Introduction
When working with geriatric patients, it is vital for a nurse to remember that their needs are not always based on resolving health-related problems and maintaining a high level of health. In some cases, individuals do not want to receive aggressive or invasive treatment, wishing to live without interventions in an environment that is comfortable and accepting. In Case Study 2, Mrs. Adams decides not to treat her colon cancer surgically or pharmaceutically, instead choosing to defer all interventions. Thus, the discharge treatment plan for the patient should acknowledge her input and focus on providing her and her family with support and health maintenance activities.
Potential Outcomes
The patient in the discussed case is 96 years old, but she is in good health, having only some mild problems. Her recent diagnosis of colon cancer, however, can disrupt the woman’s wellbeing and lead to increasing problems with time. Nonetheless, it is possible that Mrs. Adams has as much as five years to live, especially if her cancer is at an early stage (Resnick, 2016). The most positive potential outcome is that Mrs. Adams will continue living independently for some time, with her neighbors assisting in transportation and other tasks. In another scenario, Mrs. Adams may require help from professional caretakers if her level of autonomy decreases because of cancer.
Care, Treatment, and Support
The discharge plan has to include lifestyle changes, advice, and follow up visits for the patient. First of all, if Mrs. Adams takes any medications for arthritis and hypertension, she should be advised to continue following the prescribed plan. Next, since she deferred all treatments for cancer, the plan cannot include any invasive or taxing procedures. Mrs. Adams may take medication to alleviate pain – it is vital to include patient education about adherence.
Lifestyle changes for the patient involve dietary restrictions to protect the colon and lessen digestive issues. Mrs. Adams should be advised to drink fluids, especially water, to avoid constipation and dehydration (O’Keefe, 2016). She should consume less processed foods that are high in sugar and fat, avoiding red meat, caffeine, and alcohol. If the patient has trouble sleeping, she may consider some light exercise, a massage, a warm bath, or similar alternative remedies (ElMokhallalati, Mulvey, & Bennett, 2018). She should consider spending more time with her son to alleviate anxiety and receive the necessary support. Mrs. Adams will be contacted in a week after discharge to assess her health and see whether she needs any additional treatments. Her advance directives have to be obtained prior to discharge.
The Needs of the Family
Mrs. Adams’s remaining family is her son and, potentially, his partner and children. The son is likely to be the only direct relative of the patient who cares for her. Thus, his needs as a family member and a caretaker have to be taken into consideration. Clinicians need to inform the patient’s son about all changes that Mrs. Adams will go through due to her advanced age and cancer diagnosis. By being aware of the treatments and management activities, the son may react to all situations with some degree of preparedness (Oechsle, 2019). Furthermore, he may be consulted on issues related to the advance directive, including his responsibilities and choices.
Conclusion
The decision of people to defer treatment can be explained by many reasons. Mrs. Adams’ choice of spending her time at home with her family has to be respected. Her discharge plan is focused on symptom management, support, and caretaker education. Lifestyle changes for Mrs. Adams are minimal, but they ensure that she will have enough time to live comfortably and enjoy her autonomy for as long as possible.
References
ElMokhallalati, Y., Mulvey, M. R., & Bennett, M. I. (2018). Interventions to support self-management in cancer pain. Pain Reports, 3(6), e690.
Oechsle, K. (2019). Current advances in palliative & hospice care: Problems and needs of relatives and family caregivers during palliative and hospice care—An overview of current literature. Medical Sciences, 7(3), 43.
O’Keefe, S. J. (2016). Diet, microorganisms and their metabolites, and colon cancer. Nature Reviews Gastroenterology & Hepatology, 13(12), 691-706.
Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.