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NR 601 Week 7 Case Study -Neck Cancer
NR 601 Week 7 Case Study -Neck Cancer
NR 601 Week 7 Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in End-Of-Life Care:
Discussion Part One
C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer.
- Background:
- Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.
- PMH:
- Hypertension
- Hyperlipidemia
- Stomatitis
- Anemia
- Neutropenia
- Current medications:
- Carvedilol 12.5 mg po 1 daily
- Furosemide 40 mg po daily
- Surgeries:
- 2012: right radical neck dissection
- Allergies:
- None
- Vaccination History:
- Influenza vaccine last received 1 year ago
- Received pneumovax at age 65
- Received Tdap 5 years ago
- Has not had the herpes zoster vaccine
- Social history and Risk Factors:
- Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago
- Negative for alcohol intake or drug use
- Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.
- Family history:
- Negative
- Discussion Part One:
- Provide differential diagnoses (DD) with rationale.
- Further ROS questions needed to develop DD.
- Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient.
Discussion Part Two (graded)
- Physical examination:
- Vital Signs: Height: 6’0 Weight: 140 pounds; BMI: 19.0 BP: 156/84 P: 84 regular R: 20
- HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition
- NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM
- LUNGS: rhonchi in anterior chest bilaterally.
- HEART: S1 and S2 audible; regular rate and rhythm
- ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable
- NEUROLOGIC: negative
- GENITOURINARY: negative
- MUSCULOSKELETAL: negative
- PSYCH: PHQ-9 is 15
- SKIN: oral mucosa irritated-stomatitis
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Discussion Part Two:
Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.