Question

Question 1. What is the priority for caring for a patient with stage IV breast metastatic disease in bones, brain, and liver. What are two nursing interventions we can utilize when caring for her, please provide rationales.

2. Describe the ethical and legal issues of advanced directives including the role and responsibilities of the healthcare surrogate decision-maker.

Answer 1

Ans) For women with stage IV breast cancer, systemic (drug) therapies are the main treatments. These may include:

Hormone therapy
Chemotherapy (chemo)
Targeted drugs, such as trastuzumab (Herceptin) and pertuzumab (Perjeta)
Immunotherapy
Some combination of these
Surgery and/or radiation therapy may be useful in certain situations (see below).

Treatment can often shrink tumors (or slow their growth), improve symptoms, and help women live longer. These cancers are considered incurable.

- Nursing Interventions Rationale

Determine pain history (location of pain, frequency, duration, and intensity using numeric rating scale (0–10 scale), or verbal rating scale (“no pain” to “excruciating pain”) and relief measures used. Believe patient’s report.

Rationale:

Information provides baseline data to evaluate effectiveness of interventions. Pain of more than 6 mo duration constitutes chronic pain, which may affect therapeutic choices. Recurrent episodes of acute pain can occur within chronic pain, requiring increased level of intervention. Note: The pain experience is an individualized one composed of both physical and emotional responses.

- Provide nonpharmacological comfort measures (massage, repositioning, backrub) and diversional activities (music, television) Promotes relaxation and helps refocus attention.

- Encourage use of stress management skills or complementary therapies (relaxation techniques, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, and therapeutic touch). Enables patient to participate actively in nondrug treatment of pain and enhances sense of control. Pain produces stress and, in conjunction with muscle tension and internal stressors, increases patient focus on self, which inturn increases pain level.

2) Healthcare providers should take an initiative and discuss patient’s goal for end-of-life care or palliative care, as their preferences can change from person to person. Some patients might target for cure or some for comfort care, hence this trustful communication can avoid the ethical crisis surrounding that topic. The stability of these health preference goals is another issue as it has a potentiality to change with illness. Hence, the health scenario in each specific case has to be renewably evaluated so as to opt for scenario-based preferences. Here, the role played by clinicians is important as they can promote communication, education and discussion related to end-of-life care preferences and their implications among the patient, and their families in order to facilitate improved decision making. Effective advance planning or advanced directives can assist in putting forth patient’s autonomous choices but flexibility in these advanced directives can be appraised as it can accommodate any inadvertent scenario-based preference change and evaluation.

- Community standards can work well where the patient’s desire from the end-of-life treatment choices is not well demarcated [3]. It is crucial to have a public dialogue discussing the ethical issues and dilemmas surrounding end-of-life care. This open discussion can facilitate development and implementation of policies and guidelines safeguarding the interest of patients and healthcare organizations [1]. Much progress has been made to address the ethical issues surrounding end-of-life care situation, and with the continued advancement in medical science, and its leading role in our lives demands further research into this topic. As age advances so thus the illness in many cases, hence there is a need to research and implement recommendations to relive the stress faced by people during that critical time and optimize quality care to improve and ease end-of-life journey .