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Asked by Chidi13
COMFORT MEASURES: ELIZABETH’S STORY: WEEK 1 Elizabeth Jones is a 44-year-old elementary school teacher. 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 is a single parent of two children. Jennifer is 14 and Alexandra is 19. Elizabeth has been divorced for 7 years from Mel who still involved with his children and their support. He has remarried and has 2 stepchildren. 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. 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 and that she is quite cushingoid. She asks you if you have come to kill her. Current Medications: Tylenol #3-2 tabs q4h prn, Stemetil 10 mg q6h prn, Colace 2 tabs bid and Senokot 2 tabs HS prn. In your opinion, briefly discuss your thoughts on the following questions. a. What are some societal attitudes toward death and dying? b. What is your own feeling regarding death and dying? c. What do you feel is important in respect to dying with dignity? d. Review the case scenario and list items that you believe require further investigations. e. In your opinion, what are some of the issues you have identified in this case?
SCIENCE
HEALTH SCIENCE
NURSING

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