Case Study

It is 1300 hours, and you are working on an acute oncology (ONC) ward in a large metropolitan hospital.

You are caring for Brett Patterson, a 55-year-old male, who was admitted to your ward following chemotherapy 2 days ago, with nausea & vomiting, mild diarrhoea, and chills since yesterday.

Medical history:

• Stage III colorectal adenocarcinoma diagnosed 5 months ago following routine bowel screening
• Colonoscopy with biopsy, staging complete
• Bowel resection with anastomosis – tumour removed 2 months ago, recovered well.
• Current chemotherapy regime of FOLFOX via Baxter pump over 48 hours, every 14 days – commenced second dose of 12 cycles, completed 2 days ago.
• Brett takes: Endone 5mg PO 4-6 hourly PRN, Metoclopramide 10mg TDS
• Nil known allergies

Social History:

• Brett is a real estate agent, lives with partner Kim and young adult daughter Blood work:
• FBE: o Slightly high Hb (185 g/l) o Normal platelets, o Normal white cell count o Slight drop from previous in neutrophils though still within normal range (3.00 x109)
• U+E: o Potassium is slightly low, otherwise no other abnormalities.

On examination:

• Brett is intermittently nauseated with 2 x vomits today and watery diarrhoea x 3 today
• Abdomen is soft and non-tender
• Chest is clear
• Brett has a small ulcer on the left side of his tongue, dry oral mucous membranes
• Brett has noticed that his urine is quite concentrated
• PICC L arm, dressing is clean and intact.
• Brett is fatigued

Objective data:

• Temp: 37.9 Celsius,
• HR (Heart Rate): 92 beats per minute,
• RR (Respiratory Rate): 16 breaths per minute,
• BP: 110/50 mmHg,
• SaO2: 96% on Room air,
• BSL: 5.7mmol/l,
• pain free.