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A Female Patient With Advanced Lung Cancer Experiences Extreme Change With Her Treatment Goals
Quick Quiz 6/18/2013 4 comments
A 78-year-old female patient with stage 4 non-small-cell lung cancer is experiencing a variety of symptoms including pain and depression. She is currently receiving palliative chemotherapy with the goal of prolonging her life. She knows she has a terminal illness but was hoping to live long enough to see her granddaughter graduate from medical school in four months. She has morphine at home for pain but has told her husband that she wants to go to sleep and not wake up.
Female With a History of Advanced Cervical Cancer Is Admitted With Renal Failure & Myoclonus
Quick Quiz 6/4/2013 2 comments
A 68-year-old female patient with advanced cervical cancer is admitted to the hospital with a rising creatinine level and anuria. She has been well-managed on a long-acting morphine and immediate release morphine but has noticed tremors and muscle twitching in the last few days that she attributes to anxiety. Her primary goal is comfort with plans to return home on hospice as soon as possible.
Male With a History of Melanoma Presents With Chest Pain & Dizziness
Quick Quiz 5/13/2013 3 comments
A 68-year-old male with a history of melanoma presents with moderate chest pain and dizziness. He has recently been treated for melanoma with wide local excision and lymph node evaluation and is currently participating in a clinical trial. He has no history of heart disease, and his labs are within normal limits, including the troponin level.
Female With a History of Metastatic Pancreatic Cancer & Depression Is Now Experiencing Anxiety
Quick Quiz 5/6/2013 2 comments
Ellen is a 57-year-old female who is currently on chemotherapy with 5FU for metastatic pancreatic cancer. She has a history of depression and has been taking fluoxetine for four years. Since the cancer diagnosis, Ellen has reported an increase in depressive symptoms and was given a prescription for an increased dose of fluoxetine. For the past two weeks, she has been agitated, anxious, and unable to sleep. She is also taking lomotil for loose stool, pancreatin enzymes to assist digestion, and prochlorperzine for nausea.
Female With a History of Adenocarcinoma Presents With Fevers & SOB After D-FOX Infusion
Quick Quiz 4/29/2013 4 comments
Mrs. K is a 68-year-old patient being treated for a diagnosis of adenocarcinoma of the stomach with peritoneal lymph involvement using the regimen D-FOX (docetaxel, fluorouracil (5-FU) IV push, and a 46-hour infusion of oxaliplatin and leucovorin). She had tolerated the D-FOX very well until her ninth cycle – she is now experiencing fever, shortness of breath, and fatigue.
Elderly Female Patient With a History of Terminal Cancer Presents to the ED With Dyspnea
Quick Quiz 4/22/2013 1 comment
A 90-year-old woman with end stage cancer was brought into the emergency department by her family when she became dyspneic at home. The patient is awake and struggling to breathe, and was diagnosed with pneumonia. While the patient was placed on a BiPAP machine, the palliative care team was consulted, and after seeing the patient and talking with the family, it suggested a low dose morphine dose (2mg IVP) to ease her breathing. The family was terrified that using morphine would now stop her breathing.
A Female Patient Presents With a Palpable Breast Mass & a Normal Mammography Result
Quick Quiz 4/15/2013 3 comments
A 58-year-old woman presents with a palpable mass in the left breast. Her screening mammogram is BIRADS 2 (benign) with moderate density. After initial surgery, it is noted that there are persistent positive margins even after a second lumpectomy. She is in otherwise good health with no previous abnormal breast imaging or medical co-morbidities and no family history of breast cancer.
Female Patient With a History of Ovarian Cancer Presents With a Breast Mass
Quick Quiz 4/1/2013 3 comments
HG is a 38-year-old female diagnosed with a Stage III C ovarian cancer in early 2012. Once she recovered from a radical hysterectomy, she received six cycles of Carboplatin and Taxol without complication. Currently in remission, the patient noted a small lump in her left breast. She decided to call her oncologist considering she has a familial history of breast cancer.
