Reference no: EM133676176

Question

Mr. George Black is 60yrs old and works as a radiologist as the local hospital. George presents today at the GP clinic where you are working as the practice nurse for a routine checkup. George's background and medical history Height 175cm Weight 82kg Married to Lucy, a nurse. They have two adult daughters Rizy and Milarni and an adult son William, who all live nearby and visit daily. Lived predominately in the same region all his life, employed at local hospital since 2016. History of Type 2 diabetes, diagnosed at 58yrs. Medica?ons 1g metformin BD. Smokes 10 cigaretes a day, more on weekends. Consumes two glasses of red wine a night (for 30 +yrs.) All immunizations up to date, including COVID. Physically active everyday other than employment related. Mother and father both have COPD. Both parents' cigarete smokers, inside of home. Symptoms discussed with you (practice RN) George advises you that he is becoming breathless on his morning walk and is finding it difficult to complete his usual route of 2km in 40mins. During your assessment, you identify that George has lost 5kg since his last visit a month ago. George advises he has not been trying to lose weight; however, he has noticed a decreased appetite and increased fatigue. George suggests these symptoms have been present for more than 6 weeks. Investigations George's Dr requests blood tests. A Chest X-Ray was conducted and identified signs which warranted a chest CT. George and his wife Lucy, atended an appointment with the GP where they were advised that George's tests identified that he has stage II B Non-small cell adenocarcinoma (operable) (T2 N1 M0). The Gp advised that George could have surgery and possibly both adjuvant and neoadjuvant chemotherapy, and referes George to the oncology team at the local hospital. During this consultation, George discusses his concerns regarding his blood glucose levels (BGL's) over the last two weeks whilst waiting for his results. This morning his BGL was 10.8mmol, his usual BGL of a morning is 4.8 -6 mmols.

Underlying Pathophysiology

Discuss how the stress response could be contributing to George's increased Blood Glucose Levels ( BGL's).

Discuss at a systemic level, the disruption to normal pathophysiology that has resulted in the clinical manifestations of unexplained weight loss anbd breathlessness.

Nursing management

Discuss the difference between adjuvant and neoadjuvant chemotherapy and provide a rationale as to why George may receive both of these therapies as well as surgery.

Identify and discuss one nurse initiated intervention that is evidenced based and appopriate to address the clinical manifestation of breathlessness.

Collaborative Management

Identify one collaborative care team member ( for example, Physiotherapist, or Occupational Therapist) and justify how their role would support the patient and their family.