Coping with the disease symptoms is one of the aims of palliative or supportive care, believing that if one can live well, one can also die well sans much morbidity and pain. As seriously ill people experience much pain and discomfort, consequently, their normal functions are diminished (Alanticare. 2007). This service, in brief, can help reduce painful symptoms, which helps improving the quality of life of people having life-threatening disease like metastatic breast cancer.
Palliative care could take place at home, in hospitals, in hospices with people having incurable diseases.As palliative care goes beyond the mere concept of caring, it has also something to do with emotion, spiritual needs, and family relationships. Palliative care service personnel include: care consultant, care nurse, care social workers, and volunteers. This team provides the necessary information, practical support and even emotional reinforcement to the afflicted and his or her family.
With such palliative care service, care providers ensure that the patient’s rights are enforced and respected, giving protection to the patient as well as to his family (RUMC. 07). Client Assessment A 38-year-old patient named Karen (not her real name) has been diagnosed of having breast cancer a few months earlier. She is the mother of 2 children, a ten-year-old boy and a 7-year-old girl.
Her disease has metastasized to the other parts of the body including her bones. And this has been causing her an unbearable severe pain, which disables her to do normal works. She also experiences the difficulty of caring for her children.She has consulted an oncologist who is a specialist of his chosen lines and has presented some ways of coping up with the disease including chemotherapy that would work for her life-threatening disease. The diagnosis has emotionally upset her and the family.
She feels deeply sad inside and made her unable to find time to sleep. Though Karen does not expect that her disease would complete the cycle and it gets worse, she has been vocal and comfortable thinking of death. She does not like it, however, to come in hurry for its arrival.She expects that when she reaches the end of the rope, she could have a graceful exit, which could help herself and her family, especially her children. She knows that this is unavoidable.
She has been confused as to her expectations as death approaches. But the prognosis had given her strength in having a good relationship with the Creator that strengthens everything that comes to her path. Palliative treatments Cancer research institutes, including the National Cancer Institute, have been funding various researches and clinical trials relating to palliative care.The scope of these researches starts from the very moment of diagnosis to following the path of disease cycle.
From applying new pharmacological management practices to non-pharmacological uses in controlling pain, alternative management is also tried in searching ways of alleviating painful suffering due to cancer or due to other life-threatening diseases. Cancer institutions have been including national trials on inhibiting the development of breast cancer before it occurs in some areas with high-risk women.The fact remains that more than 99% of breast cancers occur in women (PHAC. 007). The use of drug tamoxifen, meanwhile, has shown reduction of new breast cancer in the study area. Aside from prevention, early detection of the disease is imperative in initiating treatment at the earliest stage.
Sometimes, however, symptom at this stage is absent. Trained personnel use radiology or mammography in probing the disease. This is then followed by clinical breast examination for early detection of cancerous entity especially in women of age 40 and over.With such early move, the probability of survival rate for afflicted person is higher. This consequently lessens the burden of pain and disableness accompanied by financial drain arising from expensive end-of-life care (Malin.
2004). When a case of breast cancer is confirmed, treatment follows depending on the cycle stage of the disease. Partly, treatment would also depend on the women’s health, the disease itself, and the disposition of the trained personnel treating the patient. Some surgical treatments options are available ranging from partial to total mastectomy.Other alternatives are also employed including marrow transplant, hormone therapy, and chemotherapy, among others.
Management of Chronic Pain In managing pain, its origin must be identified to apply the right treatment. The main objective in treating pain is to control it rapidly and completely. The next step is blocking the resurgence of pain. Regular administration of analgesic drugs must be observed with increased doses on stubborn pain as needed. For opioid administration, this medication must be given orally for the first time; otherwise, secondary choice could be through transdermal or rectal route.With parenteral, first consideration is through subcutaneous since intramuscular administration route is not advisable for opioids When necessary, adjuvant analgesics with a non- and opioid analgesic could be given.
Some patients are prone to opioids side effects. Caution, therefore, should be given to patients who are diabetics and to those who are experiencing impaired renal function. Alternatively, switching to other alternative drugs like hydromorphones or fentanyl could help avoiding some adverse effects in patients.Anti-depressants are administered with dosages less than what is administered for depression. Effects of anti-depressants appear within 3 to 5 days after administration.
Some anti-depressants include amitriptyline, desipramine, paroxetine, and nortriptyline among others. When both pharmacological and non-pharmacological treatments are combined, a desirable pain control management could be achieved. Some non-pharmacological measures can also be used in controlling pain such as applying some psychosocial interventions.Health staffs who manage pain control have included relaxation methods, which are beneficial in minimizing distress connected with pain. Relaxation technique may incorporate some methods on breathing, visualization, and stimulation with relaxing music by mimicking sounds from nature.