Male Patient Receiving Induction Treatment for AML Complains of GI Distress & Lethargy
Quick Quiz 3/26/2013 3 comments
John is a 20-year-old college student recently diagnosed with acute myelogenous leukemia. He has been admitted to the oncology unit to begin his induction chemotherapy. It is day three of his regimen. When you assess him at the beginning of our shift, he tells you he "feels terrible" and that he thinks his anti-emetics aren't working. He says he is nauseous, just had two bouts of diarrhea, and is very weak from his GI symptoms. Before seeing what he has ordered for anti-emetics, you also check to see if his morning labs are back.
Female Patient With a History of Lung Cancer Presents With Headaches & Mild Confusion
Quick Quiz 3/19/2013 2 comments
Mrs. E is a 56-year-old female with limited-stage Small Cell Lung Cancer (SCLC). She is undergoing whole-brain radiation as prophylaxis for her treatment plan (prophylactic cranial irradiation-PCI). Once her radiation is complete, she will start chemotherapy treatment. The patient now presents to the clinic with complaints of headache, mild lethargy, and confusion.
Female With a History of Breast Cancer Presents With Palpable Cervical Lymph Nodes & Skin Nodules
Quick Quiz 3/4/2013 5 comments
A 75-year-old female with a history of left breast cancer in 2008 presents with new palpable cervical lymph nodes and skin nodules of the right breast and upper back. The left breast cancer was successfully treated and her overall health history is unremarkable. She continues to see her medical oncologist at regular intervals and was asymptomatic until this new finding. A biopsy of a cervical lymph node revealed reactive lymphocytic infiltrate.
Male Patient With a History of Lung Cancer Presents With Cough & Dyspnea
Quick Quiz 2/25/2013 4 comments
Mr. C is a 71-year-old male who has a long history of smoking. He recently had some cardiac issues that were resolved, but upon a chest x-ray and follow-up CT of the chest, a 5cm left hilar mass was found. It was biopsied via bronchoscopy, and pathology confirmed squamous cell carcinoma, EGFR-negative and ALK-negative. Mr. C agreed to and completed concurrent chemotherapy and radiation and now complains of a frequent, nonproductive cough unresponsive to antitussive treatment.
Female Patient With a History of Ovarian Cancer Presents to Her Physician With a Vulvar Lesion
Quick Quiz 2/11/2013 6 comments
MN is a 45-year-old patient with a recent history of a stage 3C ovarian cancer. Today she presents to her GYN oncologist for her final cycle of Carboplatin and Taxol. Several cycles have been delayed due to leucopenia; however, her ANC is now within normal limits, and the plan is to proceed with her final cycle of chemo. She is feeling well, other than a painful lesion on her left vulva, which just seemed to develop yesterday morning.
Male Patient Admitted to the Hospital With a History of Prostate Cancer & Pain Management
Quick Quiz 1/29/2013 5 comments
As the clinical nurse specialist on the in-patient oncology unit, you attend patient care rounds where a new patient admitted the evening before is discussed. The staff nurse states that a 73-year-old man with a history of advanced prostate cancer was admitted for pain management and was very confused during the night shift, ultimately requiring a nursing assistant to stay with him to minimize the chance of any injury. The staff nurse relays that she feels a psychiatric consult is in order to work up the patient for dementia due to his profound disorientation.
Female Patient Presents to Her PCP With Hoarseness & Left Lower Quadrant Mass
Quick Quiz 1/22/2013 11 comments
A 25-year-old woman presents to her primary care physician with the complaint of a hoarse voice. She reports that for the past month, she has been fighting off several “colds” and has been dealing with allergies and thinks that it may be related. During the assessment, her abdominal exam revealed a firm mass in the left lower quadrant which was not present on any of her prior exams. She was sent to her gynecologist’s to rule out an ovarian mass.
Male Patient Experiences Ongoing Medi-Port Discomfort & New Erythema
Quick Quiz 1/14/2013 7 comments
Mr. P is a 72 year-old male who presents to the clinic today for his first cycle of gemcitabine as treatment for his pancreatic cancer. Mr. P had a Medi-Port placed about two weeks ago. A healthy scab had developed at the port site and looked benign upon inspection. A week later, the incision line’s scab is now different in color, more brown-yellow than black, and seems to be softened in appearance and texture throughout the entire scab area. The area is red, and the erythema extends about 3cm in diameter from the port site. There is no swelling or new pain. The infusion nurse has not yet accessed the port today.
