Patient Profile:

• Name: Sarah Johnson
• Age: 54
• Diagnosis: Metastatic breast cancer, Stage IV, diagnosed six months ago with metastasis to the liver and bone

Treatment Plan:

• Surgery: Lumpectomy with axillary lymph node dissection
• Chemotherapy: Adriamycin and Cyclophosphamide (AC) regimen
• Radiation Therapy: Targeted treatment to the chest wall post-surgery

Clinical Presentation:

Subjective Data:

• Reports of nausea and vomiting, especially after chemotherapy sessions
• Expresses feelings of sadness and fear regarding her prognosis and the impact on her family
• States she has lost 10 pounds in the last month due to decreased appetite and nausea
• Describes pain in the surgical area and generalized body pain that worsens at night
• Mentions experiencing a red, itchy rash on her chest from radiation therapy

Objective Data:

• Vital signs: HR 78 bpm, BP 120/80 mmHg, Temp 98.6°F
• Weight: 135 lbs (down from 145 lbs)
• Physical examination reveals tenderness in the left breast and axilla

True or False: Emotional distress can decrease treatment adherence.

Choice A reason: Upper GI bleeding is not a direct cause of right heart failure (cor pulmonale). While severe GI bleeding can lead to other complications such as anemia or shock, it does not typically result in cor pulmonale.

Choice B reason: Chronic obstructive pulmonary disease (COPD) is a primary cause of cor pulmonale. COPD leads to chronic hypoxia, which increases pressure in the pulmonary arteries (pulmonary hypertension). The right ventricle of the heart must work harder to pump blood through these high-pressure arteries, eventually leading to right heart failure.

Choice C reason: Liver failure can lead to various systemic complications such as fluid imbalance and electrolyte disturbances, but it is not a direct cause of right heart failure (cor pulmonale). Cor pulmonale is specifically related to pulmonary conditions that increase right ventricular workload.

Choice D reason: Renal failure, while serious and capable of causing cardiovascular complications due to fluid overload and hypertension, is not typically linked to the development of cor pulmonale. The primary cause of cor pulmonale is chronic lung disease like COPD, which directly affects the pulmonary vasculature.

Choice A reason: Liver cirrhosis is characterized by chronic liver damage leading to scarring and liver failure. The typical lab findings for liver cirrhosis would include elevated liver enzymes (ALT, AST), bilirubin, and low albumin levels, which are not mentioned in the given test results.

Choice B reason: Acute hepatitis refers to the inflammation of the liver, usually caused by viral infections or toxins. Lab results consistent with acute hepatitis would show elevated liver enzymes (ALT, AST) significantly higher than normal, which are not provided in the text.

Choice C reason: Cholecystitis is the inflammation of the gallbladder, often due to gallstones. Lab findings for cholecystitis may include elevated white blood cell count and sometimes mild elevation of liver enzymes, but not the specific elevated levels of serum amylase and lipase.

Choice D reason: Acute pancreatitis is an inflammation of the pancreas, and the hallmark lab findings include significantly elevated serum amylase and lipase levels. The test results show serum amylase of 920 units/L (reference: 30-220 units/L) and serum lipase of 704 units/L (reference: 0-160 units/L), which are highly indicative of acute pancreatitis. Elevated serum glucose and low serum calcium levels are also consistent with this diagnosis.