15 Jan What can you tell him about lung c

Discussion 7.1 – Case Study One

A patient who had a supraglottic partial laryngectomy with a right sided radical neck dissection 4 weeks ago is now receiving radiation therapy. He has lost 24 pounds since his surgery, which makes him 15 pounds less than his ideal weight. He tells you that he has no appetite and that what food he does eat “has no taste”. In addition although he expresses that he is glad to be alive he does not want friends to visit because it takes so much energy to interact with them. He also says that he can no longer play the piano because of difficulty moving his right arm and shoulder.

What factors are contributing to his fatigue?

Is the weight loss a concern? If so, what should you do about it?

Should you further press the issue of not wanting to visit with friends? Why or why not?

What other health care professionals or resources would be appropriate at this time?

Discussion 7.2 – Case Study Two

The patient is a 64 year old man with COPD who lives with his wife of 35 years. He retired 2 years ago when his disease interfered with his job as a carpenter. He also quit smoking about a year ago. Since then, his disease has remained stable; however, he now reports that he thinks his wife is preparing for widowhood by taking over all the home chores that he always performed including driving and bill paying. Limiting his interaction with friends, and making all decisions. He is angry and depressed. Routine assessment with pulmonary function testing show his FEV to be 40% of his predicted value, which is an improvement over the 32% value of FEV last year.

What severity classification is his COPD? Provide a rationale for your choice.

How should you respond to his statement about the wife probably preparing for widowhood?

Should he continue to drive and pay bills? Why or why not?

What psychosocial assessment of this patient and his situation should you make?

Should you include the wife in any part of this discussion? Why or why not?

Discussion 7.3 – Case Study Three

The patient is a 60 year old man who has just been diagnosed with non-small cell lung cancer. He smoked cigarettes for about 25 years starting when he was 16 years old and quit when he was 41 years old. His lung cancer is at stage I in the left lower lobe. He is distraught, saying that he can’t die now because he has one child in college and two in high school. He also fears chemotherapy and seems bitter that he quit smoking and got lung cancer anyway. His next statement is; “Why couldn’t I get prostate cancer like most men? At least they survive. No one beats lung cancer.”

What can you tell him about lung cancer survival?

What can you tell him about the benefits of having quit smoking?

For this cancer stage and type, what is/are the most likely therapy/therapies?

What resources could you recommend to help him at this time?