An 80-Year-Old Woman with Breast Cancer - Case Study Example

Case Study on Human Health & Behaviours - An 80 year old woman with breast cancer - Total Number of Words: 2,811 Table of Contents I. Introduction ………………………………………………………….. 3 II. General Information about the Patient ………………………………. 3 III. Importance of Health and Illness to the Patient …………………….. 4 IV. Patient’s Reaction to Illness …………………………………………... 5 a. Physical Changes ………………………………………….. 7 b. Emotional Changes ………………………………………… 7 c. Cognitive Changes …………………………………………. 8 d. Behavioural Changes ………………………………………. 8 V. Making Health Decisions ………………………………………………. 9 VI. The Impact of Social Influences and Inequalities over the Health Condition of the Patient ……………………………………….. 10 VII. Lifespan Issue …………………………………………………………… 10 VIII. Relationship between Emotions and Health …………………………. 10 IX. Pain ………………………………………………………………………. 11 X. Impact of Stress and Stress Management …………………………… 11 XI. Recommended Health Promotion Activities ………………………….. 13 XII. Conclusion ……………………………………………………………….. 13 References ……………………………………………………………………… 14 -1 6 Introduction As part of the clinical practicum, the student nurse will first conduct a personal interview with a patient. After providing a clear description about the patient’s case, the student nurse will examine the impact of health and illness over the patient’s thoughts, feelings and behaviour aside from the effects of thoughts, feelings and behaviour towards the patient’s illness and health. As a way of analyzing and explaining the patient’s thoughts, behaviour and perception about the illness, the student nurse will critically apply the theories related to human development and social and cognitive psychology on the health condition of her patient. Prior to conclusion, the student nurse will discuss the recommended health promotion strategies as a way of preventing the patient’s illness. General Information about the Patient The patient ‘T’ is 80-year old woman who has been married for 54 years. During her married life, she had three children – a son and two daughters. Since her son and daughters live in QLD, Australia, her son is regularly taking ‘T’ out for socialization. Over the years, ‘T’ enjoys a good relationship with her husband and three children. As her past time, she was fond of sewing stuffed toys for other people. ‘T’ has several history of breast cancer. Back in 2001, the family physician of ‘T’ confirmed that she has a breast cancer on her right breast. The second diagnosis of cancer in ‘T’’s left breast happened after her husband passed away in 2007. During the same year, she started feeling an ongoing pain and debility after she had radical mastectomy. ‘T’’s depression became alarming when she started to spend more time alone in her bedroom. Her depression combined with tiredness due to chemotherapy made her avoid socializing. Because of the patient’s old age, a bone scan revealed that she is suffering from bone degeneration disease. To relieve her from chronic pain, she was prescribed by her physician to administer 5 mg of Endone – a narcotic analgesic and 5 mg Norspan patch – a type of analgesic. Likewise, she was also taking 15 mg of Oxazepam – a tranquilizer for her anxiety and depression. Two years after she was diagnosed with breast cancer, she suffered from a mild Cerebral Vascular Accident (CVA). Although she was able to recover immediately from CVA, the fact that her husband had dementia made her become more vulnerable to internal and environmental stressors. Because of ‘T’ and her husband’s health problems, both were admitted in a nursing home to ensure that they receive assistance for their activities of daily living. ‘T’’s husband past away while in the nursing home. At first, ‘T’ became very emotional because of her husband’s death. Since she knows very well that her husband’s mental health condition is deteriorating, she eventually accepted losing her husband. Today, ‘T’ is suffering from chronic pain on the shoulders and knees because of arthritis. After going through her second breast mastectomy back in 2008, her depression got worse. Although ‘T’ never smoke or drink alcohol, her parents were moderate smokers and drinkers. Importance of Health and Illness to the Patient Before ‘T’ had her first mastectomy, she considered herself to be physically and mentally healthy. As an individual, she acknowledges the importance of health living. Her health beliefs made her refuse to even try smoking or drinking. Since Australian government is giving free annual breast examination for women more than 50 years of age (Des Exposure Australia, 2009), she would attend the physical check-up in clinic for breast examination each year. Patient’s Reaction to Illness ‘T’’s busy lifestyle and the habit of denying the possibilities that she is at risk