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: Idiopathic pulmonary fibrosis is a chronic, progressive lung disease characterized by scarring of the lung tissue. Tissue plasminogen activators (tPAs) are not used for this condition, as they are primarily designed to dissolve blood clots, not to address fibrotic changes in the lungs.

Choice B reason: Sarcoidosis is an inflammatory disease that affects multiple organs, particularly the lungs and lymph glands. It involves the growth of tiny collections of inflammatory cells called granulomas. Tissue plasminogen activators are not used in the treatment of sarcoidosis since the condition is not related to blood clots but rather to immune system dysregulation.

Choice C reason: Atelectasis is the complete or partial collapse of a lung or lobe of a lung due to alveoli deflation. The treatment typically focuses on re-expanding the lung tissue through techniques such as deep breathing exercises, bronchoscopy, or mechanical ventilation. Tissue plasminogen activators are not relevant for this condition, as they are used to dissolve blood clots, not to treat lung collapse.

Choice D reason: Pulmonary embolus (PE) is a blockage in one of the pulmonary arteries in the lungs, usually caused by blood clots that travel to the lungs from the legs or other parts of the body (deep vein thrombosis). Tissue plasminogen activators are used to treat PE because they can effectively dissolve the blood clots obstructing the pulmonary arteries, thereby restoring normal blood flow and preventing further complications.

Choice A reason: Subcutaneous administration of anticoagulants like Lovenox (enoxaparin) or heparin is a common and effective method for preventing DVT and VTE. These medications help prevent clot formation by thinning the blood and reducing the risk of thrombus development.

Choice B reason: Graduated compression stockings, such as thromboembolic deterrent (TED) hose, are used to improve blood flow in the legs and prevent the formation of blood clots. They apply consistent pressure to the legs, helping to maintain venous return and reduce the risk of DVT.

Choice C reason: Intermittent pneumatic compression devices (IPCs) are also used to prevent DVT and VTE. These devices periodically inflate and deflate, applying pressure to the legs to stimulate blood flow and prevent blood stasis, which can lead to clot formation.

Choice D reason: Strict bed rest is not recommended for DVT and VTE prevention. Prolonged immobility can increase the risk of clot formation. Encouraging early mobilization and activity is crucial to reduce the risk of DVT.

Choice E reason: Early and aggressive mobilization is a key strategy in preventing DVT and VTE. Encouraging patients to move and engage in physical activity as soon as it is safe to do so helps promote blood circulation and prevent the development of blood clots.