This case study is based on interactions with a 66 year old woman who was presented to the emergency department and had complaints of excessive vaginal bleeding and passing of large clots with abdominal pain of severity 8 out of 10…
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The patient underwent a cystoscopy and was diagnosed with cervical cancer. The doctor recommended daily pelvic radiation therapy and weekly cisplation at 30 mg/m^2.The patient has reported reduced abdominal pain; however she reports increased fatigue and shortness of breath and exertion. As she is also a very aged woman she frequently loses temper with the doctors and starts shouting and throwing things about. Nurses consider her as a very difficult patient and are afraid of being put on her duty. She is also reported to have serious lifestyle issues. She has been reported to smoke 1 pack of cigarettes daily and also drinks 4 beers on an average per day. She gets very irritated these days as she is not allowed to smoke inside the hospital complex. I was put on her duty after she had been at the hospital for about one week. When I went to meet her she was very irritated and started shouting at me. I decided to act nicely and patiently handled her tantrums. I never tried to shout back and didn’t ask any other nurse to take duty in my place. She warmed up to me after 3 days and asked my name. I took this opportunity to have a chat with her and ask her about her health. After winning her confidence my first step was to educate her about cervical cancer. She was completely unaware as to why she was admitted to the hospital. I patiently told her about her condition and also elaborated on the steps being taken to make her fit again. She was quite receptive to this and in fact wanted to know more about cervical cancer. Within 2 days she was discussing about her reports and asked me about her white blood cell count. I then decided to discuss self management with her in the presence of her grandsons. Cervical cancer had caused her to lose her appetitive .She was also witnessing the side effects of treatment such as nausea , and sores inside her mouth which made eating difficult. I contacted the hospital’s nutritionist and also consulted her doctor in preparing a diet plan for her which will make sure that her calorie and protein intake are appropriate. I also encouraged her family members to be present with her as much as they can. I presented her grandson with a game of chess and asked her to play it with her grandma. This was essential so that she maintains mild levels of physical activity and energy levels remain up. After this I decided to study her medical report in detail. The treatment plan for her was cisplation 30 mg/m^2 intravenously weekly with concurrent pelvic radiation therapy daily. I saw that pelvic radiation therapy was making her constipated. This was probably one of the reasons for her irritable behavior. I consulted with the doctor about this problem and we recommended her docusate sodium in order to make her bowl movements more comfortable. As she followed the above mentioned advices her behavior considerably improved over the weeks. She still was fatigued but was responding to treatment and being less irritable. Once this was achieved I now decided to address her problem of smoking and alcohol. Smoking has been identified as one of the reasons of cervical cancer. I prepared a chart for her which would slowly her to reduce her smoking habits. It was essential that she was shown reasons to quit smoking. She always said that she has lived with a cigarette for 30 of her 66 years; she is not going to abandon it in the end. I took the help of hospital’s psychologist and tried to show her what all she will miss if she dies due to smoking. It took a long time to convince her but she was finally prepared to give it a try although she was not completely convinced. Benner’
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