of having cancer made it difficult for her to accept the illness. She never thought that she would have risk of having breast cancer even though her mother and sister died from abdominal cancer and tumour on the brain respectively. Based on Kubler-Ross model, the five stages of grief includes: (1) denial; (2) anger; (3) bargaining; (4) depression; and (5) acceptance (Belmonte, 2009). Although Kubler-Ross model served as a framework in analyzing the physical, emotional, cognitive and behavioural reaction when dealing with the death of her husband, it does not necessarily mean that ‘T’ went through the five stages of grief. Although she was in denial and depression before she finally accepted the fact that her husband was dead, she never showed signs of anger or bargaining. ‘T’’s pre-contemplation was related to the fact that there were no obvious lumps, pain or both that surrounds her right and left breast before she was diagnosed with breast cancer. Normally, breast-cancer patients are expected to find either lumps or pain in the breast area (MacArthur & Smith, 1983). However, this was not true at the time she was diagnosed with cancer in her right breast. In fact, she did not feel that she was ill until after going through mastectomy. After the action stage of health behaviour change, her physical condition worsened after receiving chemotherapy. Upon analyzing the entire scenario, the physical deterioration associated with going through the operation and receiving chemotherapy contributed a lot in feeling depressed and worthless. Physical pain and the feeling of worthlessness made her decide to withdraw herself from social interaction and activities. The second time she was diagnosed with breast cancer happened when a nursing staff who was working in the nursing home discovered lumps on her left breast. Although the patient felt no pain, the presence of lumps indicates the possibility of breast cancer. The fact that her husband past away already made her feel more depressed. It was only in 2008 when she finally accepted the fact that she is suffering from breast cancer. As soon as she acknowledged the presence of the illness, she decided to proceed to another round of mastectomy and chemotherapy. Following the second mastectomy, ‘T’ suffered from severe pain, edema, shingles, abscesses, insomnia, anorexia and lethargy. Since her physical health is deteriorating, the patient’s depression becomes more severe and difficult to manage. Several studies revealed that the presence of strong emotional support to cancer patients can somehow enable them to easily cope with their illness. (Kuuppelomaki, 2003; Slevin et al., 1996) By listening to their personal concern about the life-threatening disease, the patient will be able to feel more secure and stronger in facing the health challenges they have to go through (Cancer Care, 2008). Since ‘T’’s husband is no longer around to give her emotional support and caring, ‘T’ has to depend on other people including her children and the rest of the health care professionals in terms of increasing her spiritual and moral integrity. Physical Changes For a long time after the second operation, she was unable to sleep properly. Moreover, her appetite was gradually lost .Tiredness set in and seemed to be with her all day. The physical pain she is feeling is controlled with medication. However, she felt a lot of discomfort due to the swelling and fluid in the arm. Before the cancer, ‘T’ was very industrious. She spends most of her time sewing toys for the community and charities. Once depression took over, ‘T’ could no longer concentrate on doing her normal daily activities. To cope with the physical changes, ‘T’ was admitted to a nursing home whereby the caregivers could willingly assist her with her physical and emotional needs. To reduce the pain she feels, nurses would administer 5 mg of Endone and 5 mg Norspan patch as necessary. Emotional Changes After the operation and chemotherapy, ‘T’ was going through a lot of emotional struggles and grief. Prior to the second surgery, ‘T’ had coped very well with the death of her husband. After going through the second mastectomy and chemotherapy, she started missing her husband making her loneliness unbearable. Her husband was always there to comfort her aside from attending to her physiological and emotional needs. Her physical discomfort and pain made her more conscious of her emotional needs. As a result of her physical incapacity, she felt useless because she was unable to do her activities of daily living on her own. Out of depression, she began to think that it would be better if she is dead. To cope with the emotional changes, ‘T’ was given the opportunity to have a twice a week session with a psychologist. Likewise, she was also given a daily dose of 15 mg of Oxazepam for