Case Study, Chapter 15, Oncology: Nursing Management in Cancer Care
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)

Case Study, Chapter 16, End-of-Life Care
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)