Cord Compression

FH- mother and brother had

pancreatic cancer
He is a former smoker, and had the
same spinal cord cancer in 2014
Spinal cord compression is a neurologic emergency caused by a
malignant tumor in the epidural space of the spinal cord (Lewis,
277).
-Decadron- 4mg/mL inj IV Q4h. inhibits multiple
inflammatory cytokines; produces multiple glucocorticoid
and mineralocorticoid effects (Epocrates).

Patient is a 68 yo male, six foot tall and 126

lb. BMI of 17.3. Assessment of T10 and T12
dermatomes indicated musculoskeletal
weakness of the LLE and RLE; but patient
is up adlib. His skin is dry and fragile, BP
increased and uses glasses when reading.
Priority Nursing Diagnosis (3 parts)
Acute/chronic pain related to compression of nerve tissue and
inflammation, as evidenced by reports of pain, alteration in
muscle tone, and guarding behaviors. Client will report maximal
pain relief or control with minimal interference with activates of
daily living.
Nursing interventions you used with rationales:
1) Determine pain history, location, frequency, duration, and
intensity on a 0-10 pain scale; and relief measures used.
Information provides baseline data to evaluate need for, and
effectiveness of, interventions.
2) Provide no pharmacological comfort measures such as
positioning. Promotes relaxation and helps refocus attention.
3) Administer analgesics as indicated, for example opioids such
as OxyContin, hydromorphone, and fentanyl. Effective for
localized and generalized moderate to severe pain, with long
acting or controlled release forms available.
Evaluation: Goal partially met, patient reports decreased pain
but not to a manageable level. Patient is up adlib and able to
perform ADLs with rest periods and movement only in a small
area.
(Doenges, p.854-855)

Malnutrition/Cachexia

The patient with cancer may experience protein

and calorie malnutrition categorized by fat and
muscle depletion (Lewis, 276).
- Ensure with each meal, 16g protein, 23
vitamins and minerals, and 160 calories per 8oz.
(Ensure.com)

(MS, 68 y.o)

Sarcamatoid
carcinoma

-OxyContin 10 Mg tablet Q12h Binds with opioid receptors

Sarcamatoid carcinomas are rare malignancies

which represent poorly differentiated epithelial
tumors that may be difficult to recognize as such.
Sarcamtoid carcinomas are uncommon and often
diagnostically challenging tumors that can arise.
Growth patents and the presence of a traditional
invasive or in situ carcinoma component are very
important for the diagnosis. (Lewis, Ritter,
Elmofty, 2005).

Patient was in need of

different types of pain
control methods besides
opioid analgesics. While with
the patient we worked on
ways for him to sit and lie
down in bed more
comfortably with pillow and
wedge support, and to eat in
the chair or recliner to
support his back better,
instead of sitting on the edge
of the bed to eat.

in the CNS, Altering perception of and emotional response

to pain. (Lippincott, 1043)
-Roxicodone 10 mg tablet Q3h. Binds with opioid receptors
in the CNS, Altering perception of and emotional response
to pain (Lippincott, 1043)
- Dilaudid inj. 0.5 mg IV Q2h. binds with opioid receptors in
the CNS, altering perception of and emotional response to
pain (Lippincott, 701)
-Miralax 17g oral BID, causes water to be retained in the
stool (Lippincott, 1124)
-Pericolase 2 tablet 8.6-50mg daily. Facilitates mixture of
stool fat and water (Epocrates).

Patients with cancer are especially vulnerable to distress

and may need more psychological support. To facilitate
support and coping I made myself available, exhibited a
caring attitude (Lewis, 279). Patient only has his daughter
as a support system but he seems happy with that. He does
not seem sad or unable to cope with the situation he is in.
he has been through this type of cancer before and has
appeared to have developed effective coping skills.

-Neutrophils- 84, increased, in some cancers neutrophils are one of the first
responders to the inflammatory calls to migrate towards the site of inflammation
(Pagana&Pagana, 53)
-Lymphocytes- decreased, 11, decreases with radiation therapy, which the patient
has recently received (Pagana&Pagana, 550).
-Calcium- decreased, 8.7, was as low as 7.1 on admission. Monitors various
malignancies, in this case the patient had spinal lesions. Hypocalcaemia is also
associated with hypoalbuminemia which is caused by malnutrition
(Pagana&Pagana, 148).
1
-MRI of thoracic spine- shows metastasis of cancer and Para spinal muscle
degeneration.