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Diagnosis/Surgery: Harold is a 54 year old male with complaints of constipation, abdominal cramping and ribbon- like stools x 2 months. His primary care physician referred him to a gastro-enterologist who ordered a colonoscopy. Biopsies were taken during the colonoscopy which showed a 8 cm tumor in the descending colon, with 4/10 lymph nodes positive for malignancy. The pathology report showed an adenocarcinoma of the colon. A CT scan was performed which showed multiple areas of metastasis in the liver and lungs. Harold is scheduled for a partial colectomy to remove the tumor and insertion of a port- a cath for chemotherapy. He may have a temporary colostomy. You are doing his pre-operative teaching, Nursing Management- Admission: Harold recovered well from the surgery and his temporary colostomy has been reversed. He received his first chemotherapy treatment with IV Sflourouracil and Oxaliplatin 10 days ago, and is admitted to your unit again with a diagnosis of rlo sepsis. He is in a semi-private room with a post-op patient that has c diff. His CBC is as follows: WBC: 600/mm3 Hgb: 62 g/dL Hct: 24% Platelets: 22.000/mm3 Nursing Management-Continued Care: Harold has had diarrhea 5-6 times daily for 2 days. He states his mouth is too sore to eat much of anything and he is very tired and dizzy. Urine output last shift was 250 ml and dark yellow. His VS are as follows: BP 80/48, P 130 and irregular, RR 28, T 102.8. Blood cultures were drawn. A chemistry panel was done and results are as follows: Nursing Management-Discharge: It is 7 days later and Harold is ready for discharge. He will be going home with the implanted port. His stomatitis has improved and his CBC and metabolic panel are roughly WNL However, he has lost 8 lbs while in the hospital, and states his appetite is “terrible.” He consumes less than 25% of his trays. He is withdrawn. pale and states I am tired from the moment I wake up in the morning.” What discharge teaching is indicated? 2 What interdisciplinary referrals are appropriate?
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