After coughing up bloody sputum one morning, James Mueller, a 68-year-old retired mill worker, sees his physician. A chest x-ray shows a suspicious density in the central portion of his right lung. Mr. Mueller is admitted to the hospital the following Monday for diagnostic tests.
Anita Sarros, RN, admits Mr. Mueller to the oncology unit and ob- tains a nursing history. Mr. Mueller is married and has three grown children. He worked in a local paper mill for 35 years before retiring at age 62. He describes himself as “pretty healthy,” except for a chronic smoker’s cough. He started smoking as a young man in the army. He has a 50 pack-year smoking history, having smoked a pack a day for 50 years, since age 18. Mr. Mueller says he briefly quit smoking following a small heart attack 3 years ago, but started again after 4 months. On further questioning, Mr. Mueller says his cough has been productive for the past few months, especially in the morning, and that he is shorter of breath than usual with activity.
Mr. Mueller’s examination data include BP 162/86, P 78 and regular, R 20, and T 98.4°F (36.9°C). Color good, skin warm and dry. Inspiratory and expiratory wheezes noted in right chest but good breath sounds throughout. No other abnormal findings are noted on examination. The physician orders early morning spu- tum specimens times 3 days for cytologic examination and schedules a CT scan of the chest the morning after admission.
Mr. Mueller’s CBC shows mild anemia, but remaining routine lab- oratory tests are essentially normal. Sputum cytology is positive for small-cell bronchogenic cancer. The CT scan shows a central mass approximately 4 cm in diameter with involved mediastinal and sub- clavicular lymph nodes. A small mass is also noted on the lumbar spine. After conferring with his physician and an oncologist, Mr. Mueller decides to undergo a trial course of chemotherapy.