Review of the medical record indicates that she was diagnosed with stage 3 rectal cancer with Mets to bones in 2013 and was treated with radiation treatments. Her last radiation treatment was in March. She is followed by Dr Lederman in New York and locally by Dr Patel. After her radiation therapy she developed lymphedema and pain to left lower extremity. She is follow by healthy lymphatic agency and was being followed by Dr DeBonet for pain. She has a history of rectal cancer with metastatic to bones and kidney. At today's visit, she is awake, alert and oriented times 3. She is accompanied by her friend and daughter. She is sitting on her sofa slump over and crying “ I cannot take this pain anymore, I cannot keep going on like this, why wont …show more content…
She reports pain in her left thigh which she describes as constant burning, shooting pain that radiates down her leg. The pain is 10/10 in severity. She states that her pain is so bad she has not slept in 4 days; the pain is preventing her from sleeping, eating and standing to perform her ADLS. “When I am in this much pain, I cannot eat” she has a poor appetite, has been taking small sips of boost nutrition supplement. The patient appointment with Dr Delo is schedule for Thursday 2:30 pm. I call Dr Delo’s office to request a sooner appointment for the patient. I spoke with Donna who informed me that, they did not have an earlier appointment available. The patient is getting lymphedema therapy and massage at home from home health agency, but it is not effective. I called Dr Conidi office with intent to discuss the patient’s unrelieved pain, I was informed by the office staff, to call back office and leave a message. The patient has tried different classed of pain reliever (Opiates, NSAID, Neuropathic pain agent) with not relive or reduction in her pain. After collaborating with the Palliative medical director and discussing the patient unrelieved pain, the different medication that has been tried with no palliation of her pain,
I think because of the dream of the doctor the budget allotted to the patient was consumed and the hospital administrators became worried. I also want to assume that educational background was also not tackled, it is important to know that the patient is understanding the teaching well and know the importance of the treatment and possible outcome if not followed. Also, social isolation when the author described Mrs. Benitez not attending church and the only option for her would be her neighbor who barely let them borrow the car to drive for 12 miles. The distance of the health care center is also a factor and the reason why can’t do follow up
We have one resident in the long-term facility who has stage four cancer of spinal cord and he has been suffering from intense pain. Every time when I enter his room, he cries and implore to the god that he can minimize his suffering. He has prescription of hydromorphone 8 mg every 4 hourly PRN , oxycodone 5 mg every 6 hourly and 50 mcg of fentanyl path change every 3rd day. After giving all scheduled and PRN medicine his pain level remains same as before. When I see that patients I feel like to give highest dose of medicine as well as alternative pain management therapy so that he can have some comfort but ethically I have no right to do that. He is hospice but he has no comfort at all. Following are the nine steps of Uustal ethical decision making model.
The patient presented with common signs of compartmental syndrome. The interventions suggested to the staff at the hospital were not fully completed. The interventions given during the case presentation consisted of assessing the six Ps, swelling, and vital signs. I took the vital signs of the patient and the nurse recorded them in their system. The patient’s blood pressure was not within normal limits, so the blood pressure completed manually. The manual blood pressure was still elevated. An increase in blood pressure can indicate pain, swelling, and impaired blood flow to the extremities. When I was with the nurse, she sent the patient for an x-ray. Furthermore, the nurse should have then assessed what the patient has been doing and done education with the patient to elevate the leg above his heart. Many people do not know the scientific rationale and positioning of elevating the extremity above the heart. The nurse should have also assessed the patients expectation of pain relief, since his current medication (Ibuprofen) was not working to his expectations. This is when we left the floor; therefore, I was not able to discuss the patient care with the nurse. The nurse simply asked the patient about some of the six Ps of compartmental syndrome and did not complete the assess...
family of difficult task journey. On that event, her health is getting weaker every day on
mental illness in which she is addicted to committed suicide and wont rest in peace until
A few months ago, she was diagnosed with leukemia and has been receiving Chemotherapy. The doctors have confessed that the Chemo has not had any impact, and found a donor match for a bone marrow transplant.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning on urination, and decreased urine output for three days.
aloud because she is not the only one who is facing this problem aslo there is many people who
The patient is a female in her early twenties who came in the hospital due to sickle cell crisis. She was in grave pain especially in the joints. Her hemoglobin level was low so the Physician ordered 2 bags of packed red blood cells and pain meds Q4hrs. The patient explained many times that the dose the physician ordered was not sufficient and that she needed more help. The nurse promised to contact the physician and to inform her of the response. The fact is she never did and was called urgently hours after to calm her patient who was crying in agony and wanted to go home to be in pain. She screamed out that no one cared. Some nurses were even callus enough to say if she wanted to leave then hand her the relevant document and allow her to go.
This patient’s condition continually worsens, to the degree of needing emergency care, because he does not take his medication.
On 1/9/18 I met Ms. Hendrick at the office of Dr. Kala, Neurologist. Ms. Hendrick reports that she had just left the lab having a repeat kidney function lab value drawn. She will find out when the values are available if she is able to have the port removed from her chest and confirm that she is not going to need more dialysis. Ms. Hendrick said she has a constant headache now. Her face still becomes numb on the right and the pain is mainly on the right side of her head. The best the pain level gets is a 5 and the worst is an 8. Now that she is limited to medications she doesn’t seem to be able to break the cycle. She reports that the Sumatriptan was not approved so she did not have that to take. Ms. Hendrick also gave me a bill that was from an MRI done ordered by Dr. Saper. I have enclosed a copy for the adjuster. All medications were reviewed; many have been stopped due to the kidney function. She no longer takes Neurontin, Lyrica, and Metformin. She will need approval by the Nephrologists before she can resume them. She does however still need the Sumatriptan injections. At this point, Dr. Kala recommends getting clearance from the Nephrologists to resume treatment with Dr. Saper. Ms. Hendrick will proceed with getting that clearance.
In Amira’s case, an issue of consent is arisen that her GP has not explained to her much about the conditions she is suffering and the medication that he prescribed. Amira was left a little confused because she did not has the chance to ask questions. For obtaining consent, it must be informed and capacity which means that Amira must be given all of the information of the treatment and they understand the information provided by the doctor and they can use it to make a decision (13). Obtaining consent will lead to enhancement of the efficiency to the treatment because Amira is happy and showing agreement to the
Since her husband died three months ago, even if her behavior considered to be abnormal we may approach this case as such behavior can be happened to anyone for a short-time period. However, we need to consider it has been 3 months already.
I decided not to give the shot based on facts that my clients was up moving around, she was doing exercise to improve blood flow and what the charge has said to me. I still had feeling that I was missing important steps. Feeling unsure about not giving the client her injection or having spoken to her about, I followed up about contacting the physician just to clarify the situation. I was not comfortable about the decision I made and felt confused about conflicting information I had been given by the charge nurse. In the end I explain to my client that she had not prescription for anticoagulant to go home with and if she still wanted to take the shot. My clients was a nurse for 35 years, so she had an in-depth understanding of the purpose and action of the anticoagulant she was taking. She explained that she was much more mobile and would like to decline the injection. Although I honored what the client wanted and knowing she likely did not neeed the injeciont I still felt that from my own understanding the right thing to do want to make sure I have physicians order to discontinue the drug. I shared this situation with a fourth year nurse whom this was her client and would be taking over her carefully
as she is ok , this shows a selfish nature as she says "why would U