her anxiety and depression. Her son also visits him in nursing home every now and then to give her comfort. Cognitive Changes With regards to cognitive changes after going through chemotherapy, ‘T’ often complains about having memory loss and concentration problems. She finds it difficult to communicate her emotional burden to other people. Based on the research study of Rausch (2000), women with breast cancer who undergo high-dose of chemotherapy encounter higher long-term memory deficit as compared to those individuals who receive low-dose. To cope with the cognitive changes, the nurses make sure that they remind ‘T’ of date and time aside from keeping her place in the same place all the time. By doing so, ‘T’ will be able to easily remember where she can find her belongings. Behavioural Changes ‘T’’s behavioural pattern changed from being a very socially busy and happy person to an anxious, withdrawn and unhappy individual. Immediately after the surgery, behaviour of ‘T’ changed drastically. She became withdrawn from her friends. She also refused to eat meals with the other residents in the hostel. There were also instances wherein ‘T’ would look down on the floor for unknown reasons. She simply chose to free herself from reality into space. To cope with the behavioural changes, healthcare professionals who are working directly with ‘T’ are trying their best to alleviate the patient’s pain and emotional burden which significantly affects ‘T’’s behavioural patterns. Making Health Decisions As a person, ‘T’ demonstrates a high standard of moral and a strong sense of humour. She is very practical, resourceful, flexible and open to ideas and suggestions. Since the day she was diagnosed with breast cancer, she has been very open in taking her physician’s suggestions on the type of treatment and medication she needed in order to cope with the said disease. ‘T’’s perceived cancer as a type of illness that could lead to her death. This thought could have developed after losing two members of her family (her mother died from abdominal cancer and her sister who died from a brain tumour). Following this tragedy, one of her sisters lost an eye to cancer. However, she recovered and became ‘T’’s biggest supporter. Based on the health belief model, it is clear the ‘T’’s personal experiences with regards to her family members who died of cancer significantly affects her perception and decision for treatment. Since she is very much aware that cancer is a life-threatening illness, she decided to undergo mastectomy and chemotherapy as a way of prolonging her life. The Impact of Social Influences and Inequalities over the Health Condition of the Patient ‘T’ is a very educated person who lived most of her life in urban areas of Australia. Because of her environmental and social upbringing, ‘T’ became very knowledgeable of issues related to health and illness. As mentioned earlier, ‘T’ has been receiving free breast examination each year. In case she failed to be informed about her breast cancer at an early stage, she might not be able to fully recover from the said illness. As an individual, ‘T’ was a very sociable person. Since there are no signs showing that social inequalities could impact ‘T’’s perception with regards to the treatment for breast cancer, it is possible that her ability to communicate well with other people contributes to her decision-making and perception regarding breast cancer. Lifespan Issue Body image is important regardless of age for the reasons that physical appearance serves as our identity. Based on Erik Erikson’s developmental theory on health and illness; “adaptation to changes in body image can be more difficult to accept in an older group of individuals because illness challenges their fundamental identity” (Lubkin & Larsen, 2006, p. 186 – 187). It simply means that ‘T’ is going through a difficult time trying to become physically accepted by other people. Relationship between Emotions and Health There is a significant relationship between ‘T’’s health and her emotions. Each time ‘T’ feels excessive pain; she tends to become more emotional. In most cases, she is being reminded of her husband each time she wanted someone who could provide her with emotional comfort. Likewise, she tends to become sickly each time she is emotionally depressed. Pain The patient is given 5 mg of Endone and/or 5 mg Norspan patch to relieve her from chronic pain. Based on the patient’s personal experience, she only receives Norspan patch in case 5 mg of Endone is not enough to alleviate her discomfort. In other words, the combination of Endone and Norspan patch is more effective in terms the pain is too much. Impact of Stress and Stress Management Stressors are commonly classified as external or internal. (Ward et al., 2003) External stressors may come from