EOL CASE STUDY
Joan is a 34-year-old mother of two children: a 10-year-old and a lively 6-year-old. You are her Palliative Home Care Nurse. Her husband is very supportive. Joan was diagnosed with colon cancer 4 years ago and was treated with resection, colostomy, and radiation treatments. Unfortunately, an abdominal CT scan performed 1 year ago revealed liver metastases. Chemotherapy failed to help, and Joan knows that her time is limited. She is determined to be at home for as long as possible.
Joan is currently taking Hydromorphone 4mg/Q4 hourly. Her PPS is currently 50%. The clinician visits Joan at home one afternoon. Her husband has taken the children out to a movie and Joan begins by saying that she is feeling “exhausted.” She adds that she has not been sleeping at night or, rather, must wake up to take her pain medication every 4 hours.
Things to think about as you answer the questions below?
Think of this patient holistically. What changes need to be made in order to increase her QOL? What do you think her priorities are as she approaches death? With a Palliative Performance Scale of 50% what do you predict her needs will be as she gets weaker?
Answer the questions in the boxes, within the boxes. Your answers should be concise. You can cite within your answer and/or at the end of your submission. You must incorporate the questions above as well as the questions in the boxes. Pay note to the grading rubric.
| WHY DOES JOAN HAVE FATIGUE?
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| WHAT DO YOU EXPECT WITH A PPS OF 50 %
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| HOW DOES HER WAKING UP EVERY 4 HOURS FOR PAIN MEDICATION INFLUENCE HER SLEEP?
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| WHAT ARE YOUR 2 PRIORITY NURSING PROBLEMS AND WHAT WOULD YOU DO TO HELP WITH JOAN’S SIGNS OF FATIGUE?
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| WHAT CHANGE TO HER MEDICATION REGIME WOULD YOU SUGGEST? WOULD YOU SUGGEST ADDING ANYTHING?
WHY?
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| WHAT IS YOUR PLAN FOR FOLLOW-UP?
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| EVALUATIONS | Accomplished | Good | Developing | Beginning |
| References/Research 2.5 marks
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All content is accurately and adequately referenced/researched and/or cited | Most content is accurately and adequately reference/researched and/or cited | Some content is accurately and adequately referenced/
researched and/or cited |
No content is accurately and adequately referenced/
researched and/or cited |
| Effort 2.5 marks | Student answers the question correctly and completely. Student incorporates information from the text and class notes into the answer. Student may look for answer outside of class | Student shows some prior knowledge and may use terminology to answer the question. Student does not use information from the text and class notes to answer the question | Student tries to answer the question but does not show adequate amount of previous knowledge in answering the question. | Student tries to answer question but reports wrong answer. |
| Evidence of Critical Thinking
10 marks |
Clearly identifies and summarizes main issues and successfully explains why/how they are problems or questions; and identifies embedded or implicit issues, addressing their relationships to each other | Successfully identifies and summarizes the main issues, but does not explain why/how they are problems or create questions | Identifies main issues but does not summarize or explain them clearly or sufficiently | Fails to identify, summarize, or explain the main problem or question. (OR) Represents the issues inaccurately or inappropriately. |
Word Count: 300-400
No. of Pages: 3