NU 665 Week 14 Discussion 1 Palliative Care Patient
University:
Regis
NU 665 Week 14 Discussion 1 Palliative Care Patient
Paper Instructions
Initial Post
Mr. Brown, who was your eighth-grade science teacher, has been a patient in your practice for many years. Several years ago, he was diagnosed with cancer and has been undergoing treatment. He recently was told that his cancer was no longer responding to treatments and that his condition is terminal.
Mr. Brown, along with his wife and daughter, have scheduled an appointment to discuss palliative care and what can be expected. Although Mr. Brown’s death is not imminent, his care needs clearly will continue to increase, and they will continue until his eventual death from the disease.
The disease process is typically accompanied by an increasing level of pain, which is of great concern to Mr. Brown and his family. The meeting today is intended to determine whether the patient and the family feel that palliative care is appropriate.
Initial Post by Wednesday (Day 3) at 11 59 p.m.
List 10 to 20 additional pieces of subjective information you need to elicit from the patient to help formulate your differential diagnoses and plan. You may not ask questions that were already addressed in the HPI/ROS. You will need two scholarly references for the questions you ask. See the rubric for more detail.
Keep in mind What are some open-ended questions that can be asked to explore the need for palliative care?
Reply Posts
Initial Response Post by Friday (Day 5) 11 59 p.m. Choose a classmate’s questions to answer
Choose a classmate’s questions to answer.
Every peer post should have only one response post. Please do not reply to a peer if a response is already posted.
You are answering as the patient. Make it case-appropriate but imaginative. Be creative and answer thoroughly. No references are needed.
During the Visit
As you learn that Mr. Brown’s level of pain has increased since his treatments ended, you suggest the use of opioids for pain management. Mr. Brown’s daughter expresses concern about the use of opioids to manage pain, stating, “Aren’t opioids bad? I hear about people dying from opioid abuse on the news all the time.
” She also asks, “What is the difference between palliative care and hospice?” What information should you provide to assuage the daughter’s concern? Include this patient education in your plan. What did you discuss with the family? Document it in the reflective response.
Reflective Response Post by Sunday (Day 7). Please respond with the following
- Four differential diagnoses and rationales with references. Support your answers with references.
Create a plan of care for that patient.
- Plan must include pharmacology, non-pharmacology, labs/diagnostics, referrals/interprofessional communications, patient education (10 to 15 individual items minimum), and follow-up.
How should Mr. Brown’s spiritual well-being be evaluated, and why is it part of total pain management?
Don’t forget to document the patient education with the above information on opioid therapy in palliative care.
Please refer to the?Grading Rubric?for details on how this activity will be graded.
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Sample Answer
The case scenario concerns Mr. Brown, who has been diagnosed with cancer and has been undergoing treatment. His cancer has ceased responding to treatments, and his condition is now terminal.
He is accompanied by his wife and daughter to schedule an appointment to discuss palliative care and what can be expected. The purpose of this paper is to discuss the patient’s differential diagnoses and the care plan.
Differential Diagnoses
Cancer pain syndrome Patients report pain in multiple sites in the body, caused by various causes and reflecting various symptoms (Mestdagh et al., 2023). The pain can be acute or chronic, ranging from mild to severe. Mr. Brown reports having increasing pain related to cancer, ranging from 5-9/10 on a pain scale.
Chronic pain syndrome This pain lasts more than three months and persists longer than the reasonably expected healing time for the involved tissues (Rahman et al., 2023). The differential is based on the patient’s report of worsening pain for more than three months.
Adjustment Disorder This is a state of subjective distress and emotional disturbance that occurs when adapting to stresses of significant life changes, stressful life events, serious physical illness, or the possibility of serious illness (Sakamoto & Koyama, 2020).
The patient reports being emotionally and psychologically disturbed due to his cancer diagnosis. Cancer-related Anxiety The patient expresses anxiety related to the fear of death as his treatment has been unsuccessful (Sakamoto & Koyama, 2020). The anxiety could be worsening his pain.
Plan of Care
Pharmacology Codeine 30-120 mg plus Acetaminophen 600 mg
Non-Pharmacology Breathing and relaxation exercises; Heat and cold compressions (Mestdagh et al., 2023).
Labs/Diagnostics The patient will be screened for distress using the Distress Thermometer and Problem Checklist.
Referrals/interprofessional communications The patient will be referred to a social worker or patient navigator for advanced care planning.
Patient Education The patient and his family will be educated that:
- Opioids are recommended for moderate to severe cancer-related pain.
- Opioids used for cancer pain in patients with no prior history of substance abuse or addiction are hardly ever associated with a new onset of addiction (Abdel Shaheed et al., 2023).
- The risk for addiction when opioids are prescribed for appropriate medical indications is extremely low if a patient has no personal or family history of abuse or addiction or significant pre-morbid psychiatric disorder (Abdel Shaheed et al., 2023).
- The patient will be screened for pain at every contact to determine the necessary opioid dose and assess for tolerance.
- Hospice care is tailored to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatment (Sheikh et al., 2022).
- On the other hand, Palliative care is specialized medical care for people living with a serious illness, like cancer, where they receive medical care for their symptoms together with treatment to cure the illness (Sheikh et al., 2022).
- Palliative care can be accessed from hospitals, nursing homes, and outpatient palliative care clinics.
- The Medicare and MassHealth insurance policies can cover palliative care.
- The patient will be educated on Recreational therapy, where he can engage in pleasurable activities to alleviate pain.
- Education on Relaxation techniques like progressive muscle relaxation to alleviate pain.
Follow-up Follow-up after four weeks to assess progress with palliative care.
Spiritual well-being evaluation Mr. Brown’s spiritual well-being can be evaluated using the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). This is important to reveal the patient’s Meaning, Peace, and Faith in relation to his pain experience and management (Rabitti et al., 2020).
References
- Abdel Shaheed, C., Hayes, C., Maher, C. G., Ballantyne, J. C., Underwood, M., McLachlan, A. J., Martin, J. H., Narayan, S. W., & Sidhom, M. A. (2023). Opioid analgesics for nociceptive cancer pain A comprehensive review. CA A Cancer Journal for Clinicians. https //doi.org/10.3322/caac.21823
- Mestdagh, F., Steyaert, A., & Lavand’homme, P. (2023). Cancer Pain Management A Narrative Review of Current Concepts, Strategies, and Techniques. Current Oncology (Toronto, Ont.), 30(7), 6838–6858. https //doi.org/10.3390/curroncol30070500
- Rabitti, E., Cavuto, S., Iani, L., Ottonelli, S., De Vincenzo, F., & Costantini, M. (2020). The assessment of spiritual well-being in cancer patients with advanced disease Which are its meaningful dimensions? BMC Palliative Care, 19(1). https //doi.org/10.1186/s12904-020-0534-2
- Rahman, S., Kidwai, A., Rakhamimova, E., Elias, M., Caldwell, W., & Bergese, S. D. (2023). Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel, Switzerland), 13(24), 3689. https //doi.org/10.3390/diagnostics13243689
- Sakamoto, R., & Koyama, A. (2020). Effective Therapy Against Severe Anxiety Caused by Cancer A Case Report and Review of the Literature. Cureus, 12(6), e8414. https //doi.org/10.7759/cureus.8414
- Sheikh, M., Sekaran, S., Kochhar, H., Khan, A. T., Gupta, I., Mago, A., Maskey, U., & Marzban, S. (2022). Hospice vs Palliative care A comprehensive review for primary care physician. Journal of Family Medicine and Primary Care, 11(8), 4168–4173. https //doi.org/10.4103/jfmpc.jfmpc_2262_21
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