Case Study Antineoplastic: Mrs. Jones presented to the Emergency Department (ED) at 0700 with re

Case Study Antineoplastic: Mrs. Jones presented to the Emergency Department (ED) at 0700 with reports severe abdominal pain, vomiting coffee ground looking emesis for two days and severe fatigue. She is a 65-yr. old 135lb, post-menopausal woman with a past medical history of Rheumatoid Arthritis (RA), hip surgery in 2011, chronic pain and high blood pressure. Recently, Mrs. Jones received several doses of chemotherapy treatment Methotrexate for a new diagnosis of breast cancer. Until this admission, Mrs. Jones reports feeling well and being able to manage any feeling of nausea or fatigue related to her chemotherapy treatment. However, Mrs. Jones reports that her chronic hip pain has increased over the last month and she has taken more frequentdoses of over the counter Ibuprofen to help relieve her pain. Mrs. Jones reports taking upwards of 4,000-4,500mg of ibuprofen in total per day for her hip pain (more than what was originally prescribed by her physician) she states “It’s over the counter so I figured it is safe to take extra since it helps so much I take a little more so I don’t have to take my Norco’s as much.” Mrs. Jones is on the following medications at home; o Ibuprofen 800mg PO q 6 hrs for moderate pain (4-6 verbal scale)o Hydrocodone/acetaminophen 5/325mg PO q 4 hrs for severe pain (7-10)o Aspirin 81mg PO q dayo Vitamin D 800IU q HSo Calcium 600mg q HSo Hydroxychloroquine 400mg q dayo Lisinopril 10mg PO daily for hypertension Mrs. Jones has also received several infusions of Methotrexate over the last 3 weeks for a new diagnosis of breast cancer. Upon closer assessment in the ED, Mrs. Jones had the following vital signs/labs; BP 90/70, HR 120, Temp 98.9 F, O2 sat 98% on RA, RR 21, + coffee ground in emesis Her lab results yielded the following; HgB 7.2 g/dLHcT 31%K+     3.5Na+   140WBC  16 Emergency endoscopy confirmed the presence of an upper GI bleed which was cauterized to slow the bleeding. In the ED, Mrs. Jones was given 2 units of blood for her low HgB/HcT and an IV push of 40mg Pantoprazole to help control her GI bleed. She was admitted to the Medical Surgical Unit with the following orders which were started in the ED; 0.9% NaCl IV continuous infusion @ 100ml/hrIVP Ondansetron 4mg/ml q 6hrs PRN for Nausea/VomitingIVP Pantoprazole 40mg q 8 hrsIVP Morphine 2mg/ml q 4hrs as needed for moderate to severe pain (5-10 verbal scale)NPO except medsStrict I/O’sRepeat BMP/CBC @ 2100Up ad lib Please answer the following questions about Mrs. Jones; 1) What is the probable cause of Mrs. Jones GI bleed?2) Should Mrs. Jones be given a prescription for aspirin/NSAIDS when receiving antimetabolites? Why or why not?3) What education needs to be given to Mrs. Jones to prevent this issue from happening again? What chemotherapy/cancer specific instructions can you give to Mrs. Jones to help her at home? (Be specific including dietary recommendations, lifestyle changes, etc.)4) What is Methotrexate? What other medical conditions is it prescribed for?5) How does Methotrexate work for Cancer?6) Of the home medications listed for Mrs. Jones, are there special considerations that need to be taken? Are there medications that are contraindicated or should be stopped?(ex: interactions with other meds? Synergistic effects with other meds? Etc..)                 Health Science Science Nursing PHARM 180 Share QuestionEmailCopy link Comments (0)

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