Patient Presents to the Emergency Department With Abdominal Discomfort & a History of Colon Cancer
Quick Quiz 12/17/2012 8 comments
Mr. J is a 57-year-old male who presented to the emergency department on a Saturday night for pain and fullness in the abdomen. He explains that he had surgery early in the summer to remove a tumor from his colon. Since the surgery, his bowel movements have been irregular, ranging from constipation to diarrhea. He had his 3-month and 6-month check-ups with his oncologist and was told everything looked fine. That was about two months ago.
Woman Presents With Vulvar Discomfort & Pruritis
Quick Quiz 12/10/2012 4 comments
GH is a 62-year-old Caucasian female who presents to her gynecologist with progressive vulvar discomfort. She reports that over the past year, she has been experiencing vulvar pruritis, which is not relieved with over-the-counter creams such as hydrocortisone, the use of which she initiated herself. She reports that she "cannot see the area" but "I know there is something wrong." She has never been evaluated for this, due to embarrassment.
Women Presents to Her GYN With Heavy Vaginal Discharge
Quick Quiz 12/3/2012 3 comments
ML, a 52-year-old peri-menopausal woman, presents as a new patient to a GYN CRNP with complaints of "a lot of clear/pink vaginal discharge and pelvic discomfort for one month." Her last menstrual period was three weeks ago, but this seems unrelated to her menses. She is not sexually active, as her husband is being treated for prostate cancer.
Woman Presents With a Painful Vulvar Lesion
Quick Quiz 11/26/2012 6 comments
JH is a 72-year-old Caucasian woman who presents to her GYN Nurse Practitioner for evaluation of a painful area to her vulva. She states that for one month she has been experiencing vulvar pruritus. She reports that over the past week, her symptoms have worsened and she has noticed a "lump on the right side" and some blood after wiping.
Patient With Advanced Lung Cancer Presents With a New Symptom Cluster
Quick Quiz 11/19/2012 3 comments
Mrs. T is a 62-year-old fashion columnist for your city's newspaper. She is receiving her second course of platinum-based chemotherapy for advanced non-small-cell lung cancer. During this office visit for her second course of treatment, Mrs. T. jokingly states that she forgot to put on her makeup but she doesn't seem to need rouge as her complexion has changed.
Patient Presents to the ED With a Chest Rash & a History of APL
Quick Quiz 11/12/2012 4 comments
Mr. R is a 52-year-old male healthy male who presented to the hospital because of acute and profound weakness lasting more than two weeks. He presented in the ED with an elevated white count of 176,000. He was admitted, and a bone marrow biopsy was obtained, and through cytogenetics it was confirmed he had Acute Promyelocytic Leukemia.
Patient Presents With Necrotic Fingertips & History of Pancreatic Cancer
Quick Quiz 11/5/2012 4 comments
In December, Mr. P., a 60-year-old white male, was experiencing nausea, insomnia, and generalized itching. His medical history is unremarkable, except for his smoking one pack per day for 20 years before quitting 10 years ago. In February, he was diagnosed with pancreatic cancer. He is undergoing chemotherapy and is now experiencing episodes where his fingertips turn blue under stress or when exposed to cold. What is your clinical suspicion?
Patient Presents With a History of Breast Cancer & Deep Vein Thrombosis
Quick Quiz 10/29/2012 5 comments
Mrs. D is a 54-year-old female who has completed chemotherapy and radiation treatment for breast cancer. During her concurrent treatment, she developed a deep vein thrombosis (DVT) in her right leg that was found by venous doppler. She was successfully treated and returns to the clinic for a post-treatment follow-up. She complains her right leg is slightly swollen, painful, and erythemic. What is your clinical suspicion?
Patient Presents to the Emergency Department With Shortness of Breath
Quick Quiz 10/22/2012 3 comments
JS, a 48-year-old female, presents to a local ED with complaints of worsening dyspnea on exertion and the inability to “catch her breath.” For the past 24 hours, she has experienced shortness of breath at rest. She also reports some mild abdominal bloating (especially after meals), early satiety, and increased flatus. She has attributed this to her history of irritable bowel syndrome (IBS), which is managed by her primary care physician.
