Pain & Symptom Management Case Study
Case Study
Mr. Hayes is a 53-year-old with widely metastatic colon cancer, which has spread throughout his abdomen. He arrives on your palliative care unit with a chief complaint of intractable nausea and vomiting for 24 hours and diarrhea (1000 cc emesis and 400 cc diarrhea in the past 24 hours). He describes that he is barely capable of managing any activities of daily living. Mr. Hayes has been found to have a non-resectable partial small bowel obstruction. The patient asks, “How much longer do I have?” and “Can we speed this up?” “I don’t want my children (ages 11 & 13) to see me like this.” The patient admits to feeling down but denies any suicidal ideation. He is clearly anxious about becoming a burden to his family and wonders how his children see him. His 13 year-old daughter confides in you that she is “afraid” her daddy is going to die. He is a devout Catholic and mentions to the night shift nurse that he is certain his symptoms and suffering are a punishment for his having a divorce ten years ago. He says to the nurse that he just wants to be left alone and does not want anyone to bother him tonight.
Discussion Questions:
- What additional assessment should be done?
- Is additional suicide assessment indicated?
- How might various disciplines contribute to his care?
- How would you answer the daughter who says she is afraid her “Daddy is going to die?”
- What community resources are available to assist Mr. Hayes and his children?
- What role might his religion play in his illness?