Sophias Senario Palliative Care for Medication - myassignmenthelp

Question: Discuss about theSophias Senario Palliative Care for Medication. Answer: Introduction The assignment deals with the case study of Sophie, a 47-year-old woman living with metastatic breast cancer. She was admitted to the palliative care unit after the worsening of the symptoms. In response to the case study the assignment discusses the role of the palliative care nurse for Sophie in conduct a comprehensive health assessment management plan. It includes the use of patient history in assessment, use of physical examination in assessment, the priorities of management. The discussion and the clinical decision-making pertaining to the case study is supported with the relevant literature. Patient history in assessment The palliative care nurses must be well versed with the significance of taking the new patient history for documentation. Based on the literature evidence, the nurse must initially gather information as per the type of tumor. The nurse must obtain the relevant breast cancer focused history. The history of the present illness may include onset, location, duration, characteristics of the signs and symptoms (Schacht et al., 2014). It should also include the Sophies aggravating and relieving factors. The nurse must document the details of the temporality of the presenting sign or symptoms. Further, the type of medication that was administered to her is also necessary to gain a perspective on the current illness symptoms and to rule out side effects (Bower et al., 2014). For instance, the use of MS Contin 120mg BD and morphine (Ordine) elixir 40mg PRN for breakthrough pain It is necessary to well establish the story of the cancer diagnosis of Sophie as a palliative care nurse. The nurse m ust then determine the appropriate manner of diagnosis pertaining to that type of tumor. The nurse must collect data on the extent of the diagnosis process that has been conducted to date. Based on the diagnosis the nurse can make decision on the care plan to be designed. According to Swartz (2014), there is a great impact of the social and the family life on the illness and the coping mechanism of the patent. Therefore, the nurse must ask the patient to retell her story even if it is emotionally difficult. It will give the nurse some perspective on the emotional trauma of cancer diagnosis. It will help obtain information on the family support received by Sophie, level of social inclusion. In case of Sophie, a strong family support was observed. As she was working, she had adequate social connectedness. As the patient retells her story, the patient and family, competence is observed in respect to dealing with the health care system (Pandey Nguyen, 2017). Sophie has strong support of her husband and her two teenage sons. The patients details indicate of high level of resilience in the distress of illness. However, there is a great potential for distress considering her worsening of symptoms. Further, there is a great role of the genetics in the cancer . Family history of cancer is the aggravating factor. Sophie as per the history shows positive coping strategies. She is engaged in meditation and yoga and the same can be used as strength to encourage her during palliative care. In conclusion, collecting the patient history is useful to provide the patient centered care in the palliative care unit. The care plan may involve the use of routine such as playing of music or anything related to Mozart as it is Sophies favourite. During care process, Sophie can be given the peppermint tea to relieve her nausea. Further, the history is useful to design the care plan as per the tastes and preferences of Sophie and her family. Physical examination in assessment The nurse must perform physical examination that is specific for the metastatic breast cancer. The first part of the physical examination would be to look and observe. One need not start with stethoscope to examine the respiratory and cardiovascular system. Valuable information can be obtained by examining the skin, facies, gait, colouration, handshake and personal hygiene. It is possible to detect the endocrine disorders, as they are immediately apparent (Zhang et al., 2015). Even if several physical exams have been completed during the diagnostic process,the nurse must once again perform the head-to-toe exam. As the patient embarks on the cancer therapy it will serve as a baseline physical exam. Further, evaluation for the metastatic disease can be triggered completely changing the staging, subsequent treatment, and prognosis (Pandey Nguyen, 2017). The physical examination of Sophie includes breast examination (for lumps). It may include monitoring the skin tethering, nipple inversion, dilated inversion, ulceration, mammary paget disease, and edema. The nurse must identify the lumps hardness, irregularity, focal modularity, asymmetry with other breast, and assess fixation to muscle by moving the lump in the line of the pectoral muscle fibers. The patient bracing her arms against her hips can do it (Lahart et al., 2015). The physical examination may also include auscultation of heart, and examination of the respiratory system, abdomen, examining lumps, and obtaining of the neurological history. Further, the palliative care nurse must be able to demonstrate her competence at the orthopaedic examination. It may include back examination, hip history, neurological examination of the lower limbs for knee, hip history, shoulder examination, and assessment of the ankle injuries. Other physical examination may include monitoring of Sophie for swollen joints. Further examination may include Sophies peripheral pulses, ENT examination, and mental state examination (Lahart et al., 2015). Once the examination is over the nurse must collate the history and the physical examination informationand present it as oral and written presentations. Management plan Patient and the family education on the care is essential to avoid aggravation of the illness. The management plan for the Sophie in the palliative care unit includes psychosocial and spiritual domains. The nurse must consider the patients and the family members preferences and value them (Wiener et al., 2015). Establishing therapeutic relationship with Sophie will help her gain positive experiences and make differences to the life of the patient. Demonstrating empathy and sensitivity is necessary as the suffering of the patients can be lessened. It will help relieve the pain, respond to treatment, lessen anxiety, and developing hope. The nurse must manage the patients to prevent stigmatisation. The nurse will encourage Sophie to communicate with the patient (Zimmermann et al., 2014). The nurse will demonstrate the exercises to increase the patients mobility and physical injury. Further, the nurse must enhance the self-care, and self-efficacy behaviour to increase coping with illness (Zhang et al., 2015). Conclusion Any kind of cancer is the debilitating symptom. It is multifactorial in nature including cognitive, emotional and physical aspects. Therefore, there is a need of Palliative management of fatigue. References Bower, J. E., Bak, K., Berger, A., Breitbart, W., Escalante, C. P., Ganz, P. A., ... Ogaily, M. S. (2014). Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.Journal of clinical oncology,32(17), 1840-1850. Lahart, I. M., Metsios, G. S., Nevill, A. M., Carmichael, A. R. (2015). 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