Discuss about the Palliative Care Practice for Initial Diagnosis.
The pathogenesis of lung cancer along with other forms is commenced after the induction from various habits like smoking which the patient was exposed to for a long time. The diseases progression promoted the development of the multiple metastases in the patient (1). The patient Tom was a chain smoker since sixteen years of age and that has rendered the development of other associated pathogenesis like breathing troubles and susceptibility to pulmonary infection. The patient complained breathing troubles along with chest pain. Lung cancer is known to be facilitated by smoking cigarettes, which leads to severe disease manifestation. The diseases manifestation occurs when the mutations in p53 gene which is a known tumor suppressor. Smoking induces the pathogenesis by a phenomenon called “field effect” which affects the epithelial tissues in the lungs and initiates cellular transformation (2). The continuation of smoking induces the mutation process, which further alter the tissue structure and metastasis generation in the surrounding tissues. This form of diseases progression takes about 20-25 years to develop and since the onset of mutation. The risk of cancer exposure is initiated by the smoking habits, which is enhanced by the effect of environment factors like pollutants. In case of Tom, who is a construction worker received risk of exposure of environmental factors. The condition of the patient was of centrally located tumor type. The patient showed signs of tumor growth, which induced coughing, chest pain, atelectasis, post obstructive pneumonia. Tom also showed sign wheezing breath and pericardial effusion. Diagnosis showed that the type of cancer in Tom was of small cell lung carcinoma (SCLC) which is common for rigorous smokers (3). It is centrally located where the tumor blocks the bifurcation of the airways. The origin of the cancer was seen in the neuro-endocrine cells which produce neurotransmitters, growth factors and vasoactive compounds which regulate the functionality of the lungs. Tom is detected to secrete ADH or ACTH. The growth of the tumor is very quick and the condition has spread to various parts of his body. The CT scan report revealed that pathogenesis of his report. Low dose x-ray scan showed abnormal mass index of the lung tissues in Tom. Lesions and other abnormalities were detected which showed signs of carcinogenesis. Tom was diagnosed also on the basis of sputum generation which showed abnormality. The main biopsy report showed that Tom had stage II carcinoma (5). Tom also displayed symptoms of chest pain, asthma and diabetes. The blood test revealed that Tom had 180mg/dl blood glucose level, which needed to be controlled. Tom complained breathing trouble from time to time, which was diagnosed to be asthma. The associated co morbidities made it more complicated to care for Tom.
The medication for Tom was provided by the practitioner to minimize his chest pain. Morphine was selected the best choice for his condition which Tom was reluctant to take due to his lack of knowledge and literacy. Tom was prescribed mitiglinide to treat his diabetes and for controlling asthma, Formoterol was administered. Mitiglinide is the most preferred drug for treating type 2 diabetes as in case of Tom, it stimulates the by the blocking the channels and influx of calcium in the cells (4). The excitation of the cell due to influx of calcium triggers the exocytosis of insulin compounds. Formoterol is the beta 2 agonist, which causes dilation of bronchial cells and provides passage off blood in the pulmonary compartments and induces the relaxation of smooth myocytes such that the air is forced inside the lungs and the breathlessness is inhibited (6). The severity of Tom’s cancer progression needed immediate chemotherapy to min size the growth of the tumor. The biopsy report showed that Tom has stage IIa, meaning his tumor was 5cm in diameter. The practitioner also prescribed targeted drug therapy for Tom, which included administration of specialized drugs which bind to specialized receptors of the tumors and identify the tumor proteins and destroy their functionality. The therapy was associated with chemotherapy, radiation therapy and interventional pulmonology from time to time. The practitioner selected Crizotinib and Erlotinib, which is a known inhibitors of the kinase enzymes in the cancer cells and help checking the cancer cell growth (7).
At the end stage of lung cancer, the main issue for Mr. Tom is that he is having extensive breathing problem and chronic pain. When palliative care is initiated, it is expected that patients current medication regimen needs to be changed. Pain is a symptom that is seen in lung cancer patient due to local effect of tumor or distant spread of tumor. Since Mr. Tom has been shifted to end of life care because deteriorating symptom of pain, it is expected that palliative pain management in initiated for Mr. Tom. Morphine is the first medication for pain management in patients. However, this medication is associated with increase in symptom alleviation at end of life (8). Hence, to provide high quality palliative care, it is expected that low dose of Opioid is given to Mr. Tom. The use of opioids is considered effective for the management of advanced lung cancer patient as it has no impact on their quality of life. The evidence also suggested that opioid administration has no impact on survival rate of patient in acute care setting. The study done regarding survival rate on opioid users in acute care setting suggested that there is no significant difference in survival time of patient after mean daily dose of opioid (8). Hence, opioid use is efficacious for Mr. Tom, only thing that needs to be considered by palliative care staff is to provide optimal dose of Morphine. It any side-effects like drowsiness persist, then other opioids can also be provided.
