Hi Assessment 2 - Health Assessment/Management Assessment Type Written Assignment Description: You are the advanced practice palliative nurse caring for Sophie and you are required to conduct a comprehensive health assessment management plan for Sophie. Please include: • Use of patient history in assessment • Use of physical examination in assessment • A conclusion based on your findings and best practice. What would the priorities of your management be? • Include relevant literature to support your clinical decision making; • Include correct referencing using an electronic reference library (e.g. EndNote); You are required to provide a peer review and critical feedback using the comment function in the Blog to at least one other student.t See instructions for providing feedback to your peers on Blackboard before proceeding. NB: Failure to respond to at least one other student will result in 50% of the marks for this assessment item being deducted. Responses are due one week after the due date of the Blog. Length 1,000 word Due 25 September Sophie Potter’s Story Case Study for NURS6711 Scenario 1: Setting the Scene Sophie Potter, a 47-year-old woman, married with two teenage sons has been referred to the palliative care unit with metastatic breast cancer. When admitted to the palliative care unit Sophia recounted her story as follows: I was 39 when I was diagnosed … I found what I thought may be a lump in my right breast and I went straight to my GP as I admit I was worried. My mother had breast cancer and died just before my 35th birthday. My GP ordered a mammogram and an ultrasound. The ultrasound result showed that there was one lump in my right breast and I was told that it would be necessary to do a needle biopsy the next day. I was very concerned and the staff at the hospital tried to reassure me and said that it was highly unlikely that it was a malignant cancer. I had to wait a week to see my GP to hear the result and I was on tender-hooks the whole time as you can never be prepared for what may happen. My GP confirmed my worst fears that the lump, although small, was malignant breast cancer. He referred me to a surgeon specializing in breast cancer surgery and requested a quick appointment. I remember thinking ‘this can’t be happening to me”! My husband Tim was with me when we visited the GP and he was shocked but tried to be positive in telling me it would be alright. My appointment with the surgeon was the following week and he explained both what had been found, a small lump that had to be removed and also the procedures he would follow. Because time was important arrangements were made to have the procedure carried out in a private hospital in two weeks’ time. On the day of my surgery I had to attend the nuclear medicine department of a public hospital to have dye injected in the area so that the surgeon could identify both the lump and the tracks of the sentinel glands given the possibility that they too may be affected. I was told that I would lose the glands under my right arm and that several of the sentinel glands were in a more difficult spot and may not be able to be removed. This procedure was quite painful but done with great care. I then travelled to the private hospital and was prepared for the lumpectomy in my right breast. My husband Tim was with me and we were told that I would need to stay overnight. Following on from the surgery we had five weeks of radiotherapy. Luckily, we had no complications other than some redness and oedema in the area. I had taken some weeks of work after the surgery but went to work during my five weeks of radiotherapy.We also had appointments with both a radiation and medical oncologist every three months in the first year and then every six months to ensure I was alright and to check my progress. My medical oncologist placed me on Tamoxifen, because my cancer was estrogen sensitive, which was fine, but we did start to put on weight. Everything was clear for three years but then, on my routine yearly mammogram and ultrasound two lumps showed up in the other breast. We had a full mastectomy in my left breast followed by six months of chemotherapy. It made me so sick and I lost all my hair and started wearing a scarf in public. We felt so miserable and lacked confidence and lost any desire for intimacy with my husband. One year later another lump came up in the scar where I had had the right lumpectomy and was told by my oncologist I could not have any further radiotherapy but I could have another round of chemotherapy. Seriously, the chemotherapy just made me so sick but we pushed on with this second round of chemotherapy. I also did a lot of vipassana meditation and when my energy levels were not too low I forced myself to walk along the beach every day to enjoy the sounds and sights and try to be positive about the future. I also began a daily regime of yoga for ten minutes each day to try and help my body and mind to remain calm and help heal. I did a lot crying but not in front of my children. I also went through a stage of feeling really angry, “why me”… “This is just so unfair”. Anyway, here I am now and my cancer has spread even further. Two months ago a bone scan showed that I now have cancer in my spine. Thankfully it is not in my brain. I have been scared about that! I am in a lot of pain and have been suffering from nausea and vomiting for the last few days! I am on MS Contin 120mg BD and I have been taking morphine (Ordine) elixir 40mg PRN for breakthrough pain, however, it is not holding my pain. I have been sipping peppermint tea and this has helped my nausea in the past, but it has not been helping me now. My husband found me doubled up with pain and vomiting last night and rang the GP as he has been worried and wanted some advice on what we should do. My GP arranged for me to come here to the palliative care unit Scenario 2: Sophie’s readmission to hospital It has been 4-months since Sophie was referred to your palliative care unit and discharged home under the care of community palliative care. You have just received a phone call from the community palliative care nurse who is sending her in an ambulance to your hospital accident and emergency unit. Sophie’s husband had tried to phone the GP as he is worried about his wife and being unable to get in contact with the GP he phoned the community palliative care nurse. Sophie’s husband Tim reported that for several days she has been complaining about central back pain, aggravated by movement, coughing, or straining. This pain has tended to come and go regularly and was bothering her. She has also been suffering from constipation and some urinary incontinence. This morning Sophie complained of tingling in her toes and perianal numbness i.e. is “a funny sensation down below”. Scenario 3: Sophie’s final days Following the recent assessment and treatments in Scenario 2 Sophie was discharged and has spent the past five months at home with regular visits to her GP and support from the community palliative care nurses. The community palliative care nurse has arranged for Sophie to be admitted to the palliative care unit as her condition has deteriorated in the last several days. Tim, her husband has been looking after her at home with the support of the community palliative care nurses. However, he has been finding it difficult to look after Sophie as she has been in a lot of pain and very restless. Tim has also become very tired. Sophie has not been eating or drinking very much despite her husband’s urging her to eat and drink. Following her admission the decision was taken, in consultation with Sophie and her husband, to commence a syringe driver with morphine and a clonazapam infusion. Sophie has been moved to a single room in the unit. She is now sleeping most of the time and comfortable. The doctors and nurses held a family meeting on the second day of her admission since the family is now aware that Sophie is dying and does not have long to live. David, Sophie’s 15 year-old son is overheard saying to his father that his mother is not eating anything and that the nurses are going to starve her to death. Tim asks you, the nurse attending to Sophie, if you are going to commence intravenous fluids because she is no longer taking anything orally? Sophie died peacefully four days after being admitted to the palliative care unit. She was very settled and pain-free. Prior to this day you, as the nurse attending Sophie, had asked if she had some favourite music she would like to hear and was told that Mozart was her favourite composer. Her sons wanted to bring in the family cat, a British Blue that Sophie loved and was with her every day during her illness at home. Arrangements were made for the cat to be brought in to spend a short time with Sophie. Since the hospice already had a resident cat her boys took responsibility to ensure that the British Blue was safe and secure during the visit and did not become scared and run away or fight with the resident cat. In the last two days of her life a lavender-infuser and low-level lighting was introduced to create a peaceful and calm environment. Her nurses provided a gentle massage when they washed and turned her. Her sons David and Charlie and her husband Tim were with her when she died and stayed with Sophie for a short time to say their goodbyes. They cried a lot and said how much they loved her. Tim chose to assist in the final bathing of Sophie and you found this quite a spiritual experience.We were supposed to use Endnote from the Uni as a reference