[ANSWER]AT3 Case Study Scenario: Mr. Brett Patterson

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AT3: Case Study Scenario: Mr. Brett Patterson

Mr. Brett Patterson

It is 1300 hours, and you are working on an acute oncology (ONC) ward in a large metropolitan hospital.

You are caring for Mr. Brett Patterson, a 55-year-old male, who was admitted to your ward following chemotherapy 2 days ago, with nausea & vomiting, mild diarrhoea, and chills since yesterday.

Medical history:

  • Stage III colorectal adenocarcinoma diagnosed 5 months ago following routine bowel screening
  • Colonoscopy with biopsy, staging complete
  • Bowel resection with anastomosis – tumour removed 2 months ago, recovered well.
  • Current chemotherapy regime of FOLFOX via Baxter pump over 48 hours, every 14 days – commenced second dose of 12 cycles, completed 2 days ago.
  • Brett takes: Endone 5mg PO 4-6 hourly PRN, Metoclopramide 10mg TDS
  • Nil known allergies

Social History:

  • Mr. Brett Patterson is a real estate agent, lives with partner Kim and young adult daughter

Blood work:

  • FBE:
    • Slightly high Hb (185 g/l)
    • Normal platelets,
    • Normal white cell count
    • Slight drop from previous in neutrophils though still within normal range (3.00 x109/l
  • U+E:
    • Potassium is slightly low, otherwise no other abnormalities.

On examination:

  • Mr. Brett Patterson is intermittently nauseated with 2 x vomits today and watery diarrhoea x 3 today
  • Abdomen is soft and non-tender
  • Chest is clear
  • Brett has a small ulcer on the left side of his tongue, dry oral mucous membranes
  • Brett has noticed that his urine is quite concentrated
  • PICC L arm, dressing is clean and intact.
  • Brett is fatigued

Objective data:

  • Temp: 37.9 Celsius,
  • HR (Heart Rate): 92 beats per minute,
  • RR (Respiratory Rate): 16 breaths per minute,
  • BP: 110/50 mmHg,
  • SaO2: 96% on Room air,
  • BSL: 5.7mmol/l,
  • pain free.

Please work through the Clinical Reasoning Cycle to detail the provision of evidence-based, person- centred care for your shift of care

https://images.app.goo.gl/ouHCDQTYMmDAwyyK7

Ref: Levett-Jones, T. (2017). Clinical reasoning: Learning to think like a nurse. Pearson

Image: https://images.app.goo.gl/dWEq2D5BmU3zqEBd6

Some suggested references:

EVIQ (2020) Folfox. https://www.eviq.org.au/medical-oncology/colorectal/metastatic/114- colorectal-metastatic-folfox6-modified-fluo/patient-information

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