During the transition of patient to end stage of disease, it is likely that pain related symptom of Mr. Tom will exacebarate. At this time, strong opioid like Oxycodone should be started for patient. Other advanced analgesics like NDM receptor antagonist may also be initiated for patient as it acts on the central nervous system to treat underlying chronic pain. Corticosteroid is also a useful treatment option for cancer related pain (9). It is also necessary to consider patient and families cultural factosr while providing palliative care. Clinician or palliative care should be vigilatnt to review adverse impact of any medication and change theme instantly. The focus should to support patient at end-of-life and not aggravate presenting symptom of patient (10).
Another major problem for patient is chronic pain. Hence, when palliative care is provided, it is necessary to review appropriate medication to manage breathing problem. Shortness of breath and cough are disturbing symptoms of end-of-life care patient and the challenges for patient increase particularly for advanced lung cancer. In case of Mr. Tom, the main challenge is that his symptom of pain has aggravated because of history of asthma and smoking. This has increased risk of complication in patient. As this medication management review is focused on reviewing medication management regimen of Mr. Tom, reviewing pharmacological options for management of lung cancer patient is necessary. Opiods can be used to treat dyspnea in patient. Many stuies have shown the effectiveness of oral opioids on shortness of breath in cancer patient. Another special consideration during end-stage of life is that low dose of opioid should be given to treat breathing problem. The initial does should be 2.4 mg morphine every four hours in Mr Tom. This can relief symptom of patient. As Mr. Tom is reluctant to take morphine because of fear of sedation, it is necessary to clearly advice to Mr. Tom that low does of Morphine will not cause any effect on patient.
During the end-stage of life, oxygen can also be administered for pain relief. However, for end-of-life patient, stringent criteria exist for treatment with supplementation oxygen because of adverse effects like poor mobility and dryness of respiratory mucosa. Opioids are effective antitussants that has low toxicity and maximum health benefits for lung cancer patient. They suppress cough and helps patient to recover from deteriorating sign and symptoms of breathing problem (11).
GP letter:
Dr. Philips (Hyopothetical)
Oncologist
Date: 28th April 2018
Re: Mr. Tom’s Medication Management Review Referral Report
Dear Dr. Philips,
I would like to thank you for referring Mr. Tom, a 55 year old patient, residence of Grove, NSW for a MMR. Based on review of case history of client, it has been found that Mr. Tom is worried about the medication that is going to be used for his treatment in the palliative care. His mental compliance is ok and he has no psychosocial issues. However, he has reported acute pain and breathing problem which has deteriorated. He has also denied using morphine after seeing one of his acquaintance being too drowsy after taking the medication. He does not want to feel drowsy as he is aiming to have control over himself and do not trouble his family.
Based on the review of specific health and psychological issue, please consider the following issues and recommendations if you will those actions with help Mr. Tom.
Along with this letter, a table of recommendation has also been added that provides evidence based discussion on Mr. Tom’s past medication, current medication and laboratory results and proposed changes in care plan for providing high quality end-of-life care to patient. I have provided these recommendatio after extensive analysis of current medication history, current clinical issues in patient and diagnostic results or other information obtained from patient interview.
If by this time, patient’s health status has changed, then my recommendations needs to be adjusted again as palliative care needs of Mr. Tom.
I am looking forward to hear from you soon regarding my proposed palliative care plan for Mr. Tom. If you need to get any extra information related patient’s health status, please feel free to contact me or discuss the same with Mrs Cec, Mr. Tom’s wife.
