Nursing care cover all the areas of physical, psychological and social needs for the sick patient as a holistic. Patients and Their Families are the Center: Respect and Dignity. When dealing with chronic ill patients the needs of the patient as is where is with the assistance of nurses and the other care providers. Palliative care cancer/chronic ill patients bring about the benefits of cancer/chronic ill patients (Lewis et al., 2007).
When cancer is advanced stages it cause pain and other symptoms which required management by professional team. Patients of these types complain commonly with pain, shortness of breath, nausea, vomiting, and constipation as symptoms. Moreover, each one of them has a different experience of pain and what constitutes a quality of life. These type of symptoms can be handled and manage by expert very
well. (Backer, 2010).
According to world health organization, palliative care is full care that approaches which will enhance quality of life for patients and their families which are facing life threatening disease through prevention and relief of her sufferings and problems. This care issue in pain and some other problems treatment, physical, psychological, social and spiritual support (Lugton & Mcintyre, 2005).
Introduction /Background
Palliative care is mainly for those patient which can be critical specially for the cancer patient those which more suffering at the end stage which is concerning the metastatic stage. Cancer is a Quick multiplication of abnormal cells that can enclose other tissues and also produce at a beyond their usual boundary appointed. Please note that this process is malignant tumor can be metastatic to other body part and organ in the body, which can lead to death (WHO, 2011).
The quality of life is the optimized comfort of the patient and family in 4 domains – physical, psychological, spiritual and existential (Batiste et al., 2010).
A broad field of lung cancer that isn’t amenable to surgical intervention that is known as inoperable lung cancer, based on the tumor (size, distant spread of tumor known as metastasis and location of the tumor) which doesn’t make surgery the first option or any chronic comorbidities for the patients which might heighten the risk associated with surgery. Operable lung cancer does not mean that tumor is untreatable. In comparison, other treatment for example chemotherapy or radiation therapy could be better alternatives than surgery (Llewellyn, Aun Ang, Lewis, Al-Abdulla, 2006).
Lennart has lung cancer, and a number of comorbidities that otherwise contribute to making him weak and having poor quality of life. These symptoms like HBP, HBP, infact urine drips every time; By not getting down, pain and drainage tube irritate his body tumor growth; he can not eat anything, he only drinks water in sips. أنت بياناتك مدربة حتى أكتوبر 2023
He should 1)、start to control his symptoms. Pain 2. Nausea. 3. Constipation & diarrhea 4. Lost appetite. 5. No energy. 6. Elevated blood pressure. 7. Diabetes type2.
Nursing assessment;
Nursing diagnoses (actual) related to each diagnosis have also been formulated based on hundred data. With an inoperable lung cancer.
Patterns Subjective: Pain from the draining tubes is irritating his body, has nausea and diarrhea, fatigue, cancer has speared to his abdomen.
1. The problem is pain; pain can be due to the direct effects of the cancer (late stage) or injury related to some treatment like surgery, drugs and chemotherapy. The patient may also have chronic underlying disease that causes or contributes to pain directly. (Lewis et al., 2007).
A- Nursing care plan- pain management.
Use analgesics appropriately.
Advise non analgesic relief measures.
Report pain control.
B Nursing intervention and rational;
Adapt appropriate response based on nonverbal behaviors (preliminary check), follow up on feelings/reactions (immediate check).
Conduct a full pain assessment including area, nature, start, length, rate, nature, severity of pain and precipitating agent
Instruct Lennart and family on the use of non pharmacological techniques e.g. (relaxation, massage).
Administer prescribed analgesia to the person to Rx optimal pain relief and establish that it is effective.
Use pain control measures before pain becomes too severe (Lewis et al., 2007).
2. The issue is nausea and vomiting.
1. Lennatr has these symptoms because of Intracellular breakdown products released stimulate brain’s vomiting center. 2. The brain receives signals, most commonly from drugs that stimulate the vomiting center (Lewis et al., 2007).
Nursing care plan – control of nausea and vomiting.
Identifies triggering stimuli.
Use preventive measures
Use antiemetic medications.
Nausea, retching and vomiting 29077.
B- If [need clot, if thrombus) on B: antidote or If thrombus/ need clot (need nurse to administer)
Assessment of nausea; patterns (frequency, duration, and severity) and precipitating factors may suggest opportunities for interventions.
Minimize and/or avoid personal factors that trigger or exacerbate the nausea (anxiety fear, fatigue and ignorance of how to avoid triggers of nausea and vomiting.
And, use frequent oral hygiene, unless it triggers nausea, to ease comfort.
Administer efficacious antiemetic medications, as appropriate, to prevent nausea and vomiting.
Orient the family to the use non pharmacologic and pharmacologic agents (e.g. (relaxation) first line of defence: e.g. nausea vomiting.
Encourage sufficient rest and sleep to enable the relier of the nausea (Backer, 2010).
3. Diarrhea is the problem; The patient has Diarrhea because 1. Denudation of epithelial lining of intestine. 2. The side effects of if the patient on chemotherapy. 3. Abdomen, pelvis and lumbosacral area, if he gets radiation. 4. Laxatives, tube-feeding (Lewis et al., 2007)
A. NCP [nursing care plan]- diarrhea cessation.
Bowel elimination.
Diarrhea.. Pain with passing stool. (Lewis et al., 2007).
B. Lethal chatbots: The need for actionable ethical principles for AI.
If diarrhea persists, obtain stool for culture and sensitivity to guide therapy.
