Essay on "Ineffective Coping Mechanisms for Stress or Anxiety"

Essay 8 pages (2583 words) Sources: 15 Style: APA

[EXCERPT] . . . .

Ineffective Coping Mechanisms for Stress or Anxiety Due to Stage 5 Pancreatic Cancer Prognosis Morbidity

Pancreatic cancer is one of the most prevalent forms of terminal cancer. There has been great progress made in understanding the activation of Hedgehog (Hh) signaling pathway reportedly related to malignant biological behavior mechanism of pancreatic cancer; yet this progress is far from reaching a cure (Xu X, Guo C, Liu J, Yang W, Xia Y, Xu L, Yu Y, Wang X., 2009, found online). Like victims of other terminal forms of cancer, pancreatic cancer patients are faced with overwhelming choices that they must make on behalf of their selves, their families, and the people who care about them. In the face of the brevity of their situation, many patients suffer from depression, arising out of a sense of hopelessness, and begin to exhibit aberrant behaviors consistent with their diminished physical and mental abilities to cope with the stress and anxiety of their terminal prognosis.

Adenocarcinoma is the most common form of pancreatic cancer, accounting for 95% of the cases reported (Unversity of Texas, 2009, found online). It involves the cells that secrete digestive enzymes (2009), and, like other cancers, metastasizes to other related organs, like the pancreas. The symptoms include: jaundice, a noticeable change in the color of urine and, or, stool; pain, when tumors press against nerves; indigestion, nausea, lack of appetite and weight loss; sudden onset diabetes or a sudden change in blood sugar levels warranting intervention (2009). As the symptoms of pancreatic cancer manifest, it might be anticipated that the patient begins to look for coping mechanisms. The mechanisms are ineffective; perhaps because the most prevalent conditions linked with the disease is depression suffered by pancreatic cancer patients, which is not well understood (Makrilia, Indeck, Syrigos, and Wasif Saif, 2009, found online). If the side effect of the disease is poorly understood, then it would follow that therapeutic interventions designed to help pancreatic cancer patients cope with the disease are likewise poorly designed and ineffective.

Using the case study assigned for this essay, and relying upon published peer reviewed literature in journals, and some reprinted on various cited web sites; this brief essay is an exploration of the coping mechanisms for the manifestations of terminal cancer found in the literature. These mechanisms prove to be largely unsuccessful or ineffective for patients coping with the profound circumstances surrounding a terminal illness like pancreatic cancer.

The Case Study: History and Physical (H&P)

Mr. Pen is a 77 years old healthy Italian man. Past history of 60 years smoking, PVD. He lives with his wife in a two storey house. He has one son who does not live with them. He noticed his urine was darker and two weeks ago he became jaundice. The patient was admitted to St. Joseph Health Center on the general surgery floor. The admitting diagnosis was Pancreatic Adenocarcinoma. The patient underwent whipple, cholecystectomy, explanation major vessels on Sept. 15/09. He complains of abdominal pain and does want to go to rehab center.

Depression and Pain: A Link

Makrilia, Indeck, Syrigos, and Wasif Saif (2009), say that depression is one of the most prevalent conditions linked to patients who suffer from pancreatic cancer. Chung (2009) supports this observation, citing the same holds true for breast cancer patients. This would suggest the need for a psychological consult, and the recommendation that the patient be administered by a registered nurse (RN) whose specialty is psychiatric nursing. This would facilitate the necessary intervention to help the patient cope with the predictable onset of depression.

While the patient has no prior history of depression, the onset of depression in patients with pancreatic cancer reportedly begins prior to diagnosis (Makrilia et al., 2009). Makrilia et al. say that pancreatic patients often are not diagnosed with depression until the end stages of life, and that these patients have worse survival rates (2009). Makrilia et al. say that pain management is also a key to managing depression (2009).

