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.
LM has had two treatment cycles to date and returns to the office with a complaint of a persistent dry cough over the past week. She thinks she may have caught a viral infection from her niece who is in daycare. She denies a fever or mucous production, but she reports significant fatigue, dyspnea on exertion, and what she describes as chest pain. Her CNRP performs an exam and notes her to have shortness of breath when speaking, but she is able to communicate effectively. LM is mildly pale and diaphoretic. Her lung assessment is clear upon auscultation.
Her vital signs reveal the following:
- Temp: 98.9
- Heart rate: 122
- Respiratory rate: 24-28
- Pulse Oximetry (SpO2): 89% on room air
Given her SpO2 level, she is placed on oxygen, 2 liters via nasal cannula, and her SpO2 rises to 98 percent. During her evaluation, she reports, "I'm having pain in my chest when I try to catch my breath; I think it is from all of the coughing." The CRNP explores the complaint and notes that during deep inspiration, LM feels a sharp pain in her rib cage/pleural region.
The CRNP proceeds with ordering a complete blood count (CBC) and a CT of the chest. The CBC results are within normal limits, but the CT has an abnormal finding.