Skip to Main Content

++

LEARNING OBJECTIVES

++

After completing this case study, the reader should be able to:

++

  • Develop a prophylactic antiemetic regimen based on the emetic risk associated with cancer chemotherapeutic agents to optimize the management of nausea and vomiting.

  • Design an appropriate treatment regimen for anticipatory, breakthrough, acute, and delayed nausea and vomiting.

  • Design a monitoring plan to assess the effectiveness of an antiemetic regimen.

  • Discuss with patients and caregivers the reason for antiemetics, their appropriate use, and the management of side effects.

  • Recommend appropriate alternative antiemetic strategies based on patient-specific conditions, such as previous response to chemotherapy and side effects.

++

PATIENT PRESENTATION

++

Chief Complaint

++

“I have stomach pain and back pain.”

++

HPI

++

Mr Jones is a 57-year-old man who presents to the ED with complaints of lower back and abdominal pain, decreased appetite, and constipation since previous discharge from the hospital 3 days ago. He was recently hospitalized for prolonged abdominal pain, fatigue, a persistent cough, and a 14-lb weight loss over the previous 2 months. An ultrasound revealed marked cholelithiasis with changes of chronic cholecystitis for which he was started on amoxicillin/clavulanate. He was found to have a 1.4-cm pulmonary mass in the lower left lung associated with endobronchial obstruction, a 4-mm noncalcified left pulmonary nodule, slightly enlarged left hilar lymph nodes, and an enlarged liver with evidence of metastasis. A diagnosis of small-cell lung cancer was made with the plan to begin treatment in the outpatient setting. He currently reports that he does not have trouble swallowing but does have a productive cough. The sputum occasionally clears but is usually a brownish color.

++

PMH

++

  • BPH (untreated)

  • Cholelithiasis with chronic cholecystitis

  • Metastatic small-cell lung cancer

  • GERD

++

FH

++

Father died at age 82 of heart and renal failure; mother died at age 68 with emphysema, obesity, MI, hypertension; two sisters, one with diabetes; three adult children, alive and healthy.

++

SH

++

Single and works as a salesman at a car dealership. He has smoked 1–1.5 packs of cigarettes a day starting at the age of 14. He still smokes but has cut back because his employer has a campus-wide no smoking policy. History of alcohol and substance abuse, but he has not had alcohol for 14 years.

++

ROS

++

Complaints include hoarseness for 1 week and fatigue. Lower extremity weakness, productive cough with brownish sputum, abdominal pain and bloating, nausea, and constipation.

++

Home Meds

++

  • Ibuprofen 400 mg PO TID with food

  • Esomeprazole 40 mg PO daily

  • Oxycodone ER 10 mg PO Q 12 H

  • Oxycodone 5 mg PO Q 3 H PRN

  • Amoxicillin/clavulanate 875 mg PO BID × 6 more days

++

All

++

  • NKDA

++

Physical ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.