Hypnosis-assisted relaxation, on the other hand, has been found an effective way of controlling pain, resulting to reduced fatigue and depression. Other non-pharmacological methods include Transcutaneous Electrical Nerve Stimulation (TENS), massaging (heat or cold) or vibration.The aim of these non-invasive methods is to relax the patient or give relief from muscle spasm. These techniques are also helpful in distracting the patients from the pain source.
Cold massaging diminishes sores and, similarly, relieves spasm. Transcutaneous Electrical Nerve Stimulations (TENS) For managing acute pain, the device known as TENS or Transcutaneous Electrical Nerve Stimulation is used. It is applied for relieving chronic pain as an adjunct treatment for managing post-surgical and post-traumatic pains. This device, however, is not recommended for use by patients with heart illness.The manufacturer of the said device has advised not to use it for undiagnosed pain until the disease development is known (Vitalityweb.
2007). TENS does not offer cure and therefore lacks curative effect. Generally, it is used only as a pain suppressant. TENS may give some skin irritation to patient allergic to tape or gel or it may inflict burn due to electrodes. This device works through the skin by generating harmless and painless electrical current to particular nerve areas. The subdued current then produces heat relieving stiffness, pain or the heat improves body mobility.
The efficacy of TENS is due to endorphins, a natural pain killer that the body produces (Wikipedia. 2007). Heat Packs For heat therapy, there are heat packs selections designed for various uses: for ankle, back, elbow, hip and thigh, knee, neck, shoulder, and wrist. Heat medication, with the use of heat packs, is applied for stiffness, sores, and joint pain.
When heat is applied to the muscle, it increases elasticity and allows more blood flow. Heat therapy is applied before exercising to loosen tight muscle, thus, reducing the possibility of having muscle injury.Manufacturers of heat packs have advised not to use them for swelling or inflamed muscles as they may aggravate the condition. Cold therapy should be used instead for such swelling (Painrelievers. 2007). Meditation- Researchers who have conducted studies on some forms of meditations have indeed recorded some positive benefits from this practice in bringing a healthy condition of relaxation.
Some factors have been observed during the process such as decreased heart, respiration and pulse rate, decreased stress hormone called plasma cortisol.Besides, researchers have observed an increasing EEG (electroencephalogram) alpha wave generated in the brain connected with relaxation. The holistic online, a site exploring alternative therapies, has cited some beneficial actions of meditation in bringing muscle relaxation and consequently calming the individual. Research conducted by R.
Keith Wallace at U. C. L. A. on Transcendental Meditation, revealed that during meditation, the body gains a state of profound rest.
At the same time, the brain and mind become more alert, indicating a state of restful alertness.Studies show that after TM, reactions are faster, creativity greater, and comprehension broader….. During meditation, blood pressure stayed at 'low levels', but fell markedly in persons starting meditation with abnormally high levels.
The meditators' skin resistance to an electrical current was measured. A fall in skin resistance is characteristic of anxiety and tension states; a rise indicates increased muscle relaxation. The finding was that though meditation is primarily a mental technique, it soon brings significantly improved muscle relaxation. Meditation reduces activity in the nervous system.The parasympathetic branch of the autonomic or involuntary nervous system predominates. This is the branch responsible for calming us (ICBS.
007). Patients having painful movement undergo immobilization process of either involving the entire body or body parts like limbs. Prolonged immobilization or positioning therapy, however, may produce bad results such as atrophied muscles or loss of function. Some non-conventional therapeutic methods in managing pain are used as alternatives, which include meditation, prayers, some forms of exercise, herbals, aromatherapy, and acupuncture.Meditation has a calming effect on mind just like praying.
Other strategies like physical exercise are also incorporated as complementary therapies in pain management plan. These strategies, however, are lacking in strong scientific back-up in supporting their effectiveness to relieve cancer-based pains. Some users, however, find that a particular unconventional therapy is undeniably helpful in relieving stress and pain. Some forms of exercise added into chronic pain management plan have included Tai-Chi, Yoga, and the likes.The use of herbals could be found in some of the studies of the National Cancer Institute such as the use of capsaicin from hot chili pepper, or the use of the active principles of ginger in treating chemotherapy-related nausea in patients with cancer. When using aromatherapy and massage, some safety measures must be considered.
In applying essential oils, dilution must be properly adjusted to the carrier from 0. 25 to 0. 1% according to treatment area since very ill patients metabolize much slower than normal healthy person.Therapists must be knowledgeable about the essential oils they use in massaging as some oils may irritate those suffering from asthma and lung cancer.
