Case Study Scenario: Mr. Brett Patterson

AT3: Case Study Scenario: Mr. Brett Patterson

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
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:
- Slightly high Hb (185 g/l)
- Normal platelets,
- Normal white cell count
- Slight drop from previous in neutrophils though still within normal range (3.00 x10⁹/l
U+E:
- Potassium is slightly low, otherwise no other

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
Brett is fatigued