Question

Case Study: Nursing homework

A 70-year-old man with a history of hypertension, hyperlipidemia, appendectomy, initially presented to his primary care physician with occasional bloody stools and dull right upper quadrant pain. Blood was sometimes mixed into his stools but was more often seen on the toilet paper after wiping. He attributed his symptoms to hemorrhoids and did not undergo the colonoscopy recommended by his primary care doctor. His pain and hematochezia were improved for some time, but they began to worsen 10 months later. At that time, he also developed bloating and a feeling of not evacuating his stool completely. A colonoscopy was performed, which found a 5 cm mass which was found to be a moderately differentiated adenocarcinoma. CT imaging of the chest, abdomen, and pelvis was positive for metastatic disease. The patient underwent a laparoscopic left hemicolectomy with colostomy creation. The surgical pathology showed an adenocarcinoma of the colon with invasion of the subserosa and involvement of 20 out of 26 regional lymph nodes, making his cancer stage 4. The nuclear medicine bone scan shows metastasis to the spine and multiple ribs. He had no family history of colon, breast, or ovarian cancer. The patient is a widower with 3 children and 7 grandchildren. He is a retired postal worker that enjoys watching football and playing golf. Soon after recovering from surgery, he presented to the oncology clinic for consultation. He is very knowledgeable about his options and has researched his disease thoroughly. He states that he does not want aggressive therapy and would like to explore palliative care or hospice as an option once he returns from a family vacation to Hawaii.

Three weeks later the patient presents to the hospital in severe pain. A palliative care and hospice consult are ordered. On the admission, the patient reiterates that fact that he does not want aggressive therapy and requested and signed a DNR. Prior to the palliative care consult the patient developed altered mental status. A neurology consult was ordered. An ordered CT scan of the head shows metastasis. The living will name the oldest child as the health care surrogate. The health care surrogate met in consultation with the neurologist, oncologist and palliative care physicians and all the physicians agree that hospice is appropriate. The health care surrogate refuse to except the prognosis and refuse to sign the hospice papers. He requested that aggressive measures are taken to save he father’s life. He also wants the DNRO rescinded.

1. The patient’s is extremely agitated and moaning in pain after following the current pain regimen, what are you to do?

2. As the patient’s nurse, what are you to do in this scenario?

3. Does the health care surrogate have the right to go against the patient’s wishes, rescind the DNRO?

Please answer the three questions by following Instruction below:

Please use Nursing books only for research and please put a reference with names of the nursing books used, year of Nursing books use must be year 2015 and up,

references, citation, Author etc.

• Minimum of paragraphs ( a paragraph is a minimum of 6 sentences).
• Clearly written using APA format.
• Use at least one reference ( must be a nursing research article, LIRN

Answer 1

ANSWERS :

1. * Assess the pain level of patient using pain scale

* Provide comfortable position to patient

* Monitor vital signs

* Administer analgesics and sedative medications as prescribed by physicians orders

* Perform the required diagnostic evaluation for the patient

* Applying of topical medications for temporary relief from pain at the anal region

* Health education to drink plenty of oral fluids

* Plan for a sitz bath if ordered by physician

* Educate to intake high fiber rich diet

2. On seeing of the age factors and the progressive nature of the disease condition it is the responsibility of the nurse to decrease the suffering of patient using effective treatment and procedures. Considering the seriousness of health problem nurse has to involve the family members of the client to participate in the health care services to the patient. Discuss the treatment regimen with the patient and family and encourage in active participation of patient care. Nurse has to provide complete education to the patients regarding medical management, spread of disease to other body parts, importance of surgery, providing health educations on healthy life style practices, giving reassurance to the patient, providing psychological and spiritual support in achieving a safe and quality care t the patient.