Discussion 7.1 – Case
Study One

A patient who had a supraglottic partial laryngectomy with a
right sided radical neck dissection 4 weeks ago is now receiving radiation
therapy. He has lost 24 pounds since his surgery, which makes him 15 pounds
less than his ideal weight. He tells you that he has no appetite and that what
food he does eat “has no taste”. In addition although he expresses that he is
glad to be alive he does not want friends to visit because it takes so much
energy to interact with them. He also says that he can no longer play the piano
because of difficulty moving his right arm and shoulder.

What factors are contributing to his fatigue?

Is the weight loss a concern? If so, what should you do
about it?

Should you further press the issue of not wanting to visit
with friends? Why or why not?

What other health care professionals or resources would be
appropriate at this time?

Discussion 7.2 – Case
Study Two

The patient is a 64 year old man with COPD who lives with
his wife of 35 years. He retired 2 years ago when his disease interfered with
his job as a carpenter. He also quit smoking about a year ago. Since then, his
disease has remained stable; however, he now reports that he thinks his wife is
preparing for widowhood by taking over all the home chores that he always
performed including driving and bill paying. Limiting his interaction with
friends, and making all decisions. He is angry and depressed. Routine
assessment with pulmonary function testing show his FEV to be 40% of his
predicted value, which is an improvement over the 32% value of FEV last year.

What severity classification is his COPD? Provide a
rationale for your choice.

How should you respond to his statement about the wife probably
preparing for widowhood?

Should he continue to drive and pay bills? Why or why not?

What psychosocial assessment of this patient and his
situation should you make?

Should you include the wife in any part of this discussion?
Why or why not?

Discussion 7.3 – Case
Study Three

The patient is a 60 year old man who has just been diagnosed
with non-small cell lung cancer. He smoked cigarettes for about 25 years
starting when he was 16 years old and quit when he was 41 years old. His lung
cancer is at stage I in the left lower lobe. He is distraught, saying that he
can’t die now because he has one child in college and two in high school. He
also fears chemotherapy and seems bitter that he quit smoking and got lung
cancer anyway. His next statement is; “Why couldn’t I get prostate cancer like
most men? At least they survive. No one beats lung cancer.”

What can you tell him about lung cancer survival?

What can you tell him about the benefits of having quit
smoking?

For this cancer stage and type, what is/are the most likely
therapy/therapies?

What resources could you recommend to help him at this time?