Yours faithfully,
(Name and date)
Table of recommendation:
Patient demographics:
|
Name: |
Tom |
|
Address: |
|
|
Phone number: |
_______ |
|
Date of Birth: |
17.05.1963 |
|
Marital status: |
Married with Mrs. Cec |
|
Gender: |
Male |
|
BMI |
28.0 |
|
Allergies: |
Allergy to dust |
|
LF: |
Not compromised |
|
Pregnancy |
N.A |
|
Smoking: |
1 pack per day |
|
Alcohol: |
No alcohol consumption |
|
Carer details |
Aboriginal liaison officer , nurse and family members |
|
Treating Dr. details |
Oncologist |
Medical conditions: Advanced lung cancer
History of uncontrolled diabetes, heavy smoker and history of respiratory problem due to asthma
Medication history of Mr. Tom indicates the risk factor of lung cancer in patient. One researcher states that smoking is one of the major risk factor of lung cancer (12). Mr. Tom’s past history of chronic asthma also explains the pathway that led to lung cancer development in patient. Another author gives the evidence that chronic inflammation during asthma plays an important role in cancer development (13). Through meta-analysis of evidence, it was proved that asthma increases risk of lung cancer I patient.
Persistent pain and breathing problem is the main complaints of patient.
Evidence by (3) suggest that breathing problem is one major issue that challenges advanced lung cancer patients and their family caregivers from coping with the disease. Many lung cancer patients have reported that they have hard time catching their breath. The rate of anxiety and depressive symptom in higher in lung cancer patient compared to other patient.
Medications history:
|
Brand/Generic and Strength |
Mr GB medications Dose/Duration/frequency |
Date initiated |
Current/ceasing date |
|
Metformin |
1 tab daily |
15.05. 2015 |
Continuing till date |
|
Albuterol |
2.5 mg, 3-4 times daily |
10-01. 2010 |
10.12. 2013 |
|
Morphine |
5mg every 6-7 hours |
10.04. 2018 |
Continuing till date |
Current medications:
|
Brand/Generic strength |
Dose/duration/frequency |
AMH or MIMS recommended dose duration or frequency |
|
Morphine |
5mg |
every 6-7 hours |
Laboratory results:
|
Parameters |
Normal reference |
Mr. Tom results |
Significance |
|
Bronchocopy |
Di |
0.88 |
High, confirmation of central tumor. |
|
CBC |
Abnormal number of blood platelets and |
High |
|
|
Biopsy |
Detection of cancerous cells |
Abnormal cancerous cells |
High |
|
Fasting PP |
70-99 mg/dl |
150mg/dl, |
High |
Table of Recommendations:
|
Current condition/drug problem |
Current managements EBM discussions and things you already did |
Recommended actions or change |
Expected outcome |
|
Uncontrolled diabetes |
Patient has been suffering from uncontrolled diabetes. As metformin did not controlled his blood sugar, |
Dose of morphine should be changed |
Symptom improvement and pain relief in patient |
|
Pain |
opioid like oxycodone for treatment of high blood sugar as it is a strong opioid that can provide pain relied to patient. |
Opioid should be given but at low dose |
|
|
Breathing problem |
Opioid drug is also necessary to treat breathing problem |
Opioids should be given at low does |
It is important to promote patient education to ensure the improved quality of life in the case of Tom. This process includes intervention-based duration regarding the importance of the pathogenesis and the associated lifestyle changes that have negative repercussion on the diseases progression (15). In case of Tom, it is highly advisable that he quits smoking immediately, as the smoking during the carcinogenesis enhances the diseases manifestation (16). This will also help him overcome his asthma and relieve him from chest pain. Tom should be advised to adapt healthy eating habits and make sure to maintain the excess requirement of nutrients and vitamins to keep the health issues in check (17). Physical exercise can also be helpful for the patient and can reduce fatigue and improve the mental issue. The recent follow up of Tom, revealed that his cancer progression has reached end stage and chemotherapy and hospitalization will create more problems for him. Tom’s health is deteriorating with the effects of chemotherapy which is why medication and lifestyle changes is best suited for him right now (18). Tom should be encouraged to lead a healthy lifestyle and take his medication regularly. Evidences have shown palliative care improves the quality of life among patients like Tom (19). Encouragement to be close to family acts as a psychotherapeutic effect on the patient. Active cancer treatments would be avoided at this stage of life to inhibit the effects of the clinical manifestations. The general idea behind the palliative care is to focus on the patients physical as well as emotional needs since this disease drains the motivation to live (20). Relieving pain in Tom’s case is very important and should be considered as a top priority. Active involvement of the family members also induces better living chances in the patients.
References:
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download