Clinical management and patient’s response and evidence based comparisons
Upon admission, following subsequent blood works, the doctor on duty ordered for Miss N.M. to be administered IV Lasix 40mg, Nifedipine 10mg po stat, cocktail stat (100cc 50% Dextrose, 20 cc of calcium gluconate and 20 units of soluble insulin) slow push to be infused 3 unit of Packed Red Blood Cells, and IVF 2.5L/24 hrs: normal saline. Four days later Miss N.M. was diagnosed with Hypokalemia, obstructive Uropathy, Anaemia and Likely Cervical Cancer. A biopsy confirmed Cervical Cancer Stage III B and bilateral Nephrostomy tubes were ordered and inserted to aid the client in eliminating wastes from here body.
With the administration of the IV Lasix 40 mg and Nifedipine 10 mg po there was a significant improvement in the client’s blood pressure readings 149/96 122/82. However, there was still no urinary output of significance. There should have been increased urinary output due to the therapeutic action of this loop diuretic. The administering of the loop diuretic, cocktail (100cc 50% Dextrose, 20 cc of calcium gluconate and 20 units of soluble insulin) and the insertion of the nephrostomy tubes improved the clients potassium reading from a 7.6 to a 5.8mEq/l. Normal potassium level range between 3.5-5.0. The potassium level in the blood was still elevated thus Kayexalate 15g po tds was added to the regime. This antihyperkalemic drug releases sodium ions in exchange primarily for potassium ions and ultimately expels potassium from the body via the intestines (Deglin, Vallerand & Sanoski, 2014). With the nephrostomy tubes institu, there was improved in the electrolyte balance of the client.
A study conducted by Mishra, Desai, Patel, Mankad and Dave (2009) saw the correlation between advanced cervical cancer and obstructive Uropathy and the need for insertion of percutaneous nephrostomy tubes. The study was conducted with individuals whom had either bilateral hydronephrosis or unilateral hydronephosis. Ultimately the study showed the great impact that the percutaneous nephrostomy tubes had on the lives of advanced cervical cancer victims as it pertains to their renal function. Miss N.M. had bilateral nephrostomy tubes inserted due to the advanced staging of her cervical cancer (IIIB). This was the best means by which excretion from the kidneys could have been obtained. With the aid of the IV Lasix 40mg and Kayexalate 15g po electrolyte balance is hoped to be achieved.
The ultimate goal in the management of cervical cancer is eradicate the abnormal tissue growth or to shrink the abnormal tissues. Stage III cervical cancer is currently best managed by a combination of radiation therapy and chemotherapy. Cancer Research UK (2014) posits that chemotherapy uses anti-cancer or cytotoxic drugs to destroy or shrink advanced cervical cancer cells by intravenously administering drugs such as Cisplatin (Platinol®), 5-fluorouracil (5-FU). While radiation therapy is treatment with high energy x-rays that have the ability to kill cancer cells. It is administered by a machine that aims x-rays at the body for approximately 4 to 6 weeks (external beam radiation) or by placing small capsules of radioactive material directly into or near the cervix (internal or implant radiation). Most patients receive both kinds of radiation therapy during their course of treatment (Texas Oncology, 2016 & Wiebe, Denny& Thomas, 2012).
Research has shown that chemotherapy not only has the ability to kill cancer cells but make radiation therapy more effective. Therefore, the strategy of administering chemotherapy concurrently with radiation treatment is appealing because chemotherapy and radiation therapy together, amplifies the eradication or destruction of cancer cells. (Cancer Research UK, 2014; Texas Oncology, 2016 & Wiebe, Denny& Thomas, 2012) Several clinical studies performed in patients with locally advanced cervical cancer utilizing concurrent chemotherapy and radiation therapy have suggested that this strategy may improve remission rates and prolong survival. Texas oncology 2016 indicates that a combined radiotherapy and chemotherapy (chemoradiotherapy) is the recommended treatment for most women with a cervical cancer that is larger than 4cm, or has spread beyond the cervix. For the past few years, this combination of treatment has shown that it is more likely to cure a cervical cancer than radiotherapy alone. It is recommended that Miss N.M. begin chemotherapy or radiotherapy or a combination of both (chemoradiotherapy ) as this will improve her chances of a disease-free survival.
References
Cancer Research UK (2014). Controlling advanced cervical cancer symptoms. In Cancer Research UK. Retrieved from http://www.cancerresearchuk.org/about-cancer/type/cervical-cancer/treatment/controlling-advanced-cervical-cancer-symptoms
Deglin, J.H., Vallerand, A.H., & Sanoski, C.A. (2014). Davis’s drug guide for nurses. (14th ed.). Philadelphia, PA: F. A. Davis Company.
Mishra, K., Desai, A., Patel, S., Mankad, M., & Dave, K. (2009). Role of percutaneous nephrostomy in advanced cervical carcinoma with obstructive uropathy: A case series. Indian Journal of Palliative Care Jan-Jun; 15(1): 37–40. Doi 10.4103/0973-1075.53510.
NHS Choices. (2015). Cervical cancer - Complications. In NHS Choices. Retrieved on June 12, 2016 from http://www.nhs.uk/Conditions/Cancer-of-the-cervix/Pages/Complications.aspx
Texas Oncology (2016).Stage III Cervical Cancer. Retrieved on June 6, 2016 from http://www.texasoncology.com/types-of-cancer/cervical-cancer/stage-iii-cervical-cancer
Wiebe, E., Denny, L., & Thomas G. (2012) Cancer of the cervix uteri. International Journal of Gynaecology and Obstetrics 119S2 (2012) S100-S109.