...and require effective physiological and psychological management of the complications. Pain is a common complication of end stage cancer patients who are undergoing either curative or palliative treatment. It can range from mild, moderate and severe depending on the progress of the disease. When it comes to palliative or end stage cancer (terminal illness), severe chronic pain management becomes even difficult for the family and health care providers. In fact, in such cases pain becomes primary and chief complaint of people for referrals....
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...Case study #1 1. The priority teaching would be to never abruptly stop taking the medication especially without consulting your physician, but try to take it in the morning so she would not have to get up a lot during the night to empty her bladder. 2. Decreased cardiac output r/t increased vasoconstriction aeb variations in blood pressure readings a. Monitor and measure blood pressure in both arms, using a manual technique for an accurate reading b. Monitor response to medication to control blood pressure. Give fluid and sodium restriction as indicated Disturbed Sleep Pattern r/t use of prescription diuretic aeb awaking various times in the middle of the night * instruct patient to take hctz in the morning to avoid waking up at night * assist the patient to identify envoiormental factors that make sleep difficult. Knowledge deficit related to lack of information about the disease process and self-care as evidence by patient lack of complaiance with medications. * Describe the nature of the disease and the purpose of the procedure and the treatment of hypertension * Explain the importance of a peaceful environment and theraupetic, and management of stressors. 3. Two non pharmacologic ways of managing hypertension include limiting your alcohol intake and the DASH diet which includes a diet that encourages you to reduce sodium intake and eat foods rich in nutrients such as potassium, calcium and magnesium. ...
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...Administration and Pain Management in the Terminally Ill Cancer Patient: Case study of a patient in the terminal phase of breast cancer. This case study is based on Ms. D, a 48-year-old married woman diagnosed with Bilateral Breast Cancer. She underwent a bilateral mastectomy 4 years ago. Lymph involvement was noted at the time of the surgery. Recent metastases of the bone has been diagnosed and she is in the terminal phase of the disease process. Up to this point, she has been on a regimen of Oxycodone 5 mg P.O. every 6 hours as needed for pain, Zantac 150mg P.O daily for heartburn, Docusate 100mg P.O. twice a day to promote bowel movements, Celexa 40mg PO daily for depression and enteric coated aspirin 81mg PO daily for prophylaxis of transient ischemic attacks and MI. She remains in her home and is receiving care at home. Ms. D has complained recently of significant increased pain and trouble sleeping, most likely due to the bone metastases in the area of the lumbar spine. She has stated that the pain has dramatically decreased her quality of life recently also. She has expressed the desire to remain at home during the terminal phase of her disease, but needs more adequate pain management to preserve her quality of life for as long as possible. She is married and her husband is very loving and supportive of her desire to stay in the home during this phase. He has voiced some concerns about drug dependency if the patient were to receive stronger pain medication. I have contacted...
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...resulting in a faint scar, as stated by Carville, 2003. Mrs Baxter’s wound will heal by secondary/tertiary intention. Tertiary intention is also known as ‘Delayed Primary Intention” (Carville, 2003). As seen in the case study, Mrs. Baxter’s wound is quiet large (5x7x3cm) and secondary intention healing is needed as the wound extends from the epidermis to the dermis and the subcutaneous tissue (Schilling McCann, 2006). Schilling McCann, 2006, classifies this as a full thickness wound. Secondary intention healing is characteristically used when the wound edges are unable to be...
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...1. INTRODUCTION Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This chapter aims to present a simple approach for diagnosis and evaluation of LBP according to current clinical guidelines. The contents will discuss in details the definition and prevalence of LBP and important steps of diagnosis starting from history-taking, physical examination, radiological studies, and finally how to manage the patient and when to refer. Also, inflammatory back pain will be elaborated in easy to digest way. A major advantage of this chapter is that carefully designed tables, diagrammatic presentations and illustrations were used to help practicing clinicians performing proper and adequate work up for patients with LBP. Objectives: 1. To present a comprehensive approach for diagnosis and evaluation of LBP according to current clinical guidelines. 2. To recognize the red flags of...
