Holistic Assessment of End-of-Life Care: A Case Study of Carol’s Illness

QUESTION

NUR272 End-of-life Care: Assessment Task 2
Case Study – 1) Background and Assessment Carol is 43 years of age, living on small acreage in the rural hinterland of the Sunshine Coast near Nambour, with her husband Tim (50yo), their son Simon (17yo) and daughter Penny (12yo) who are both secondary school students. Although Carol was born and raised in Brisbane, she settled in the district when she met Tim, a local. Carol was initially diagnosed with bowel cancer 10 years ago after a sustained period of alternating constipation and diarrhoea, and weight loss after the birth of Penny. A colonoscopy at that time showed that multiple adenomatous
polyps had become malignant. At this time, Penny’s mother mentioned that her mother had died many years earlier from ‘something in her bowels’. Carol underwent a partial colectomy and chemotherapy, and has kept good health since, with annual screening. However, a year ago after some pain and nausea, with breathlessness on exertion, Carol was found to have metastases in her liver and lungs. Further chemotherapy appeared to slow the progress of her disease at that time. Now, Carol is now in the advanced stages of her illness and has been given a prognosis of ‘a few months.’ She reports constant low to medium abdominal pain, especially in the right upper quadrant; she remains breathless with little
exertion and generalised weakness. Carol reports erratic bowel habits, where she is mostly constipated.
Tim continues to work at his job in town, as well as maintain the acreage. Simon and Penny have continued to go to school, although both of them have had their parents called to the school following some behavioural incidents with other students.
Rubric criteria

• Demonstrate accurate assessment of the holistic needs of a person living with a life-limiting illness and their family.
• Application of the principles and practices of reflective and academic writing and referencing in the style appropriate to the discipline.

Ethical use of intellectual property.
Questions
1. What is the likely trajectory of Carol’s illness?
2. From your assessment, what type of pain is most likely with Carol’s disease? What are
the characteristics of pain that must be included in your assessment?

3. What are the elements of assessing Carol’s constipation?
4. What are some of the concerns the family might be experiencing? How could you
assess these?

ANSWER

Holistic Assessment of End-of-Life Care: A Case Study of Carol’s Illness

Carol’s Illness Trajectory

Based on the information provided in the case study, Carol’s illness trajectory indicates that she is in the advanced stages of her life-limiting illness. Carol was initially diagnosed with bowel cancer 10 years ago, which progressed with metastases in her liver and lungs despite undergoing partial colectomy and chemotherapy. The recent development of constant low to medium abdominal pain, breathlessness on exertion, and general weakness suggests that her condition is deteriorating. Additionally, the prognosis of ‘a few months’ indicates that Carol’s illness is in the terminal phase. As a result, her healthcare needs will focus on palliative care and symptom management to enhance her quality of life and alleviate discomfort.

Type and Characteristics of Pain in Carol’s Disease

Carol is likely experiencing nociceptive pain, which results from tissue damage caused by her advanced cancer and metastases. The characteristics of pain that must be included in the assessment are the location, intensity, quality, and duration. The constant low to medium abdominal pain, especially in the right upper quadrant, indicates the location of pain. Assessing the intensity of pain using a pain scale (e.g., numerical rating scale) will help quantify Carol’s pain experience. Understanding the quality of pain, such as sharp, stabbing, or dull, will provide insights into the underlying mechanisms causing her discomfort. Lastly, documenting the duration of pain, including its onset, frequency, and exacerbating or alleviating factors, will aid in tailoring pain management interventions to her specific needs.

Elements of Assessing Carol’s Constipation

Assessing Carol’s constipation involves gathering relevant information to understand the frequency, consistency, and potential causes of her erratic bowel habits. The elements of this assessment include:

Frequency: Determine how often Carol experiences bowel movements to identify patterns or irregularities.

Consistency: Assess the texture and formation of her stools to determine if they are hard and difficult to pass.

Contributing Factors: Explore factors that may contribute to constipation, such as her pain medications, reduced fluid intake, or decreased physical activity.

Bowel Obstruction: Rule out any signs of bowel obstruction, as this can be a complication of her advanced cancer.

Concerns of the Family and Assessment Strategies

The family may be experiencing a range of emotional, psychological, and practical concerns during this challenging time. Some of the concerns they might be facing include grief, anxiety about Carol’s prognosis, stress related to caregiving responsibilities, and financial strain due to medical expenses.

To assess these concerns, the nurse can use various strategies, such as:

Communication: Engage in open and empathetic communication with the family to explore their feelings, fears, and coping mechanisms.

Support Resources: Assess the family’s knowledge about available support services, such as counseling, respite care, or support groups, and offer referrals as needed.

Coping Mechanisms: Explore the family’s coping strategies and resilience in managing the emotional burden associated with Carol’s illness.

Financial Assessment: Discuss any financial concerns with the family and provide information about financial assistance programs or resources available to ease the financial burden.

In conclusion, a comprehensive holistic assessment of Carol’s illness and her family’s needs is essential to provide individualized and compassionate end-of-life care. By understanding the likely trajectory of her illness, assessing the type and characteristics of her pain, evaluating constipation, and addressing family concerns, the healthcare team can develop a well-rounded care plan that enhances Carol’s quality of life and provides support to her family during this challenging time.