You are working 7PM-7AM on an oncology service of a university medical center with a pediatric/adolescent/adult population. The staff working with you includes an experienced oncology RN, an experienced RN who has completed orientation to oncology, 3 PCTs (Patient Care Technicians) and a nursing student. Interns and residents (oncology) are on call. The patient assignment is as follows:
AC 66 year old male
Adm. Dx: Colon cancer (Stage 2) – receiving chemotherapy cycle as an outpatient. Hosp. day 2, admitted for diarrhea and dehydration
PMH: Colon resection 2 months ago
Soc. Hx: Married, lives with wife and 3 children (20 yrs, 18 yrs and 12 yrs);
Wt: 62.7 Kg; Employed, owns home, health insurance, occasional alcohol
Report: Port-a-cath CVC in place – site clean/dry
FOLFOX protocol (5-FU, leucovorin and oxaliplatin) last week
Bland diet, unable to tolerate
Antiemetics and anti-diarrheals PRN
D5W w/20 mEq KCL @ 100 mL/hr
Morning labs: RBCs – 3.8, Hgb 12, Hct 38, WBCs 4, Platelets 99
Stool culture negative for C-diff
2. Identify at least 3 factors (co-morbid conditions, support systems, environmental factors, etc.) that could delay discharge.
a. Include evidence based strategies utilized to prevent these complications (with references)
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