Emanuel Jones, 60 years of age, is male patient diagnosed with small cell carcinoma. He underwent surgery in the past to remove the left lower lobe of his lung. He is receiving chemotherapy. Two weeks before a round of chemotherapy, a complete blood count with differential, and a renal and metabolic profile are obtained for the patient. The patient presents to the oncology clinic for chemotherapy with a temperature of 101°F. Further assessment reveals decreased breath sounds in the right base of the right lung, and a productive cough expectorating green colored mucus. The patient is short of breath and has a pulse oximetry reading that is SaO2 of 85% on room air. The patient has a history of benign prostate hypertrophy (BPH) and has complaints of urinary frequency and burning upon urination. The patient is admitted to the oncology unit in the hospital. The oncologist orders the following: blood, sputum, and urine cultures; and a chest x-ray. An x-ray of the kidneys, ureters, bladder (KUB) is ordered. An arterial blood gas (ABG) on room air, CBC with differential, and renal and metabolic profile are ordered. Oxygen is ordered to begin with nasal cannula at 2 L/min and titrate to keep SaO2 greater than 90%. A broad-spectrum antibiotic, levofloxacin 500 mg in 100 mL of NS is ordered to be administered IV over 60 minutes once daily. (Learning Objective 8) 1. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9)

Introduction

This assignment focuses on two case studies involving patients with different respiratory conditions. The first case study involves Emanuel Jones, a 60-year-old male diagnosed with small cell carcinoma. The second case study focuses on Joe Clark, a 79-year-old male receiving hospice care for lung cancer and chronic obstructive pulmonary disease (COPD). Both patients require medical intervention and management to address their respiratory symptoms and provide palliative relief.

Case Study 1: Emanuel Jones

Emanuel Jones is a 60-year-old male patient with a history of small cell carcinoma. He has previously undergone surgery to remove the left lower lobe of his lung and is currently undergoing chemotherapy. Before his next round of chemotherapy, a comprehensive assessment of his health status is performed. This includes a complete blood count with differential, as well as a renal and metabolic profile.

During his visit to the oncology clinic, it is noted that Emanuel Jones has a temperature of 101°F. Further assessment reveals decreased breath sounds in the right base of the right lung, accompanied by a productive cough that produces green-colored mucus. He is also experiencing shortness of breath and has a pulse oximetry reading indicating a SaO2 level of 85% on room air.

In addition to his respiratory symptoms, Emanuel Jones has a history of benign prostate hypertrophy (BPH) and complains of urinary frequency and burning during urination. As a result of his symptoms and clinical findings, he is admitted to the oncology unit in the hospital for further evaluation and management.

The oncologist orders several diagnostic tests to determine the underlying cause of Emanuel Jones’ respiratory symptoms and to guide appropriate treatment. These tests include blood, sputum, and urine cultures, as well as a chest x-ray. An x-ray of the kidneys, ureters, bladder (KUB) is also ordered to assess the genitourinary system.

To monitor Emanuel Jones’ respiratory status, an arterial blood gas (ABG) on room air is ordered. This will provide information about his oxygen and carbon dioxide levels, as well as the acid-base balance in his blood. Additionally, a complete blood count with differential and renal and metabolic profile are ordered to assess his overall health status and organ function.

To address his decreased oxygen saturation level, Emanuel Jones is initiated on supplemental oxygen therapy. Initially, he is started on nasal cannula at a flow rate of 2 L/min. The oxygen flow rate will be adjusted as necessary to maintain a SaO2 level greater than 90%.

As a precautionary measure, a broad-spectrum antibiotic, levofloxacin 500 mg in 100 mL of normal saline, is prescribed to be administered intravenously over 60 minutes once daily. This antibiotic will provide coverage against a wide range of potential pathogens and help prevent and treat any respiratory infections.

Case Study 2: Joe Clark

Joe Clark is a 79-year-old male patient who is currently receiving hospice care for his terminal illnesses, which include lung cancer and COPD. He presents with bilateral pleural effusion, a condition characterized by the accumulation of fluid in the pleural space of each lung. This accumulation of fluid has compromised his lung expansion, leading to respiratory distress.

Joe Clark reports feeling short of breath and anxious, fearing that each breath may be his last. As a palliative measure to relieve his discomfort and improve his respiratory symptoms, he is admitted to the hospital for a thoracentesis. This invasive procedure involves draining the fluid from the pleural space to allow the lung to expand and improve breathing.

In addition to the thoracentesis, Joe Clark is prescribed low-dose morphine to provide relief from dyspnea and discomfort. Morphine is commonly used in palliative care to manage severe respiratory symptoms and improve patient comfort. He is also prescribed Proventil (albuterol) inhaler for as-needed use and Flovent (fluticasone propionate) inhaler to be used twice daily for his COPD.

To ensure adequate oxygenation and alleviate respiratory distress, Joe Clark is ordered 2 L/min of supplemental oxygen via nasal cannula as needed for comfort. This additional oxygen will help improve his oxygen saturation levels and alleviate his respiratory symptoms.

Conclusion

These case studies highlight the diverse respiratory conditions encountered in clinical practice and the importance of individualized management and treatment. Both Emanuel Jones and Joe Clark require medical interventions tailored to their specific needs to address their respiratory symptoms and improve their overall well-being. Further analysis and assessment will be required to determine the most appropriate interventions for these patients.