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...got the patterns down. Pill brokers and dealers reported congregating in open air drug markets typically strip mall and pharmacy parking lots, and outside methadone clinics to buy, sell, and trade prescription drugs. These markets were reported to involve a variety of transactions, including the purchase of prescription drugs for cash, as well as trades for crack and heroin. Pill brokers also reported the purchase of used fentanyl patches from nurses who have stolen them from pain patients or from disposal containers in hospitals. Some individuals frequenting the drug markets also barter their oxycodone for other opioids or benzodiazepines, typically alprazolam. Doctor Shopping focus group participants indicated that even in a small state like Delaware, doctor shopping appeared to be fairly easy. The vast majority of abusers reported obtaining medications through doctor shopping, and most reported frequenting at least four physicians in order to obtain sufficient amounts of their desired medications. Occasionally clinics and hospital emergency rooms were reported as locations for doctor shopping as well. A heavy user stated: Another focus group member was saying about the doctors, it’s out of control. I had 8 doctors that would give me four or five different kinds of painkillers at one time” (Beard, Cicero, Inciardi, & Surratt, 537-545). On the other hand, in 2008 W.C. Becker, R. A. Desai, D. A. Fiellin, L. E. Sullivan, & J. M. Tetrault stated, “{Data on licit and illicit...
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...Running head: CANCER PAIN MANAGEMENT 1 Cancer Pain Management Lavon R. Williams University of South Alabama Running head: CANCER PAIN MANAGEMENT Cancer Pain Management Cancer is rapidly becoming a chronic illness, and an estimated that 10 million individuals in the United States are survivors of cancer (Sun, Borneman, Piper, Koczywas, & Ferrell, 2008). According to 2008, cancer statistics from the American Cancer Society, about 2 565,650 people die in the United States from cancer every year. Approximately 1.6 million new cases of cancer are expected to be diagnosed in the United States this year (American Cancer Society, 2012). This is why the health care needs of cancer patients are unique, and many are at risk for developing late or long-term side effects and pain from their primary treatments. These long-term effects may also hinder optimal physical, psychological, and cognitive functioning for patients (Sun et al., 2008). Pain is experienced by 30% to 50% of cancer patients receiving treatment and by 70% to 90% of patients with metastatic or advanced disease. In almost every cancer-related case pain is inadequately managed due to a lack of patient and professional knowledge of optimum management (Sun et al., 2008). This paper will discuss how nurses can help provide adequate pain management in advanced cancer patients. Patient and family needs Support for the patient and family may include education and information, coping skills, counseling and psychotherapy...
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...which causes the body’s immune system to target and attack primarily its own joints and joint linings (Brodwin, Tellez, & Brodwin, 2009, p. 124). Since RA is a systematic disease, it affects the body as a whole, and is not limited only to joints. The inflammation and pain can spread from the joints, into the cartilage, connective tissue, and ultimately into adjacent organs (Cush, Kavanaugh, & Stein, 2005, p. 323). After the initial diagnosis of RA, there are three classifications that RA can develop into. The first is called Monocyclic RA, which means that an individual is afflicted with a single episode of inflammation, lasting up to five years, and then enters remission....
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...Pain is a global marvel which has been rigorously contemplated and described from different points of view. However, this subject continues to bewilder health care experts and researchers from many disciplines. Moreover, Pain is a combination of different domains of responses, particularly; social, behavioral, physiologic, emotional, psychological that may influence the person’s pain fortitude. Many components could influence the pain experience, manifestation and cause a dilemma for healthcare workers and researchers who will try to gauge the pain response. It is understood that expertise in pain assessment would result in an improved pain management (Flaskerud, J.H., 2015). The Joint Commission on Accreditation of Healthcare Organizations...
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...policy regarding geriatric and/or demented patients and pain control. I believe this needs to be changed because although we have an initial assessment protocol, we do not have any kind of protocol to control a geriatric or demented patients pain. Since demented patients are quite often left unable to communicate their feelings, I believe there would be, less adverse effects and better patient outcomes for this group of people and better satisfaction with their families. B There are many people associated with proposing the change within the facility. First would be to go through the assistant nurse manager and nurse manager who would then bring the proposal to the nursing and medical directors for the ER. The ANM and NM would have to decide whether the proposed change would be beneficial for the patients and their outcomes and do further research which they would then propose to the directors. From there, they would decide whether the research was sufficient enough to implement a change. C Full APA citation for at least 5 sources | Evidence Strength (1-7) and Evidence Hierarchy | 1. H., Bell, J., Karttunen, N. M., Nykänen, I. A., M., & Hartikainen, S. A. (2013). Analgesic Use and Frailty among Community-Dwelling Older People. Drugs & Aging, 30(2), 129-136. doi:10.1007/s40266-012-0046-8 | 2 and Experimental | 2. Haasum, Y., Fastbom, J., Fratiglioni, L., Kåreholt, I., & Johnell, K. (2011). Pain Treatment in Elderly Persons With and Without Dementia...