"Since the 1930s, a triad of symptoms has been described preceding or accompanying the diagnosis of pancreatic cancer: depression, anxiety and a sense of impending doom. Symptoms of clinical depression may include anorexia and weight loss, but there might also be cachexia-related symptoms misattributed to depression. Other common symptoms are negative thoughts and behaviour, sleep disturbances, loss of interest and joy in many aspects of daily life and feeling of hopelessness. Level of fatigue has been found to correlate significantly with depression levels. Symptoms may also include panic, social isolation or even suicidal ideation. Cognitive impairment may be present, a phenomenon called depressive pseudodementia, in which the patient's results on the Mini Mental State Examination (MMSE) are better than expected. Most studies have been based on newly diagnosed patients, so there is danger of recall bias influencing their psychological status (Makrilia et al. 2009)."

This information points to an understandable link between pain and depression. For that reason, the involvement of a pain management RN working closely with the psychiatric RN would be strongly recommended, and of benefit to the patient and the patient's family.

The Nursing Element in Terminal Illness

The nursing element in this case is integral to both identifying the patient's onset of depression, and in providing guidance for interventions that could help this patient find ways to mitigate or even to delay the onset of depression. There are new and innovative and therapeutic ways that can be introduced to patients suffering a terminal illness that might help to counter depression. In an article found in the Journal of Palliative Medicine, Anne Horne-Thompson and Denise Grocke (2008) explore the ways in which music can be utilized as a therapy for depression, and improving the quality of life for end of life patients. Quantitative research yielded results that supported the hypothesis that music helps to manage anxiety, a precipitator to depression, in terminally ill patients, is alleviated with music therapy (2008). This is a therapy that might be explored with the patient in this case as it could bring the patient together with the family in a way that takes them away from the source of their anxiety and depression.

While palliative nursing is beginning to receive more attention, the Canadian Nurses Association has a position paper that speaks to nursing and terminally ill patients (CNA Position, 2008). The position paper states that end of life care must be a collaborative effort, and that it will include a mixture of nursing specialties: mental health, nutrition, and, in this case, oncology nursing.

Jacquie Peden, Carolyn Tayler, and Carleen Brenneis (

Terminal Illness, Patient and Family

In this case study, the patient is a 77 years old Italian, with one adult child who lives away from the home; and a wife living with him in the home. Carol Robinson and Karen Janes (2001), in an article published in the Cancer Oncology Nursing Journal, say that conscientious, systematic, and ongoing assessment of the family is as integral to the patient's care as is the direct nursing care given the patient. Interaction is created between the patient and the family by prompting the patient to have discussions with the family members about the patient's illness. While this patient's only child is an adult, there is no less a need for the patient to talk to his son, and to be open and forthright about the obstacles he is facing, and those they will encounter as a family. Robinson and Janes encourage patients to acknowledge that the disease has an effect each member of the family, albeit in different ways (p. 65). Ostensibly, redirecting the patient's focus to the needs of his family might help to alleviate the onset, and to counter the impact of his depression. Helping the patient focus on those things around him that he can have a positive impact on will help him to cope with his debilitating condition.

An article by E. Adali, a. Merkouris, E. Manoussou, and M. Priami found in the ICUS and Nursing Web Journal introduces a topic that is certain to come up in conversation between family members and even between the patient, the family, and the nursing and physicians professionals working the patient: end of life euthanasia (Adali, Merkouris, Manoussou, and Priami, 2004, found online). It is an emotional topic, and one that Adali et al. says comes about in the context of the patient's quality of life (p. 3 of 9). This is a subject that really is family members or the patient's first steps in acknowledging their mortality; and arises out of the desire to prevent the prolonged suffering of a loved one, or the patient's loved ones.

Even though many healthcare professionals support the idea of legalized euthanasia, it is, in the United States, not legal. Conversations with the family about euthanasia should be handed in a professional manner, recognizing the source of the conversation is a desire not to see a loved one suffer. Ending the suffering with drugs would indeed be an easy enough solution, but at… READ MORE

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