Nursing Critical Care For The Patients Presentation Help

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CASE STUDY
24
GASTRIC CANCER
For the Disease Summary for this case study,
see the CD-ROM.
PATIENT CASE
History of Present Illness
A.G. is a 62-year-old Latino male who presents to his family PCP complaining of persist-
ent weakness, fatigue, and lack of energy that began approximately three weeks ago.
When questioned about abdominal discomfort or pain, the patient noted that he “seemed to
get heartburn more often lately despite taking his medication for GERD.” He denied vom-
iting, weight loss, swelling in the abdomen, and early satiety. A CBC was ordered and
revealed a red blood cell count of 3.2 million/mm), hematocrit of 31%, and hemoglobin
concentration of 10.1 g/dL. A fecal occult blood test was performed and the stool was pos-
itive for blood.
Patient Case Question 1. What disorder is suggested by the patient’s complete blood
count?
Past Medical History
Benign prostatic hyperplasia
Asthma
Gastroesophageal reflux disease
Family History
Mother is alive at age 82 with type 2 diabetes mellitus and hypertension
Father died at age 59 from acute myocardial infarction
Patient has two sisters (ages 60 and 64) who are alive and well
Maternal grandmother died from breast cancer and an aunt passed away from complica-
tions secondary to colon cancer
Eyes, Ears, Nose, and Throat
Extra-ocular muscles intact
(-) nystagmus
Slightly pale conjunctiva
• Sclera clear
• Normal funduscopic exam without retinopathy
· Auricular canal occluded with wax bilaterally
• Deviated nasal septum without sinus tenderness
• Nose without discharge or congestion
intact and normal
Oropharynx clear, teeth intact; tongue mid-line and negative for abnormalities, tonsils
Neck
2
Supple without masses
• No palpable nodes or auscultated bruits
Normal thyroid
• (-) jugular vein distension
Lungs and Thorax
• Clear to auscultation and percussion
• Breath sounds resonant and equal bilaterally
Good air entry
• No crackles or wheezing
Heart
Regular rate and rhythm
• Point of maximal impulse normal at the 5th intercostal space
• Normal S, and S2
• (-) for murmurs, S, and S4
Abdomen
Soft but tender to palpation
No masses, swelling, or bruits
• Normal peristaltic activity
• No organomegaly
Genitalia/Rectum
• Normal male genitalia
Diffusely enlarged prostate without distinct nodules, consistent with benign prostatic
hyperplasia
Musculoskeletal/Extremities
Spooning of fingernails (koilonychia)
(-) cyanosis, clubbing, and edema
Limited range of motion upper and lower extremities consistent with degenerative joint
114 PART 3 GASTROINTESTINAL DI
Muscle strength and tone 4/5 bilaterally
Peripheral pulses palpable bilaterally
Neurological
Oriented to person, place, and time
Deep tendon reflexes 2+
• Normal gait
CNs II-XII intact
• No motor or sensory deficits
Other
Serology: (+) for H. pylori antibodies
Peripheral blood smear: hypochromic, microcytic erythrocytes
presented above?
Patient Case Question 6. Identify five risk factors for gastric cancer in this patient.
Patient Case Question 7. Which type of deficiency is expected by the clinical data
Laboratory Blood Test Results
See Patient Case Table 24.1
19 pg
Patient Case Table 24.1 Laboratory Blood Test Results
Na
139 meq/L MCH
Chol
K
4.4 meq/L MCHC
26 g/dL
Ca
Ci
101 meq/L WBC
5,200/mm iron
HCO;
22 meq/L
AST
93 IU/L TIBC
BUN
14 mg/dL
ALT
112 IU/L Transferrin sat
Cr
0.6 mg/dL Total bilirubin 2.1 g/dL Ferritin
Glu, fasting 104 mg/dL Total protein
7.1 g/dL Vit B12
MCV
70 fL
Alb
4.6 g/dL Folic acid
188 mg/dL
9.1 mg/dL.
34 ug/dL
720 ug/dL
7%
8 ng/mL
790 pg/mL
340 ng/mL
Patient Case Question 8. Which ten laboratory test results from this case study suggest
that the patient is iron deficient?
Patient Case Question 9. Why was it appropriate to test for vitamin B12 and folic acid
levels?
Patient Case Question 10. What is suggested by the liver function tests above?
Specialized Tests
Upper endoscopy revealed a 5 cm x 3 cm mass in the upper stomach near the junction
the esophagus and stomach. A biopsy of suspicious tissue revealed cellular abnormalitie
Social History
The patient is a retired music professor and lives alone since his wife passed away six years
does not contain healthy servings of whole grain products, fresh fruits, and vegetables. He
significant amount of hamburger and processed meats, especially wieners. His daily diet
ago. He smokes 1% packs of cigarettes and drinks 3-4 brandy Manhattans daily. He eats a
does not have a regular exercise program but does “some walking.”
Medications
Omeprazole 20 mg po QD
Ipratropium bromide 2 puffs QID
• Triamcinolone MDI 2 puffs QID
• Albuterol MDI 2 puffs PRN
• Terazosin 1 mg HS QD
Patient Case Question 2. Which of the drugs listed directly above is the patient taking
for benign prostatic hyperplasia?
Patient Case Question 3. Which of the drugs listed directly above is the patient taking
for asthma?
Patient Case Question 4. Which of the drugs listed directly above is the patient taking
for gastroesophageal reflux disease?
Allergies
Aspirin (upset stomach)
Physical Examination and Laboratory Tests
General
The patient is a pleasant, overweight Latino male in no apparent distress. He appears to be
his stated age.
Vital Signs
BP 120/95; P 78; RR 15; T 98.5°F; Wt 182 lbs; Ht 5’6/2″
Patient Case Question 5. Are any of the vital signs above abnormal?
Skin
• Warm and dry
• No lesions, bruising, or discoloration
• Normal turgor

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