A. Our client, Mrs. Thomas has been given the unfortunate diagnosis of metastatic breast cancer. When considering the current and future needs of this client, significant thought and planning must be directed toward the client's level of well being. In the case of a terminally ill patient, it is important to help facilitate a high quality of life that encompasses both physical and psychological health. I would recommend initiating palliative care for Mrs. Thomas. Palliative care would allow the client to receive a combined and holistic approach for medications, equipment, counseling, and symptom treatment all fascinated through one program. The community health nurse needs to be careful not to impose ones own perception about quality of life upon the client. With the experience of having helped both of my parents through the dying process, I know that it is important to separate my own experience and perceptions from those of my client. Just as each person takes on life with a different philosophy, so it goes with the dying process. The nurse must not assume that the patient's priorities are the same as his or hers. Open communication regarding the patient's wants and needs must be initiated. Though not all patients have had the time or skills to know how to deal with a terminal illness, one of the most important jobs of the nurse is to connect the patient to the proper resources needed for navigating through the various aspects and stages of their disease process, and to do so without judgement or bias. B. Many terminally ill patients begin to navigate through the stages of grief as outlined by Elisabeth Kubler-Ross. While caring for this client with a lingering terminal illness such as cancer, my first strategy would be to keep the lines of communication open, managing the patient's emotional and spiritual needs and outlining the stages of grief as the client progresses through them. By initiating a good line of communication, one can recognize and guide both Mr. and Mrs. Thomas through denial, anger, bargaining, depression and acceptance (Kubler-Ross). It will be easier to better manage Mrs. Thomas' physical needs if her psychological social needs have been addressed. My second strategy in helping to improve the quality of life for Mrs. Thomas and her husband would be to manage Mrs; Thomas' comfort. Working carefully with a palliative or hospice team to manage the physical discomforts of the patient's illness, can greatly increase quality of life. This is often a critical area of educating the patient on pain control. Patients are often afraid to take pain medications, and therapeutic communication is likely to be necessary. (Johanson). My third strategy would be to set up an interdisciplinary palliative care team to to manage the health of Mrs. Thomas. Terminal illness can be overwhelming for a family, where likely there are other factors - be it financial, familial, psychological, and no one person can manage it all. By working with the family to institute a good team for care, the burden can be lifted off the family and this will ideally allow them to care for their loved one without becoming burdened or overwhelmed. It is important to consult the family regarding any spiritual support that they would feel comforting. Is there a minister or spiritual guide currently in their life? If not, would they be open to a visit from someone that is akin to their spiritual values? These are questions that should be carefully addressed.
C. Nursing Care Plan for Mrs. Thomas
Mrs. Thomas is a 56 year-old female with a history of breast cancer. Mrs. Thomas is married with two grown sons, aged 28 and 30 both of which live out of state. Mrs. Thomas has a strong familial history of braes cancer and one year ago, was treated for a malignant mass in her right breast. After a right mastectomy, chemotherapy and radiation six months ago, the cancer has now returned with...
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