Question

Jane is an 84-year-old woman diagnosed with breast cancer 2 years ago, now with metastasis to the bone and lung. She has refused any further active treatment (i.e chemotherapy and radiation) and has asked her health care representative daughter Patty to help her talk to her oncologist about her wishes. After this discussion, the patient, daughter, and physician have agreed upon a hospice evaluation.Upon evaluation and subsequent admission to hospice services, the patient’s most pressing need was adequate pain control. Previously, she had tried scheduled Tylenol without relief-her pain rated at an 8 on a 0-10 scale. Her oncologist then prescribed Hydrocortisone 7.5/750 mg. 1-2 tabs every 4 hours as needed, which lowered her pain acuity to a 6. At this point, an adjuvant might be considered for bone pain-possibly Decadron. If Jane experiences shortness of breath related to lung metastasis, the Morphine and Decadron are both helpful in alleviating this symptom.

1. As the admitting hospice nurse, you recognize that 8 on the pain scale greatly impair Jane’s quality of life. Using the WHO step approach, what would be your plan on intervention?

2. Knowing that Jane probably has two types of pain due to the metastasis, what adjuvant might you consider for the bone pain?

3. Looking to the future, what other comfort issues might Jane face as her metastasis impacts her life?

4. How could you keep Jane reach her goal of selected activities (e.g. shopping, lunch, church?)

5. Make a drug study on the medications given to Jane.

6. Make a pain and comforting cycle for your patient using this diagram: See the diagram in your modules.

Answer 1

(1) The number 8 on the 0-10 pain rating scale indicates the severity of the the pain suffered by Mrs. jane . THe intervention in the managing the pain are includes medications , , additional procedures , exercise , psychoplogical therapy etc. and should also focus on intervention and goals that help us to maintain or improve the functional ability . use a self management techniques and strategies and buildb bthat works for us into our own management plan ,

Pain medications ;- There are several pain medications that can be effective in helping us to manage our pin including simple analgesics e.g ;-paracetamol , NSAIDS and opioids .

Exercise and physical therapy ;- There are many treatments that can help for example heat / cold therapy , peripheral nerve stimulation / transdermal electronic nerve stimulation (TENS) , occupational therapy , therapeutic exercise

Psychological Therapy

psychological therapies can help people to cope with pain , depression related problem and disablity that can occur . it focuses on acknowledgement our pain , sttress management , dealing with guilt , identification of negative factors and importance of positive thinking , identifications of goals and looking at support including relaxtion therapies , challenging negative or unhelpful belief / thoughts .

(2) Bone pain is often described as adeep or penetrating pain , it often is worse at night and when we move the affected limb . Bon e pain , tendernessor achiness is a common problem , particularly among those who are middle aged or older. Bone pain cause by tumor results into muscles pain along with it .As muscles pain (known as myalgia ) is often less intense than bone pain but can be vry unpleasant .

(3) Mrs . jane life after getting the metastasis of breast cancer to the bone and lungs . Wich can significantly on their qualiity of life . As she is becoming more dependent on the medical therapies . her start with the morning dose of medicine and ends with the drug regimrn . her satbility in doing daily activities goes down . Her body organs functioning lose the elasticity with the growing age and upon the btumor she becomes more lethargic and dependents on others even for basic daily schedules tasks for .

(4) WE can encourage the Jane to motivate her to do her hobbies independently such as shoppings and walking and hangouts with the friendsn , this all gives her to the positive influence to her mind and psychological building their independently .

(5) Mrs . Jane drug therapies include tylenol and hydrocortisone and dracodron

Tylenol is a non opioid or non narcotics , like acetomenophen and NSAIDs drud to control mild to moderate pain

Hydrocortisone is used as treatment ofr a variety of cancers , such as leukemia , multiple meloma and gthe breast cancer . Cortisone is also used to treat nausea and vomiting associated with some chemotherapy drugs . cortisone is uasedto stimulate appitite in cancer patient with severe appitite problems.

(6) THE PAIN AND COMFORTING CYCLE are as given below ;-