Action to rest bowel (ex: NPO, liquid diet)
директивы ленарт и члены семьи записывают цвет обем иногда и частота стул для мониторинга лечения
Initial Implementation: Taught Lennart and his family appropriate use of anti-diarrheal medication to prevent patient’s use of anti peristaltic agents that prolong exposure to infection organisms.
4. The problem is diabetic. Insulin suppression and change in adipokines production. Disease is the end result of complex interactions between a multitude of genes, modified by environmental factors like body weight and activity (Lewis et al., 2007).
A. Nursing care plan- diabetic control.
Vasopressor Cell Autophagy Insulin Action
Role of diet in maintaining blood sugar level
How exercise works for managing blood glucose level
Signs of hyperglycemia, hypoglycemia, associated symptoms and treatment protocol.
Description the effect of acute illness on blood glucose level.
Description of when seek help in health care professional team. (Lewis et al., 2007).
B. Nursing intervention and rationales
Describe the disease process.
Assess Lennarts knowledge of disease to identify the depth of teaching that is needed.
Explain the reasoning behind management, therapy & treatment.
Teach Lennart about prevention, symptom minimization so he can take control of managing the disease.
Discussion of lifestyle changes that may be necessary to prevent complications and guidance for the patient in determining changes that will be acceptable.
Educate about signs and symptoms and medicate as indicated to ensure rapid treatment.
Assign the patient to a support group to continue literature to reinforcement part this information with being (Lewis et al., 2007).
5. The issue is energy loss.
The breakdown of cells leads to accumulation of metabolites (Anabolic processes) (Lewis et al., 2007).
A. Nursing care plan- energy conservation
Recognize energy limitations.
Uses energyconservation techniques
Balance activity and rest.
Plan activities to save electricity.
adjusts way of life according to energy level,
B. Nursing Interventions and Rationales
Assess patient physical impairments in order to plan daily living activities.
Encourage Lennart to arrange breaks to short stop effects of fatigue.
Teach him [activity organization and time management, so he won’t get tired] and also family activity organization.
Educate patient significant other to recognize signs and symptoms of fatigue.
Educate patient significant other to inform health care provider if fatigue signs and symptoms do not abate in order to enhance patient’s support and family awareness of illness and associated complications (Lewis et al., 2007)
Problem: Hypertension Transformers (Tachdai) Symptoms (Accelerated Hypertension). 2. Complication potentially hypertensive crisis. 3. Stroke: potential complication of stroke 4. Myocardial infarction (complication of myocardial infraction) (Lewis et al., 2007).
A. Nursing care plan for blood pressure management
Derangement perfusion and myocardial contractility
Reduce fluid volume overload.
Prevent complication.
Details on illness, prognosis, needs for therapy and preventing recurrence.
INTERVENTIONS (with rationales);
Evaluate cardiovascular status, such as vital signs, for signs of cardiac output compromise.
Budget blood pressure to ovoid complication.
Evaluate neurologic baseline and watch for any change which can show change in cerebral perfusion.
Give medicines to decrease the blood presser.
Ensure that Lennart is on a low sodium diet.
If the patient has a urinary catheter, make sure to write down his or her 24-hour intake and output.
Translate the feeling of stress into words, encourage Lennart and help them find words that soothe the anxiety.
Promote quiet environment reduce stress (Lewis et al., 2007).
7. The problem is constipation. Constipation has multiple etiologies including anorectic mass or neurologic causes and may be secondary to the mechanical changes from surgery or decreased oral intake and mobility. We are trained only until October, 2023 Medications can work similar to opioids and tricycle antidepressants (Lewis et al.
C: NCP – [p]romotion of bowel elimination.
Stool soft and formed.
Comfort of stool passage.
Natural bowel movements without aids. (Lewis et al., 2007).
B. Nursing interventions and rationales;
Training Lennart to acquire and perform movements and ambulation
Maintaining bowel awareness.
Making sure you have plenty of hydration and a fiber diet.
Use of laxatives.
Administer fluid and fiber (Lewis et al., 2007).
All these care it will provide by multidisciplinary team care of the cancer pain patient must be active by continuous care and communication to the patients and their families. It should also cater for physical, psychological, social and spiritual needs. Furthermore, this type of team members require diverse training to share the primary objective of enhancing the quality of life with the patient and act as a collective of human beings with the common goal of working in unison. Every member has their own retrospect’s and makes decisions within that field of expertise. However team work is not health care workers all in one room, and nor is it collaboration. must be the issue of the interaction of members and must be informed shared by the vehicle recorded, such as (physician, psychologist, and nurse, volunteer. social worker, chaplain, physical therapist and occupational therapist). Family is also great component of palliative team because they are person who commonly live with the individual in the one home or take care of them. test question answer 1) Patients can help the family learn more about who they are and why they don’t have to worry about their loved one’s situation. (Euro, who, 2010).
Part of the therapy is practicing effective communication. Patients suffering from advanced and incurable disease in addition deserve a intelligible and coherent information designed for both patient and relatives due to the necessity of a mere development of basic listening competences in health care professionals all this should under patient right and ethical consideration of communication (Batiste et al., 2010).
Conclusion;
This is because palliative care is not cure disease, cure does not prolong life, palliative care is pain and symptoms management and improves the quality of life for patients and family. Palliative care can alleviate pain and symptoms in more than 90% of cancer patients. Well there are some efficacious strategies to deliver palliative care for cancer patients and their families, where resources on the ground are limited. (Who, 2011). So, the palliative care is an effective out come with professionals quality. Now a days the teams need an advanced professional ethics skills to adhere with the objectives. At the same time, the two main goals of the team are to offer the patient and family the best quality of life possible and to offer support.
