Fanatic Cancer Case Study

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

The patient tells me his last visit with Peter Dourdoufis, MD was just last week. I do not yet have a note from that visit. He says that he underwent an EKG and a stress test evaluation. To his knowledge, everything was okay, but he actually has an appointment tomorrow with Dr. Dourdoufis to review everything. No medication changes have been made per his report. He tells me that his blood pressures have been in a good range. Here today, his blood pressure is 126/76. He is not having problems with chest pain, shortness of breath, dyspnea on exertion or lower extremity swelling. He is still working

At today visit she is home alone. She is awake, alert and oriented. She states that she will be picked up by the bus to go to her radiation treatment. She reports that she continues to have neoplasm related pain in her shoulder and bladder. She describes

On 02/10/2015, he complained of chest pain and shortness of breath. He was evaluated with an electrocardiogram, which was abnormal. His

D.D has no known allergies and his current vital signs are 36.8F, 115 pulse, 25 RR, 102/77, 91% SpO2. His lab work is all normal except for elevated WBC and glucose. D.D is put on a morphine PCA pump (1.78mg every 2 hours) to help regulate his pain, metronidazole (1500mg once a day) and cefTRIAXone in dextrose (2000mg once a day) to help fight the infection, oxyCODONE (3.6mg every four

He reports no major changes in his condition, since his last visit. His pain is rated as 3-6/10, described as dull, hard, aching or worse. Pain is increased with sitting, standing, walking, lifting, looking up and down, turning to the sides, bending, and twisting. He is unable to work. He is very limited physically. He has to modify or avoid social and recreational activities to manage the pain. He feels like his quality of life is severely affected. His pain is 80% in the neck and 20% in the upper extremities, mostly on the

At today's visit he is accompany by his wife. He is awake, alert and oriented times 3. He complained of neoplasm related back pain that he describes as stabbing and constant that radiates to his abdomen, the pain is 4/10 in severity. His neoplasm related pain regimen includes Fentanyl Patches 75 mcg Q 48 hrs; Dilaudid 2mg PO Q 4 hours as needed for neoplasm

T.C. went out for testing immediately and unfortunately the test came back that the cancer had aggressively metastasized throughout his body. His pain level increase daily and he became increasingly dependent for all aspects of daily care. Prognosis was for weeks rather then months.

A review of his medical record indicates that he has HIV and is being treated with antiretroviral medications. He also has HIV-associated Hodgkin's Lymphoma and history of fracture to back. He is currently being treated with chemotherapy. He has completed 8 chemotherapy treatments with 4 remaining treatment. He is schedule to start radiation therapy next week. He is followed by Dr. Rosen for oncology and Dr. Ramgopal for infectious disease.

Pain is one of the most common and feared complications of cancer. It is exacerbated by stress, anxiety, fatigue, and malaise which accompany advanced cancer. Pain is generally absent in the early stages of cancer, but it is a significant factor as the illness progresses to advanced stages. Cancer-associated pain can arise from a variety of direct and indirect mechanisms including direct pressure, obstruction, and invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation (McCance 2010). Pain is generally accepted as whatever the patient says it is, wherever the patient says it is. Treatment of pain and its associated symptoms is a primary responsibility of the healthcare team. Treatment modalities for pain include the use of opioid analgesics, patient-controlled analgesia, psychological interventions, and preventing recurrence of pain. Reinforcing the reporting of pain by the patient is important, as is a respect for the social and cultural differences with respect to pain perception.

John Doe is a 57-year-old male who was diagnosed with Esophageal Cancer in January of 2017. He attended the St. Bernards Cancer Center located in Jonesboro, AR for consultation and treatments. His initial consultation was February 9, 2017 with one of the oncologists. At the first appointment, John met with the registrar personnel to complete all required paperwork, met with a nurse, nurse practitioner, cancer navigator, and oncologist. After his initial visit, the treatment plan was completed by staff members and he would begin treatments in the following weeks. John received both radiation and chemotherapy to treat his diagnosis. He began radiation and chemotherapy treatments on February 27, 2017 and finished on April 6, 2017. His radiation treatment was scheduled daily and his chemotherapy treatments were scheduled twice weekly for six weeks. He has a two-week follow-up appointment scheduled for April 21, 2017. At this follow-up visit, John will meet with a nurse, cancer navigator, and oncologist. This visit is solely

Thanks for the great post. Considering the patient personal and family history, your diagnosis is appropriate, although a confirmatory diagnostic tests and referral to a surgeon is highly recommended. I do also agree with the treatment plan of chemotherapy and radiation in most cases before surgery to reduce the tumor size and prevent metastasis. To help the patient with the tough time and improve the healing process, providing adequate support (education and emotional) is advise. Encourage the patient to enjoy times with family and friends, rent a comedy movie, practice meditation or prayers will be beneficial. The patient should be encouraged to appreciate and enjoy each day as a gift, also seek healing and optimal health.

HEENT is fine without facial asymmetry. He has conjugate gaze. There is no neck vein distention. In listening to his lungs, he has good air sounds on the right side, but I can hear very few breath sounds on the left side. His cardiac exam is rapid, a little bit irregular, heart rate of 100. His pulse ox is 95% on room air. The abdominal exam is unremarkable without organ enlargement or tenderness. I cannot hear bruits. He does have palpable distal pulses but there is a little bit of edema, left leg worse than the right leg. He does have an open wound on the inside of his left knee which looks more like a scratch, but apparently it was a vein harvest site. It is leaking clear edema fluid. According to the daughter, he does have a stage II sacral ulcer that is going to be followed by the wound nurse. I have continued all of his essential hospital medications. I did ask that he be weighed on a daily basis, he is in the Heart Failure Program. I have asked that we keep his legs elevated as much as possible. We are going to try to get some type of a reclining chair from physical therapy. All the therapies are going to see him. He is still on a different dysphasia 3 diet with honey thickened liquids. We will have the wound nurse see him. I am going to get baseline labs for prognostic purposes. I think we are going to be cautious in his discharge because I think it will be probably in terms of months before he can become a full caregiver for his wife and they may need to get some outside help in the home. I am going to send a copy of this to his daughter Lisa. Her cell phone number 919-349-6556. Her fax number is

Mr. Pasquarello is a 70-year-old gentleman who was recently discharged from the hospital on 8/7 after being admitted for an acute lower urinary tract infection. He was placed on antibiotics. It is to be noted that his chest x-ray at the time of previous admission had no focal infiltrate or pleural effusion identified. He is known to have atrial fibrillation, anxiety disorder, hypertension, and diabetes mellitus. He is also known to have carcinoma which is metastatic. The patient presents to the ED on 8/10/2017 complaining of shortness of breath at that time he is found to have bilateral pleural effusions and previously treated with yttrium-90 but he appears to be now on a downward spiral. Original CAT scan showed large bilateral effusions,

GB is a very pleasant individual who was admitted for chemotherapy. GB is a 41 y/o Hispanic male with an oncology diagnosis of MCL. The expected duration of this admission is 14 days for his high-dose chemotherapy for MCL, cycle #3A of R-CODOX –M regimen, of Chemotherapy. GB has been placed on a regular diet; current weight: 66kg; height: 169 cm; BMI: 23 (normal weight range); Braden score: 22 (not a fall risk, continue to reassess/monitor); placed on chemotherapy precautions and has a central line-triple lumen. GB’s wife has been staying with him at night and keeps him company when she