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...Abstract While attending clinical at DMH I used one of my patients to develop a case study. My case study will require me to use the skills I have been practicing to make a connection between medical and nursing problems. Some of these skills include assessment, rationales, critical thinking, and problem solving. In this paper I will go over my patient’s health history, lab tests, pathophysiology, diagnosis, and her medications. I will also provide a detailed nursing assessment, a detailed nursing process and explain reasons and rationales about my decisions involving her care. I. Health History Client Health and History: On April 9, 2014, at Decatur Memorial Hospital, my client was a 76 old Caucasian female with the initials DK. She was born in the small town of Olney, Illinois. Her husband explained that it is about a two and a half hour drive to Decatur Memorial Hospital from their hometown and this was not their first trip here. DK and her husband have been married for 56 years and have three children: two daughters and a son. She worked for McDonalds for 12 years and then retired to be a stay at home mom. My patient was admitted to the hospital based on an abnormal finding from a CAT scan. They CAT scan showed a mass in her right kidney. The patient described that she had no idea of the mass. She went in for a CAT scan because of blood in her urine and experience of her previous diagnosis of kidney cancer, and was informed of the findings. In June of 2013, she had...
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...Clinical Audit An audit of subcutaneous syringe drivers in a non-specialist hospital K Dunne, K Sullivan, A Garvey, G Kernohan, A Diamond, C Duffy, J Hutchinson drug administration can facilitate the management of pain, control of nausea and vomiting, restlessness, confusion and drying secretions in the throat. Abstract T he use of syringe drivers as a method of drug delivery to control symptoms in palliative care is a common and accepted practice, but one which has evolved rather than been subject to close multiprofessional scrutiny and guideline formation. There is evidence that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of...
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...In this case, vaginal pH would be above normal postmenopausal usually pH exceeding 5 which is a positive indication of atrophic vaginitis (Bachmann & Nevadunsky, 2000). In addition, labs also confirm atrophic vaginitis. This patient is in menopause and levels of estrogen would indicate not only menopause but confirm the diagnosis of atrophic vaginitis. Serum hormone concentration would show levels of circulating estrogen at less than or equal to 4.5 (Bachmann & Nevadunsky, 2000). The labs alone confirm the diagnosis of atrophic vaginitis especially given the fact the patient is confirmed to be in menopause and atrophic vaginitis. A chlamydia and gonorrhea swab was obtained and was...
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...Postoperative pain Postoperative pain is an unpleasant sensory and emotional discomfort associated with the tissue damage caused by the surgery. Postoperative pain management should include a precise and a systematic assessment to manage appropriately. Pain is an internal subjective experience which cannot be seen by others or detected by investigations. Therefore the postoperative pain assessment largely rely on the clients complain and should be ongoing, individualized and documented. As the etiology is clear in postoperative pain, a single dimensional pain scale, that measures the intensity of the pain, is usually used that rates the pain out of 10 through the clients self-reporting. In some cases a multi-dimensional pain scale is used...
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...spread, and there have been increasing numbers of cases in the northeastern and north central US. The Lyme disease agent, Borrelia burgdorferi, causes infection by migration through tissues, adhesion to host cells and evasion of immune clearance” (Steere, 2004). This disease is transmitted to humans from the bite of the Blacklegged (deer) tick. It usually produces a bulls-eye rash, but not in all cases. According to National Library of Medicine (2013), "Stage 3 or late disseminated Lyme disease can cause long-term joint inflammation (Lyme arthritis and heart problems. Brain and nervous system problems are also possible" (Outlook (Prognosis)). Lyme disease has afflicted a high school basketball coach and gym teacher of a small school in Liberty, Pa at age 36. He is the father of two children and a member of a local sportsman's club. He has been dealing with the ongoing symptoms related to chronic Lyme disease for about seven years. It has been a life altering disease for a previously active young man. He reports symptoms as severe pain and swelling in all of his joints that inhibit full rotation similar to rheumatoid arthritis. Also, he has persistent severe back pain which keeps him on the sidelines during most of his career and personal activities. He no longer hunts with his friends or plays ball with his children. These had always been previously paramount in his life. Some days he is unable to work due to the pain flare ups and ultimately affecting his career. The...
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