The community nurse is a key resource to these patients both in providing a link to healthcare and in promoting quality of life.
The community nurse is a key resource to these patients both in providing a link to healthcare and in promoting quality of life.
Nursing Plan
Many patients with a chronic, terminal illness are cared for in the home. The community nurse is a key resource to these patients both in providing a link to
healthcare and in promoting quality of life.
Scenario:
Mrs. Thomas is a 56-year-old female with a history of breast cancer. Three of Mrs. Thomas?s five female relatives died before the age of 50 from the same illness.
After identification of a malignant mass in her right breast one year ago, Mrs. Thomas underwent a right mastectomy with the removal of five axillary lymph nodes,
followed by chemotherapy and radiation therapy. She subsequently suffered moderate lymphedema and pain in her dominant right arm. At that time, the BRAC (Be Ready
Against Cancer) analysis was positive, revealing a higher than average chance of the disease recurring.
Six months ago, Mrs. Thomas felt a pea-sized, hardened lump in her left breast. A biopsy was positive for malignancy. She underwent a second mastectomy with
chemotherapy and radiation. After treatment, the cancer was found to have metastasized to her lungs, and further surgery was not determined to be a viable option. She
has been given a poor prognosis for recovery, and palliative care is now recommended.
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After the last chemotherapy, Mrs. Thomas experienced a moderate degree of pain on most days. Even though she had been prescribed Vicodin (hydrocodone/paracetamol),
Mrs. Thomas endured the discomfort without pills most of the time because she says she did not want to become “addicted to drugs.” Lately, however, her pain
level has been increasing and she spends much of the day crying in bed. She can no longer hold the clerical job that helped to supplement her husband?s income, and
they find it difficult to make ends meet, even though she is receiving a small disability check each month. Mrs. Thomas has medical insurance but no long-term
healthcare insurance. Since all of her close female relatives have died, she has few people to help her. She does not want to call on friends or coworkers for support.
Mrs. Thomas lives with her husband of 31 years in a private home in the suburbs of a large city. Mr. Thomas has suffered from chronic depression that has been managed
with medication. He is a police officer who is extremely supportive of his wife and is attempting to provide for her care at home. However, Mr. Thomas is now showing
increased signs of depression because of difficulties at work and because of the stress of his wife?s condition. He often forgets to take his medication due to the
stress. Mrs. Thomas has become concerned because she fears he is suicidal. This, in turn, is causing Mrs. Thomas even more distress, as she feels her husband is
suffering because of her illness. Because of Mrs. Thomas?s condition, the couple does not go out and does not have friends over to visit.
Mrs. Thomas has two sons, aged 28 and 30. Both live out of state with their wives and children and are very upset about their mother?s condition. Even though they
phone regularly, they find it too painful to visit her in person. The lack of personal contact with her immediate family makes Mrs. Thomas even sadder, yet she says
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