VS 4/12/15 4/13/15 Temp. 37.0 C 36.2 C HR RR BP SpO2 95 • • • • Smoker Lives alone in disability housing Obese Divorced Sedentary lifestyle Maternal history of dementia Paternal history of Coronary Heart Disease Lab Values Client has stage IV breast cancer Client has poorly differentiated non-small cell lung cancer in left upper lobe, stage IV Client has completed 4/6 cycles of palliative chemotherapy ** Client was hospitalized two weeks prior for anemia, which required a blood transfusion; client left hospital against medical advice Sodium 142 Potassium 2.8 L Chloride 100 Carbon Dioxide 34 H Anion Gap 8.0 Glucose 83 BUN 6L Creatinine 0.58 Magnesium 1.0 L WBC 9.0 RBC 2.99 L HGB 8.7 L HCT 26.8 L Failure To Thrive (FTT) MCV 89.7 Decreased ability to adapt to change Increased need for care or feelings of helplessness Illness of chronic health problems Side effects from certain medications Decreased appetite Lack of interest MHC 29.1 RDW 17.3 H HDW 3.7 H PLT 51 L MPV 10.5 Absolute NEUT Count 7.91 NEUT % 88 H Lymph % 5L Client presents to ED on 4/13/15 with weakness Abdominal CT scan shows an adrenal mass and interval hemorrhage Client required 7 units of platelets Palliative radiation currently to stop bleeding Medications 96 18 18 146/84 132/72 99% Hospitalization 97% Comorbidities/Past Medical Hypertension Hypothyroidism Dyslipidemia Anemia Eczema Left-sided sciatica 3 normal pregnancies Post-Traumatic Stress Disorder Anxiety Drug Dose Route Frequency Class Docusate Sodium 100 mg PO BID Laxative Folic Acid 1 mg Daily Vitamin Levothyroxine 224 mcg PO Daily Thyroid Hormone Ondansetron Hydrochloride 8 mg = 4 ml IV Q8HRS 5-HT3 Receptor Antagonist Pantoprazole Sodium 40 mg = 1 vial IV BID Dose Route Frequency Class Acetaminophen 650 mg PO Q4-6HRS Paraaminophenol derivative Albuterol Sulfate 180 mcg Inhalation Q4HRS Bronchodilator Diphenhydramine HCl 25 mg PO Q6-8HRS Antihistamine Oxycodone 5mg or 10 mg PO Q4-6HRS Opioid analgesic Tramadol 50 mg PO Q6HRS Narcotic Drug Dose Route Frequency Class Potassium Chloride 40 mEq PO Q4HRS Magnesium Sulfate 50 ml IV Once • • • • • • Proton Pump Inhibitor Drug Thank You A special acknowledgement to Mrs. Nancy Doyle, the nursing staff on 3 West at SNHMC in Nashua, NH, and my fellow peers of Cohort 12. PO Electrolyte Supplement Mineral References: 1. Liebman, H.A. (2014). Thrombocytopenia in cancer patients. Thrombosis Research, 133(2), 63-9. doi: 10.1016/S0049-3848(14)50011-4 2. Higgins, P.A. (2005). Adult failure to thrive in the older rehabilitation patient. Rehabil Nurs, 30(4), 152-9. 3. Aschenbrenner, D.S., & Venable, S.J. (2012). Drug therapy in nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