As a matter of fact, some wounds arising from invasive cancers produce unpleasant odors; essential oils with fragrant scent could mask this foul odor. The deodorizing accent of aromatic oils can make the patient’s wash routine pleasant. Each essential oil has its own goodness and can be helpful if sprayed in vapor to help with nauseating patients. Peppermint or ginger could be used as such.As some essence from plant origin contain bactericidal and anti-cancer properties, lemon grass, dill, and Frankincense could be used for the said purpose.
Though essential oils from plants may not offer cure for cancer, they can be used against some bacterial or fungal infections and for relieving stress. Essences are also known for their calming effect and for the emotional properties. Model of Caring Some of the vital factors of palliative care involve giving comfort and good quality life for the patient, which are made possible by palliative team workers.These workers may include physician, nurse, social worker, clergyman, and other health providers. One or more workers from the team are involved in treating the pain and managing the symptoms.
It is therefore important to have an open communication with the patient hile health workers or nurses render compassionate care (NPR. 2007). Senior workers, on the other hand, give guidelines concerning treatment choice. Health workers and nurses provide the needed inpatient care and may some time assist the patient in making some advanced directives such as living wills.
Emotional and spiritual supports are extended to the patients as well as for his family. Health workers with the assistance of a chaplain or clergyman give the patient with his family some assistance in making some end-of-life decisions. From the early start, it becomes imperative that all women with possible or initial diagnosis of breast cancer should avail of support and information from a breast cancer nurse specialist. Being a nurse in a palliative care is like seeing death not once but many times.
On the last days of one’s life, it is so important the presence of people whom the patient loves and the people loving him. A graceful death knows what is happening and it is so vital showing one’s love and compassion for the dying. Hospice Service For self-managing of a life-threatening disease, some individuals and family cope up by engaging the services of Hospice, which offers care to terminal patients including their families. Hospice care is patterned symbolically from the olden times, which portrayed hospice as a place where travelers, sick, and dying could have rest and comfort.Hospice personnel help the dying to prepare mentally for his passing and provide comfort and rest to the family members. Some hospices, through sensitive counseling, let every one to demonstrate grief and sorrow in unique personal ways.
Some obvious signs would appear that the patient is reaching the end of his life like when the physician or clinician takes off his oxygen supply and then initiate administering morphine. This simply means that the treatment has reached a new level: from managing the incurable disease to now managing his pain and giving him comfort and ultimate rest.Through better counseling, the dying is prepared mentally in having a good death that is distress- and suffering-free, which is in accordance with his and family wishes, and which is in harmony with clinical, ethical and cultural norms. Knowing what lies ahead, a dying could have chosen donating his body to a certain medical school.
A dying could have exercised his last rights and had put all of his business affairs in order: had put the vehicle in a chosen name; had placed all important documents including will, marriage and birth certificate, and CDs in a lockbox.And lastly, could even have told the beloved survivors to order 12 copies or more of his death certificate for the records. And with that, the dying patient has made peace with death. Funeral Arrangements A funeral service gives way to saying farewell to the passing of loved one.
For this matter, it is important to contact the funeral director for help and guidance in making decisions and options. Funeral director sees that it is better to pre-arrange a funeral since death in the family is distressing and planning the funeral right at the moment of death would add more burdens to the family.Pre-arrangement may or may not mean to prepay for funeral costs. Briefly, some ways of prepaying include purchasing a special insurance policy that covers the expenses, or by trust fund deposited in a bank, or by savings or deposit account payable to funeral home on time of death.
During the time of death, it is important that members of the family are informed so that they will not feel being left out. The funeral home is responsible for some services like transporting the dead to funeral home: filing of the certificate of death; giving some options on choosing the burial place, and other arrangements; selecting casket, markers, etc. and posting obituaries.Sometimes, the funeral director arranges the after-care service to help the family through the grieving moments. Funerals vary as to one culture or religion, but basically funeral objectives remain the same. Through funeral service, groups of mourners are brought together creating an opportunity to give spiritual support to their loved one.
The funeral director may help the family to select and confirm the final disposition, which is meaningful for the deceased, they want. Some final disposition preferences include interment, and earth burial with gravesite.Additionally, the body may be entombed with a casket placed in a mausoleum of marble and stone. The body could be cremated and then have the ashes earth- buried, entombed or scattered. Usually after cremating the dead, the ashes remain in a container until decided on the final disposition.
Sometimes, the body is immediately cremated or buried without observing any rites or ceremonies. The body is said to have a direct disposition. For all the cost of funeral, funeral home or the director is willing to have a review of the service and funeral goods expenses, which the family is certain to have met in a manner it expects.
