Question

Ms. D is a 47-year-old woman who was diagnosed with vulvar cancer at the beginning of 2017. She is also HIV-positive. By the time Ms. D engaged in care, the cancer had proliferated quite quickly in the setting of a compromised immune system. Upon discovery of the Stage 4 cancer, doctors recommended a dose of radiation and chemotherapy. However, during the course of this episode Ms. D was struggling with substance use. During her hospitalization, she tested positive for a number of substances, including heroin and cocaine.

1. What are the best pain management approaches for cases in which extreme pain is combined with active addiction?

2. What are some ways to mitigate the risk of further addiction and or potential overdose in this patient?

3. When would the nurse or other members of the care team suggest hospice for Ms. D, and what could hospice offer in the care of this patient?

4. If Ms. D decides to stop treatment such as chemotherapy and radiation despite her oncologist stating treatment will give her more time. Should the nurse support this decision, why or why not? How should the nurse advocate in the patients best interest in this ethical dilemma?

Answer 1

1.Patient who is in a active addiction to relieve pain the following management can be effective

• She can be given a opioid sparing analgesic like paracetamol, cycloxygenase 2 inhibitor
• Ketamine ,gabapentin can be used as an additional attenuation medication
• If patient is admitted controlled analgesia can be helpful with proper monitoring of the patient
• Provide diversional therapy

2.Some way to mitigate the risk of further addiction are

• Counselling session
• Effective prevention of withdrawal symptoms
• Encouraging the patient to visit health-care professionals  to check out the pills in the middle of the course which they have ,to assess for any overdose
• Provide medication for a short period of days (every 7 th day replacement can be taken)
• Provide a sense of hope that the health care professionals can help her to come out of addiction and will help to manage pain effectively

3.Hospice care can be suggested to patient who are terminally ill and can survive only or less than 6 months.A patient who us in advanced stage can also take hospice or palliative care.The hospice care could offer emotional and spiritual relief to a patient who is in pain ,loss,fear,hopelessness and nearing death.

4.Every patient deserves the right to make decision on their treatment.The autonomy of the patient to be accepted and respected bybthe healthcare team.The nurse in this situation should respect the patient's feeling as well as do things which is in the best interest of the patient.Engage in conversation to understand the patient's feeling and then provide information of what benefits are available with treatment ,survival rate along with the side effects of the treatment.The final decision fromnthe patient is to be considered.