NU142CL Unit 10 Final Case Study Example

A New Diagnosis and Four Competing Needs: A Final Case Study of a Composite 64-Year-Old Man Admitted With Breathlessness From a Pleural Effusion Who Learns He Has Lung Cancer, With Problems Selected, Ranked and Matched to Evidence

[Student Name]

Purdue University Global

NU142CL: Medical-Surgical Nursing I Clinical

Unit 10 Final Case Study

[Instructor Name]

[Date]

The patient is composite; values are bracketed where illustrative, and treatment decisions belong to the oncology and medical teams.

The Patient

Patient DD, a composite 64-year-old former roofer who smoked for forty years, came to the emergency department short of breath walking across a room. A chest X-ray showed a large right pleural effusion. He has high blood pressure and mild chronic lung disease. On admission: respirations [26], oxygen saturation [89] percent on room air, heart rate [104]. A thoracentesis drained [1,400] mL of fluid, and cytology and a lymph node biopsy confirmed advanced non-small cell lung cancer. His wife and adult son visit daily. He still works part-time fixing roofs for neighbors and says his main goal is to keep doing that as long as he can, a goal that later shaped the conversation about treatment.

Selected Data

Saturation [95] percent on [2] L after drainage, falling to [91] by day three as fluid reaccumulated; right-sided chest pain [6] out of 10 with deep breaths; weight loss of [6] kg over three months; albumin [2.9] g/dL; calcium normal. He sleeps poorly and asked the night nurse, "How long have I got?" Left out: his old knee surgery and routine labs that were normal and do not affect the plan. Kept, although normal: his calcium, because high calcium is a known complication of lung cancer and a normal value matters for interpreting later confusion or fatigue. Kept, because it shapes everything else: his weight loss and low albumin, which point to poor nutrition that affects healing after procedures and his strength for treatment.

Ranking the Problems

1. Impaired gas exchange from the pleural effusion. It ranks first because the fluid is returning and his breathing limits everything else, including conversations about his diagnosis.

2. Acute pain from the pleura and the procedure, which also makes him breathe shallowly.

3. Anxiety and grief after a new life-limiting diagnosis, shown by sleeplessness and his question at night.

4. Need for informed decisions about treatment goals, which depends on the first three being addressed.

He asked how long he had at two in the morning, which told the team that the diagnosis was weighing on him as heavily as his breathing.

Evidence Matched to Each Problem

Breathlessness: drainage relieves symptoms, and for fluid that returns quickly, an indwelling pleural catheter or a procedure to seal the pleural space is considered; positioning upright, oxygen to a target and a fan directed at the face can ease the sense of breathlessness (Harding et al., 2023).

Pain: scheduled analgesia with breakthrough doses, reassessed after each, and splinting with a pillow during coughing and deep breaths.

Anxiety and decisions: when patients with newly found metastatic lung cancer of this type were randomized to receive palliative care from the start, alongside their oncology care, their quality of life and mood scores were better, and patients in the palliative group lived longer despite receiving less aggressive end-of-life care (Temel et al., 2010). That evidence supports introducing palliative care early, not only at the end of life.

What the Team Did

A palliative care consult was requested on day three with his agreement, framed as an added team focused on symptoms and support. An indwelling pleural catheter was placed on day four so fluid could be drained at home. Pain was controlled at [3] with scheduled medicine. The nurse sat with him and his wife after the oncologist's visit to answer questions and arranged for the chaplain, whom he requested. He chose to begin treatment and to meet the palliative team again at his first oncology appointment.

Teaching for Home

He and his wife were taught to drain the pleural catheter every other day, recognize signs of infection at the site, and call for worsening breathlessness or fever. They received written instructions and practiced twice with the nurse (Potter et al., 2023).

Why Breathlessness Still Ranks First

Ranking breathlessness first was questioned by a classmate, who argued that his distress about the diagnosis was the bigger problem. The team's answer was that both were real, but that a man who cannot breathe comfortably cannot think through treatment choices or take in difficult news. The catheter and scheduled pain medicine came first so that the conversations he wanted could happen with him able to speak in full sentences. The ranking set the order of actions on the first day, not the importance of his fears; the palliative referral and the nurse's time with the family were scheduled for the same day the catheter decision was made.

Conclusion

The case shows how a new cancer diagnosis brings physical and emotional needs together, and why ranking breathlessness first does not mean postponing the conversation he started at two in the morning.

References

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.

Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733-742. https://doi.org/10.1056/NEJMoa1000678