Case Study on "Patient With Terminal Lung Cancer"

Case Study 8 pages (2087 words) Sources: 6

[EXCERPT] . . . .

Patient with Terminal Lung Cancer

The purpose of this study is to conduct a case study on a patient with terminal lung cancer and to determine the best practices in providing palliative care for this patient.

Learner Objectives for the Case Study

(1) Upon completion of this study the learner will be able to identify the best practices in providing palliative care for a patient with terminal lung cancer.

(2) the learner will, upon completion of this study, be well-informed of the needs of the patient with terminal lung cancer in terms of their needs of daily living with terminal lung cancer.

(3) the learner will become informed concerning treatment options available for terminal stage lung cancer patients.

Introduction to the case Study

The individual in this case study is a terminal lung cancer patient who is 59 years of age. This patient who will be referred to as Nan in this study is Caucasian. Nan is married and has been for 42 years and the couple has three daughters, all of whom are married and living outside of their parent's home. The couple additionally has several grandchildren and the oldest of which is living with the couple in their home.

IV. Etiology

Lung cancer is greatly attributable to carcinogens in the environment with the most important of these being tobacco smoke. The incidence of lung cancer following World War I, when men began smoking cigarettes is stated to have been on the rise quickly only twenty years following that war. The epidemiology of lung cancer is in modern times the epidemiology of smoking with other factors reported to be of minor importance. This is because cigarette smoke contains several proven carcinogens in the particulate and gaseous phase which includes:

(1) Aromatic Hydrocarbons

(2)Nitrosamines

(3) Nitrosonormicotine

(4) Polonium; and (5) Arsenic . (Meddean, nd)

It is reported that the individual's exposure to specific substances "have a synergic effect in being causatively associated with the use of tobacco products in development lung cancer." (Meddean, nd) Included are such as:

(1) asbestos;

(2) chloromethyl ethers

(3) Mustard gas

(4) Radioactive Ore. (Meddean, nd)

Host factors that affect the development of lung cancer are inclusive on a complex interaction between the host and environment with factors that play a role that is stated to be somewhat minor being:

(1) risk of second primary;

(2) associated malignancies;

(3) CLL

(4) Aryl Hydrocarbon Hydroxylase;

(5) Scar carcinoma; and (6) Tuberculosis. (Meddean, nd)

V. Medical History

The individual in this study has a history of smoking cigarettes for approximately 39 years having started smoking at age 20 while in college. The patient reports that the risks associated with smoking were not know at that time however, the patient wishes that she had never started smoking. The patient has been on a smoking cessation program and has successfully quit the use of cigarette tobacco nearly a year ago. The patient has a history of low blood pressure although otherwise she is very healthy except of course for the terminal lung cancer for which she is being treated.

VI. Medications affecting assessment

The patient's memory appears to be mildly affected however this is likely due to the high dose of painkillers that the patient is presently prescribed to assist her in coping with the pain from chemotherapy and radiation treatment. Otherwise patient is cognitive and positive and communicates quite clearly.

VII. Other data

This patient is under a great deal of emotional distress as she realizes that her disease is terminal and while she may be fortunate enough for the disease to go into remission, at the same time, this disease is terminal in nature and her life is going to be cut short in comparison to the years she could have otherwise expected to live. This patient has three daughters and several grandchildren. She has been married 39 years and is greatly distressed as to what will happen to her husband when she dies.

VIII. Brief Cultural/Social/Family History and Physical Exam

This patient is from an upper middle class family therefore, resources are not critical in relation to her receiving treatment however, the family has had to downsize their home in order to ensure that they do not replete their resources. Nan is an outgoing individual who enjoys playing golf with her husband however, lately she has had to be content to wave at her friends as they pass by on the greens close to her home. She is not overly distressed about the dent that this disease has put in her social interactions however she is distressed about the impact that this has had on her long-term marriage. Quite simply, she is suffering from a great deal of depression.

IX. Significant Findings and Assessment for Consideration in Patient's Care

Nan's granddaughter Clarissa, who is 18 years of age and recently moved into the home in order to assist in Nan's care toward the end of this disease. The cancer cells have spread to seven of Nan's lymph nodes following removal of the right upper lobe of the patient's lung although the patient has recovered well from the procedure. The radiation and chemotherapy appeared to have brought the patient into remission three months ago only to return and the doctor for this patient has stated that he knows little that can be done for the patient. Nan, however, has decided to participate in a John Hopkins study that is testing an experimental cancer drug. The doctor expects Nan to live six to eight weeks longer and has stated three months at the absolute longest estimation for this patient's continued survival.

X. Palliative Care

The work of McNeil (2010) reports a new study that emphasizes the impact of end-of-life care in which doctors found that patients "with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared -- but they also lived nearly three months longer." (McNeil, 2010, p.1) This study shows that palliative care is not about bringing on death but instead it is about assisting patients in living longer lives with the best quality of life possible. (McNeil, 2010, paraphrased) the study specifically reports that patients receiving palliative care from the beginning "reported less depression and happier lives as measured on scales for pain, nausea, mobility, worry and other problems. Moreover, even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis, they typically lived almost three months longer than the group getting standard care, who lived a median of nine months." (McNeil, 2010, p.1) Palliative care is stated to begin "with a long conversation about what the patient with a terminal diagnosis wants out of his remaining life. It includes the options any oncologist addresses: surgery, chemotherapy and radiation and their side effects. But it also includes how much suffering a patient wishes to bear, effects on the family, and legal, insurance and religious issues." (McNeil, 2010, p.1) the focus of the palliative care teams includes a focus on "…controlling pain, nausea, swelling, shortness of breath and other side effects; they also address patients' worries and make sure they have help with making meals, dressing and bathing when not hospitalized." (McNeil, 2010, p.1) Included in palliative care provisions are such as home nursing however, this is only covered by Medicare and other insurers "if the patient abandons medical treatment and two doctors certify that death is less than six months away. " (McNeil, 2010, p.1)

The final stages of lung cancer include the patient's experience of severe pain. Management of this end-of-life pain in terminal lung cancer patients "is complex." (Livestrong, 2011) Also included in the patient experience in the end-of-life stage of terminal lung cancer are such as "visual and tactile hallucinations, delusions, incoherent speech and anxiety" all characteristic of delirium." (Livestrong, 2011) This includes disorientation to time, person, place and events and is common in 85% of terminal lung cancer patients in the final stage of the disease. This delirium is believed to be caused by 'organ failure, infection or side effects of medications." (Livestrong, 2011) Another distressing symptom for the terminal lung cancer patient at end-of life is noising breathing also known as the 'death rattle' which is due to "increased oral and respiratory secretions." (Livestrong, 2011)

It is reported in the work of Eldridge (2009 ) that a recent study provides hope for those who wish to spend their last days at home and who have terminal lung cancer. Palliative sedation is a treatment presently being used in hospitals in cases where there is an inability to control the patients pain in any other way. The stated goal of palliative sedation is "to alleviate suffering, not shorten life." (Eldridge, 2009)

According to the Agency for Healthcare Research and Quality "In patients with lung cancer who have pain unresponsive to standard methods of pain control, referral to a specialized… READ MORE

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