Terminal Cancer – Palliative Care Clinical Description The patient is a 67-year old Caucasian woman with a history of breast cancer. She first presented with breast cancer eight years ago, which successfully went into remissions after a round of radiotherapy…
The current symptoms of the patient vary from day-to-day. The metastasis to the bone means that the client has progressive pain which is generally worsening. The liver metastasis has caused a loss of appetite, nausea and occasional bouts of very severe abdominal pain. The patient also has a chronic cough which is thought to originate from lung metastases, and will occasionally complain of chest pain. This has been confirmed by an abnormal chest X-ray. Overall, the patient has expressed dissatisfaction and at times feels unable to enjoy life, with an overall feeling of ‘sadness’. The patient also claims to have difficulty remembering some things, which is a common symptom of terminal cancers in general (Karabulu et al, 2010). Pain as a Symptom One of the most distressing symptoms for the patient, as with many terminal cancer clients, is the pain and the anxiety which comes from fear of increasing amounts of pain. Pain management is important in terminal cancer, but is not always effective. Hemming & Maher (2005) examined the management of pain and the difficulties which arise. The article highlights the fact that terminal cancer patients often have pain coming from many areas of the body, as seen in our case study above. Bone and nerve pain arising from metastases may be causing extreme pain, which is more difficult to treat. Hemming & Maher (2005) also highlight the fact that pain may be holistic, whereas treatments tend to focus purely on treating physiological pain with analgesics and other pharmaceuticals. The article also notes that pain is an extremely complex system and the mechanisms of this are not completely understood, again making pain management an extremely difficult process. Hemming & Maher (2005) examine the multiple ways in which pain should be approached. Firstly, they highlight the understanding of different types of pain; somatic, visceral, neuropathic and bone. Knowledge of this can help appropriate pain management systems to be correctly found. There is also an importance placed on the spiritual elements of the pain, which Hemming & Maher (2005) suggest need to be approached simultaneously with the more traditional physical approach. From here, the attending clinician could use an ABCDE of assessment of the pain to help them understand the location and type of pain, again helping to highlight what type of pain management may be necessary. Pharmaceutical interventions can then be considered. This should be approached in three ways. Firstly, ‘by the ladder’, which means that treatment should start from the non-opiod option and become progressively stronger by need. The article also highlights the importance of giving pain medications ‘by the clock’, or regularly, to maintain relief. Finally, Hemming & Maher (2005) advocate that pain relief be given ‘by the mouth’ through oral administration. Lynch & Abrahm (2002) focused on the Dana-Farber Cancer Institute and their approach to pain management in terminal patients. The approach here was done in a number of steps. The first of these involved assessment, with the Dana-Farber Cancer Institute advocating using numeric, verbal and a Wong-Baker-like FACES scale to judge the standard of pain of the individual. After this, patient education is conducted. The patient should be knowledgeable about the medication and approaches to pain that they are taking, particularly as a fear of addiction and the problems with ...
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