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NURSING 7124 Management of Chronic Illness

Task

Case Study- 2 John Blackwell You have been employed as Community Case Manager RN for a local community health service.

John is a 65-year-old Italian man with type 2 diabetes with who presented to his GP with difficulties voiding (a slow stream and dribbles) and pain in his lower back. After some medical investigations he was diagnosed with prostate cancer and underwent an urgent radical prostatectomy (with a suprapubic incision to remove some lymph nodes (for cancer screening as well) one week ago. The lymph nodes appeared to have cancer so they were sent for histopathology and testing. The CT scan and MRIs prior to discharge showed the cancer has possibly spread to his sacrum (as there was a suspicious lesion) and he has some suspicious shadowing in the brain. He was commenced on dexamethasone 5mg daily to slow down the spread of the cancer and to help with lower back pain in conjunction with other analgesia. The dexamethasone has impacted his ability to control his blood glucose levels and it has recently risen in the last few days. His BGLs are ranging from 8-14mmol/L but have been as high as 16 mmol/L post operatively in the ward since starting dexamethasone.

He was discharge home this morning from hospital and has received a CHSP (Commonwealth Home Care Support Program) home care package of care which the discharge facilitator from the hospital instigated from the local home care service provider (you are employed by this service). John has temporary IDC, with an out-patients appointment and trial of void (TOV) in 6 weeks. His PICC line is insitu for possible use for chemotherapy and it was dressed yesterday in the ward.

He is scheduled for an oncologist consultation and planning with the oncology nurse early next week after his surgical wound has had a chance to heal. His prognosis is 2-10year life expectancy depending on chemotherapy outcomes, but the doctors are not entirely sure until the frozen sections and histopathology resections (from surgery) results are returned. This usually takes 10-14 days. The doctors have indicated that the chemotherapy is more likely to be used for life prolonging measures rather than seeking a cure.

The family are looking into non-conventional treatment options. John recently retired from the building industry, he lives with his wife and has a large supportive family who live close by. He has four adult sons who are all married with small children. The diagnosis of a life limiting illness has impacted his mental health. He is currently shocked by the diagnosis and has been talking like he is in the denial phase of grief with the pending diagnosis. He stated the tests will come back clear and he will be alright and is looking forward to getting into his garden greenhouse again and getting the lettuce, tomatoes and basil planted as spring is approaching.

He is a current smoker, drinks frequently 8-10 standard drinks a week (mostly red wine and Grappa) and eats a Mediterranean diet. He is 171cm tall and weighs 105kg.

Past Medial History

Type 2 diabetes Hypertension

Peripheral neuropathy, numbness in feet

Sciatica

Medications

Metformin 1g BD,

Dexamethasone 5mg daily mane

Panadol Osteo 1200mg TDS

Endone 5mg QID PRN as needed for pain for one more week

Frusemide 40mg BD

Potassium Chlorvescent 1 tablet diluted daily in 150mls of water.

Atacand 16mg Mane

  1. Design a Self-Management Care Plan
  2. Student to fill out Goals and corresponding interventions under each goal

Smart Goal 1:

John will be able to achieve satisfactory pain management of his lower back pain within two weeks time frame by using reliable information sources and with the help of pharmacological and non-pharmacological interventions.

Smart Goal 2:

John will maintain the infection control strategies for one week to help him with his wound healing process, IDC and PICC line.

Smart Goal 3:

John will manage his tight diabetic control between the recommended limit ( 8-14mmol/L)  by using a diabetic diet and other reliable sources for the next two to three weeks to help heal wounds.

Required 6 to 7 self management intervention and Rationales

NURSING 7124 Management of Chronic Illness

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