Care Management: Recommendations for Patient Needs
Situation: Mrs. J is a 44-year-cholangiocarcinoma. She has been admitted to the hospital with a new onset of back pain, nausea, and vomiting. She is suffering pain from new spinal metastasis, nausea continuous, emesis daily, partially digested food, postprandial bloating, and early satiety. She has already undergone surgery and a course of radiation therapy. Other pertinent findings: well-hydrated; abdomen soft, mild distension, non-tender to palpation; denied abdominal pain; no abdominal masses; normal bowel sound; normal neurological exam. Current antiemetic order: ondansetron (Zofran) 4mg IV or PO Q 4-6 hrs prn. Continued despite no relief of N&V.
needs related to symptom management, the trajectory of her disease process, and broader treatment options/palliative care concerns.
QUESTIONS:
- Describe recommendations for prioritizing this patient’s needs – i.e. what issue(s) should be tackled first, second, third, fourth, fifth etc),
- Describe how they should be addressed, and what other members of the interdiscplinary team should be called upon for the needs beyond area of practice of a nurse.
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Solution Preview - Describe recommendations for prioritizing this patient’s needs – i.e. what issue(s) should be tackled first, second, third, fourth, fifth etc.).
a. Pain control is your first priority. In fact, some of nausea may be due to pain. Since she has end-stage cancer with bone meds, narcotics are necessary. Since she may vomit oral medications, I would opt for IV Demerol instead of morphine sulfate since nausea and vomiting occur more often with …
