hltenn010 apply a palliative approach in nursing practice skin recurrence
Utilising the following case study prepare a report addressing the questions below. Elizabeth Urquhart is a 44-year-old elementary school teacher. She is a single parent with two daughters, Jennifer 14 yrs., and Alexandra 19 yrs. Elizabeth has been divorced for seven years with the father Mel is still involved with his children and their support. He has remarried and has 2 step children. Elizabeth was engaged to be married to Frank, but she called off the wedding when she developed brain metastases. Frank still visits her frequently. Alexandra is at university in a town about 150 km away. Jennifer is at home in high school but having problems with her school performance. Elizabeth has two sisters and one brother living near her. Her father died of cancer 2 years ago. Her mother, Madge, also lives nearby but has had little contact with her daughter since the divorce. Madge is a devout Catholic and does not believe in divorce. Six years ago she had a lumpectomy for breast cancer followed by adjuvant radiotherapy and chemotherapy. She was well for almost 4 years, when she developed a skin recurrence in her scar. This was treated with further surgery. About two months later, while at work, she had a grand mal seizure. A CT of her brain revealed at least 6 metastases to her brain. She had whole brain irradiation and was placed on dexamethasone, a powerful cortisone drug and anti-seizure medication. Further investigation revealed metastases in her liver, lung, and peritoneum. She began chemotherapy but had no response to 3 different regimens. No further treatment is planned. Symptoms included some abdominal pain from a grossly enlarged liver, nausea, constipation, abdominal distension and increasing weakness. She also has had a number of panic attacks resulting in weekly trips to the emergency department. Elizabeth has not allowed any of her friends to visit her over the last four months. Elizabeth is referred to you for palliative care assessment and follow-up. You see her at home. Your first impressions of her are that of a very ill woman in quite a bit of distress. She asks you if you have come to kill her. Current Medications: paracetamol 1-2 tabs q4h prn, Stemetil 10 mg q6h prn, Coloxyl with Senna 2 tabs prn 1. Identify the needs of Elizabeth, her family and/or carers. What tools would you use to identify these needs and why?
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