Patient Presents With a History of Advanced Breast Cancer & New Back Pain
Quick Quiz 10/15/2012 4 comments
Mrs. P is a 78-year-old woman with Stage III breast cancer being treated with aromatase inhibitors. At her three-month checkup, Mrs. P complains of recent difficulty ambulating, constipation, and new back pain. She attributes these symptoms to her dwindling appetite, fatigue, and doing too much gardening recently. What is your concern?
Patient With a History of Cervical Cancer Presents With Vaginal Discharge
Quick Quiz 10/9/2012 2 comments
Mrs. C is a 45-year-old female with a history of stage TIbI cervical cancer diagnosed seven years ago. She underwent radiation therapy and received IMRT followed by HDR (High-Dose Rate) intracavity boost radiation to the vagina. She presents to the gynecology clinic with persistent vaginal discharge with a foul odor.
Patient Presents with a Cough & Shortness of Breath
Quick Quiz 9/24/2012 3 comments
LM is a 68-year-old, recently-diagnosed stage 3c ovarian cancer patient. Three months ago, she underwent an uncomplicated hysterectomy, bilateral salpingo-oophorectomy, and a cancer staging procedure. She also began treatment with Carboplatin and Taxol. Today, LM presents with a cough, shortness of breath (SOB), and chest pain.
Patient Presents With Back Pain & Rash
Quick Quiz 9/17/2012 1 comment
Mrs. E has Stage IV adenocarcinoma of lung origin, her treatment with chemotherapy changing many times due to the progression of her disease. She has a history of chronic low back pain, urinary tract infections, and deep vein thrombosis. She presents today with low back pain and rash. What is suspect for this low back pain and rash?
Patient With Bilateral Breast Lesions & Repeated Antibiotic Use
Quick Quiz 9/10/2012 2 comments
A 33-year-old woman has ongoing issues with bilateral breast lesions thought to be infectious and has been treated with antibiotics intermittently. The lesions would resolve but then recur despite treatment. Ultrasonography of the breast showed the cystic nature of the masses. What is your concern?
Patient Presents with Breast Mass & Scalp Lesion
Quick Quiz 8/13/2012 4 comments
A 58-year-old female with no other history of disease presents to her physician with a palpable left breast mass. In addition to the left breast mass, the patient also presents with an unusual lesion on her scalp. What is your clinical concern regarding the lesion on her head?
Patient With Amyloidosis Presents With Fatigue
Quick Quiz 7/30/2012 4 comments
In 2006, Mr. D was diagnosed with systemic amyloidosis (AL) affecting the kidney, and remains in remission following autologous hematopoietic stem cell transplant (aHSCT). He presents to his primary practitioner for evaluation of worsening fatigue. His chronic osteoarthritis has been flaring up lately, but the pain resolves when he takes ibuprofen 400 mg oral twice per day, as needed. What would you be most concerned about?
Lung Cancer Patient Presents With Confusion, Lethargy & Excessive Thirst
Quick Quiz 7/23/2012 4 comments
Ms. PJ was recently diagnosed with small-cell lung cancer. She was subsequently admitted to the hospital for superior vena cava (SVC) syndrome. After receiving her first chemotherapy she developed confusion, became lethargic, and complained of excessive thirst. What is the likely concern for this patient?
Stage II Breast Cancer Patient Presents With Vaginal Atrophy
Quick Quiz 7/9/2012 7 comments
Susan is a 46-year-old breast cancer survivor with Stage II A, ER+PR+, HER2neu disease. At the time of diagnosis, Susan was premenopausal with monthly menses and without complaint of menopausal symptoms. Post treatment, she is experiencing sexual side effects. Is this related to treatment?
Woman Presents With Vaginal Bleeding Post-Hysterectomy
Quick Quiz 6/25/2012 3 comments
JD is a 46-year-old woman with one episode of post-coital bleeding that resembled a menstrual flow with continued vaginal spotting. She reports that two years ago she had a hysterectomy for cancer but does not know what kind; she also said she was treated with “some beam and liquid” that went into her arm. Her GYN exam reveals a mass. What are the next steps?
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Latest Blog Roll
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Michelle Bragazzi, BS, RN, 5/3/2013  32
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