Patient With Terminal Lung Cancer Case Study

" (2003)

It is reported in the work of Morrow (2009) that prior to palliative sedation being considered the team of people caring for the patient or the palliative care team "…will look at many possible options to help relieve suffering, such as aggressive symptom management (using any and all medications and treatments that may help) and mental support to help with emotional concerns. The goal is to make the patient as comfortable as possible. When this effort isn't enough, palliative sedation may be an option. " (Morrow, 2009, p.1) in some cases the symptoms are difficult if not impossible to treat and fail to respond to any treatment despite extremely high doses of pain medications. Also causing severe distress is such as "frequent and severe nausea and vomiting, uncontrollable tremors or seizures, and severe breathlessness are just a few examples of distressing conditions. In these cases, sedation may be the only way to get adequate relief." (Morrow, 2009, p.1)

Once the palliative care team has made the decision to use palliative sedation "…a sedative medication is given and increased until the desired comfort level is achieved. Often, patients are able to maintain consciousness while sedated to a comfortable degree. But if a patient is still experiencing intolerable symptoms, inducing unconsciousness may be an acceptable last resort." (Morrow, 2009, p.1)

Morrow reports that medications used to induce sedative effects include such as "anti-anxiety drugs, such as Valium and Phenobarbital, and pain medications. The feeling of sedation may range from a gentle calm sensation to complete unconsciousness. Generally, the lowest amount of sedative medication that has the desired effect of relieving suffering is used. This may mean that the patient remains conscious for as long as possible. " (Morrow, 2009, p.1) in the case where an unconscious state is induced as the only method that is available for providing relief to the patient who is suffering the sedative may be used temporarily "…with the medical staff allowing the sedatives to wear off to reassess the patient's comfort level.It may be decided that the only way to ensure comfort is to maintain complete sedation until death occurs. If this is done, death will usually occur within one week." (Morrow, 2009, p.1)

Three criteria are reported that the case of the patient must meet prior to palliative sedation being considered. Those three criteria include:

(1) alternative means of alleviating suffering have been ineffective or have produced intolerable side effects;

(2) the goal of sedation must be to alleviate suffering, not end the patients life or hasten death; and (3) the patient must be close to death already, so sedation would not significantly shorten survival. (Morrow, 2009, p.1)

Summary and Conclusion

This case study has examined the nursing practice and the concerns and considerations when caring for the patient with terminal lung cancer. There are many considerations of a grave nature that requires the collaboration of a palliative care team to ensure the patient's comfort and to reduce the stress of the patient and their family during this very trying end-of-life experience in terminal lung cancer patients.

References

Lung Cancer Etiology (nd) Retrieved from: http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/lungca/smok-med.htm

Eldridge, L. (2009) Definition of Palliative Sedation. Health's Disease and Condition. 2009. Medical Review Board 20 Dec 2009.

Kvale PA, Selecky PA, Prakash UB, American College of Chest Physicians. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007 Sep;132(3 Suppl):368S-403S. PubMed.

Morrow, Angela (2009) Palliative Sedation: Alleviating Suffering When All Else Fails.….....