This paper with be focusing on case scenario 3. The patient in this scenario is Jennifer Vaughan, 34. She lives with her partner William, has no children yet. They have two pet dogs. Her parents live an hour drive away and see her father once a week. Her parents have no history of cancer. Jennifer presented to hospital with abdomen pain and fullness. After laparotomy, it was found that Jennifer has carcinoma of right ovary which was followed by right oophorectomy. Three months after her early treatment, she was diagnosed with lymph node metastases on her right groin which means her disease has spread and cannot be cured. Jennifer will now be in palliative care setting, where the main aim is symptom management and deliver quality life. This concept includes many subjective elements such as physical, emotional and social function, cultural, attitudes to illness, patient’s daily living activities including communication with the family. However, in the following paragraphs, issues relating to Jennifer’s situation such as physiological, psychological, social and spiritual will be discussed briefly. The issues mentioned above will also demonstrate the complication of Jennifer’s experience and how the Registered Nurse (RN) is effectively able to care holistically while making sure that all care provided is of high ethical standard.
Firstly, from the case scenario, the physiological issue of Jennifer include symptoms such as nausea, vomiting, abdominal pain, fatigue, anorexia, weight loss, constipation and difficulty in ambulating. According to Farrell and Dempsey (2011) the symptoms of ovarian cancer include increasing abdominal pain, pelvic pressure, bloating, indigestion, flatulence, gastrointestinal symptoms. The assessment and management of pain in the palliative care setting is the most significant role of RN in order to provide comfort and ease the death of the person, at the same time maintaining the dignity of the person who is dying. Pharmacological intervention to manage pain at the end of life can include use of appropriate dose of opioids and other co- analgesics depending on the intensity of the pain that can be determined by use of pain management tool (Ferrell, Levy, and Paice, 2008). Side effects of opioids can include conditions such as constipation, nausea, and sedation. Prevention and management of such side effects can also often improve the quality of life of the person.
Intervention to manage nausea and vomiting which is the consequence of malignant bowel obstruction in advanced cancer can be treated by use of antiemetic medications and also by use of venting gastrostomy tube instead of nasogastric tube as suggested by Lynch and Sarazine (2006). The advantage of this type of tube is that it helps to decrease the episodes of vomiting in the patient, decrease compression on other organ and also provides some comfort to drink and eat liquid at the end stage of life (Lynch and Sarazine, 2006). The nurses need to educate and advocate the patient and patient’s family member about frequent oral hygiene, because of the advanced bowel obstruction nutrition and hydration can bring more complication, eventually decreasing the level of comfort in the patient. In such cases, the nurse can provide support, grieving the loss of interacting with the patient in association with food that symbolises the sign of life (Lynch and Sarazine, 2006). This can help both the patient and family to calm down psychologically and cope accordingly.
Non pharmacological interventions include repositioning to prevent pressure ulcer which may relieve the discomfort or pain (Searle & McInerney, 2008). Quality of life at the end stage of life is highly correlated with the number of physical symptoms experienced following psychological distress argues Lockwood-Rayermann (2006). Therefore management of physiological symptoms along with psychological, spiritual and social needs can meet...