Hepatocellular Carcinoma, Case Study Example

Introduction

The patient is a 66-year-old female who currently resides in a long-term care facility. She has a history of depression and faces critical physical and psychosocial challenges in her daily life. Her social support system is limiting because of her residency and the overall depressive state of this type of facility. This patient is currently in the wisdom/despair stage, according to Erikson (Simply Psychology, 2013). She was admitted to the emergency department in a full code for chest pain, and the primary diagnosis that was determined was necrosis of the liver resulting from Adenocarcinoma with the placement of a drain tube. However, she has a lengthy history of medical problems, including Type II Diabetes, Bacteremia, breast, liver, and spinal biopsies, MRSA in the lungs, depression, cervical cancer, COPD, GERD, gout, a pressure ulcer on the right heel, and frequent UTIs. She also suffered a stroke in 2001. Due to her long history of medical problems, the patient requires immediate medical attention and a comprehensive treatment plan.

Analysis

Based upon the patient’s current medical condition, her chest pain is a direct result of adenocarcinoma of the liver leading to a necrotic state (Rajan). The patient’s level of pain has compromised her health status, thereby leading to her admission to the emergency department and the need for immediate medical treatment.

The patient’s current condition is a result of this basic level of pathophysiology, whereby there has been a significant level of tissue necrosis due to cirrhosis of the liver, resulting from adenocarcinoma (Medscape). The patient requires additional diagnosis and evaluation based upon laboratory values and other tests that may contribute to a probable diagnosis and subsequent treatment plan.

In using the laboratory values as identified through testing, her systolic blood pressure was elevated, heart rate was normal, body temperature is in the normal range, respiratory rate is normal, and the CBC count was elevated upon admission but has since returned to normal. However, the patient’s level of hemoglobin is low, which may be a sign of anemia. In addition, her hematocrit was measured at 33.1, which is also on the low end. Although some of these values are not in the normal range, they are not dangerous enough to be serious contributing factors to the patient’s diagnosis and do not pose a significant threat to her current condition. Therefore, additional evaluation is required in order to determine how to best approach treatment planning for the patient over the short term. From a nursing perspective, it is necessary to determine how to move forward with the patient’s advanced condition so that treatment is immediate and is appropriate.

The primary medications being administered to the patient are listed as follows:

Conclusion

For this patient, it is essential to establish a treatment plan as soon as possible to alleviate symptoms and to manage the diagnosis. The chosen treatment plan is chemoembolization; therefore, the nurse must monitor this treatment, along with evaluating the chest port and Foley catheter at regular intervals. The patient must be consistently monitored and notes should reflect any dressing changes and other actions taken by the nurse. At shift change, nurses must communicate regarding the course of action for the next shift and the chosen treatment plan. These elements are critical in managing the patient’s symptoms, monitoring any possible drug interactions, and in determining if the chosen treatment plan is appropriate.

Finally, a concept map should be considered as a means of evaluating the patient’s condition and prognosis. The concept map is described as follows:

References

Medscape (2013). Hepatocellular carcinoma. Retrieved from http://emedicine.medscape.com/article/197319-overview#a0104

Rajan, T.J. Metastatic colon adenocarcinoma to liver. Retrieved from http://esynopsis.uchc.edu/eatlas/gi/108.htm

Simply Psychology (2013). Erik Erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html