extreme environmental condition like hot or cold temperatures whereas internal stressors can be related to physical abnormalities related to inflammation or infection. It can also be caused by psychological factors such as excessive worrying. The physical stress of ‘T’ is related to pain associated with the after effects of mastectomy and chemotherapy whereas her emotional stress is related to grievance over the death of her husband and her feeling of worthlessness. Even though the role of emotional regulation between stress and hypertension remains unclear (Gerin et al., 2002), several studies show that negative emotions such as anger, anxiety and frustrations could increase the physiological stress which normally causes a person to experience hypertension (Lawler et al., 1998; Miller et al., 1998). These internal or external stressors, regardless of whether the stress occurs over a short- or long-term period, could negatively affect people physically, mentally, and emotionally. Regardless of age, several studies show that a stressful condition could cause a person to experience a significant decrease in the performance of their declarative memory (Lupien et al., 1997; Kirschbaum et al., 1996; Newcomer et al., 1995). Stress has also a huge impact on a person’s heart and circulation system including irregular hear beats. (Cooper, 2005; Kivimäki et al., 2002) In some cases, stress causes the human body to release inflammatory markers (Giannessi et al., 2007) which worsens the heart and circulatory diseases resulting to heart attack or stroke. Similar to the case of ‘T’, stress triggers inflammatory diseases like rheumatoid arthritis (Walker et al., 1999). Even though it is not clear as to whether or not stress could increase a person’s risk to cancer, the study of Zweitzig et al. (2006) reveals that stress could activate a gene that leads to metastatic cancer which is associated with the increase level of marker AGR2. Even though a lot of peer-reviewed studies show that stress triggers a negative effect to the overall well-being of a person, it is possible for a person to experience a positive type of stress known as ‘eustress’ – a positive form of stress which could stimulate a positive behaviour and energizes a person (Wann et al., 1999). For this reason, the adaptation of a proper stress management is highly recommended to conteract the negative health consequences of stress (Nelson & Simmons, 2003). To cope with stress related to her illness, ‘T’ was thought how to do the deep breathing exercise. This technique has been proven effective in terms of reducing the physical pain that the patient is experiencing. Recommended Health Promotion Activities One of the health behaviour that ‘T’ needs to change is the time wasted before she contemplated the need to treat her breast cancer. Basically, the earlier the patient receives treatment procedures the higher the chances they could recover from breast cancer. With regards to ‘T’’s health condition, the recommended health promotional activities should be related to the following: (1) proper nutrition; (2) importance of pain medication; (3) significance of counselling and spiritual growth; (4) importance of listening in the provision of holistic care; and (5) importance of socialization which could uplift the confidence and spirit of the patient. Conclusion Upon analyzing the case of ‘T’, it is clear that the patient’s thoughts, feelings and behaviour on health and illness is highly dependent on the culture and health beliefs of each individual. Likewise, there is also health and illness has also a significant impact over the patient’s thoughts, feelings and behaviour. For instance: Since ‘T’ is well-educated, she acknowledges the fact that women more than 50 years old are at risk of breast cancer. Because of age factor, she always have mammography test each year. On the contrary, ‘T’’s health condition also affects her personal thoughts, feelings and behaviour with regards to different issues in life. *** End *** References: Belmonte, J. (2009). HelpGuide.org. Retrieved August 2, 2009, from Coping with Grief and Loss: Support for Grieving and Bereavement: http://helpguide.org/mental/grief_loss.htm Cancer Care. (2008). Retrieved August 2, 2009, from What Can I Say to a Newly Diagnosed: http://www.cancercare.org/pdf/fact_sheets/fs_loved_one.pdf Cooper, J. (2005). Palpitations. Circulation , 112:e299 - e301. Des Exposure Australia. (2009, January 17). Retrieved August 3, 2009, from ...Important Message About Breast Screening for DES Exposed Women: http://desnsw.blogspot.com/2009/01/important-message-about-breast.html Gerin, W., & al., e. (2002). The Role of Emotional Regulation in the Development of Hypertension. International Congress Series , 1241(7):91 - 97. 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