Case Study: Pain (Essay Sample)

CASE STUDY
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Case Study
Introduction
Pain is considered one of the evident symptoms among cancer patients. In fact, 70% of patients in advanced cancer stage experience it. Moreover, an estimated 65% of patient with non malignant condition have also been known to suffer from pain. Consequently, such patients need adequate pain management for prolonging of their lives. According to Fallon,Hank&Cherny,(2006, p.1026),Pain refers to a compound physical, psychological, and social distress that a patient goes through in the course of progress of the disease. It is caused by many factors such as nerve damage and Organ damage among others. It is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The following paper discusses pain management in palliative care of a cancer patient. It explores the various types of pain of a cancer patient, the assessment, drug administration, side effects, non pharmacological approach and evaluation.
The case study under focus
The case study is about a female patient forty five years of age. She has been admitted to the ward and is under analgesic. Medical history indicate that the woman was diagnosed with breast cancer stage three early in the year (2january 2014).She underwent a surgery to remove the right breast that was cancerous. After which, she has undergone six rounds of chemotherapy and twelve rounds of radiotherapy. Nevertheless, the patient continues to complain of excessive pain at different parts of the body namely: The breast, the right limb. At the time of admission, she is purely under analgesic.
Palliative care in pain management
Palliative care is a medical care system created to help the cancer patient get relieve pain, symptoms and stress that is posed by cancer. Moreover, it is known to help in improving the quality of life and prolong ones final days. Riley et al (2008, p. 1032) notes that palliative care is essential for the unimpeachable assessment and treatment of the form pain while considering vital patient factors. It operates on the basis of the sanctity of human life. Palliative care specialists work hand in hand with all parties involved using a coordinated plan to enhance better management outcome. Palliative care specialists recognize the fact that most of the symptoms can be managed. In essence, they have an assessment plan that enable them manage the pain properly. One key aspect is to determine the types of pain that the patient is going through and draw up a plan for its management. Specifically, they have a clinical responsibility to determine the nature and cause of pain and its appropriate treatment (Colvin, Forbes&Fallon, 2009, p.1086). However, it is important to note that palliative care is continual monitoring and reassessing process that must given utmost attention.
Types of pain
A cancer patient experience diverse kind of pain. The mechanisms of the pain depend on its generation. In reference to this case study, the patient is likely to experience the following
Neuropathic pain
The patient describes this pain to be aching, burning, shooting or stabbing effect in terms of its quality. It is often associated with abnormal sensation. The pain is caused by nerve damage due to metastasis of the tumor to the nerves of the body (Skyes&Bennet, 2009, p.76). In her case, during surgery to eliminate tumors, the cancerous cells cell got to the nerve endings. There is evident peripheral damage and does conform to specific dermatomes. The patient describes it as continuous in nature. However, this pain can also be brought about by chemotherapy and radiotherapy. The pain is poorly responsive to opoids.
Visceral
The pain is due metastases of the tumor into the body cavity and the hollow viscous area. The patient describes it as a deep dull ache in the abdomen and thorax (Sykes&Bennet, 2009. p.77). The patient complains of associated symptoms such as pain while coughing. In fact, blood comes out in form of sputum. The patient also complains of abdominal pain and difficulty in going for along call.
Somatic
It is characterized by the cancerous cell spread over a bone or liver or any other organ. For instance, the patient in this study experiences pain bones pain and chest capsule pain (Sykes&Bennet, 2009, p.77). There is usually a sudden increase in body temperature of the area affected. The severity of pain increase as the cancerous cells continues to metastasize in the body.
Assessment of the Patient’s pain for Palliative care
It is the most important step that palliative care physicians and nurses undertake. There are several factors that physicians consider in assessing the patient
Severity
It refers to the extent to which the patient feels the pain. In other words, this is the intensity of the pain. The physician assesses the patient’s perception of the pain. It is usually influenced by several factors such as the physical nature of the pain, the duration it has been present and any form of medication underway. In the case study, the patient has had breast cancer for the past two years. However, in the course of operation, the tumor metastasized to the lymph nodes and spread to other organs such as the liver. Initially, the patient complained of mild pain but with subsequent days and month worsens. The nurse uses pain recording system which has a pain chart. The pain chart uses scale of pain intensity to produce measurement of the individual’s pain. Specifically, the visual analogue scale commonly known as likert was used (Fisch&Burton, 2010 p.112). It is distinct to the paint. The patient’s pain estimate is 8 out of ten.
Localization, Region and Radiation
Under this segment, the palliative care specialist seeks to establish the locality of the source of the pain. In reference the case study, the female patient has pain emanating from the right breast that was diagnosed with malignant tumor. However, further diagnosis reveals that the tumor has metastasized to the lower limb consequently causing her severe pain. In fact, she is complaining of inability to stretch the leg.
Organ assessment
From earlier discussion, it is clear that some of the visceral organs are affected when cancerous cells spread to their locality. An x-ray done on the woman reveals that body organs such as the abdominal cavity and lungs have been affected. The chest cavity has also been affected. The woman experiences pain during coughing which is also characterized by blood stains. An investigation of organs is an essential part of assessment because it helps establish the organs that require adequate attention.
Psychosocial assessment
While pain may be a biological occurrence, medicine shows that it has a direct psychosocial effect on an individual. Consequently, the patient is not an exception. Psychosocial assessment is mainly achieved through involving the patient in daily care and observing any behavioural modification (Medical Service Commision, 2011, p.9). For instance, the female patient has shown several behavior modifications. Firstly, she has shown slow response to the presence of visitors. While initially she was relieved by their presence, currently the patient is reserved and rather wishes to be left alone. The patient has also been constantly heard desiring to die rather than suffer in pain. It is evident that the patient is undergoing a psychological trauma on effect of pain. There are times she has asked to see all her children with the thought that she was dying soon. In fact, in the recent past, she showed signs of memory lapse. Medical research shows that intense pain that causes neuropathic damage is associated with memory lapse (Cherwin et al, 2009, p.74).
Intervention
The management of pain securely aims at optimizing comfort and function in the face of expected deterioration. Pain tolerance is usually raised by relief of the symptoms (Pharmacological) and non pharmacological intervention. Accordingly, discomfort fatigue, anxiety, failing organs, anger boredom in a patient lowers her pain tolerance.
Pharmacological Intervention
The pharmacological intervention to be given is purely based on the results of the assessment obtained as illustrated above. The patient seems to be in severe pain and the analgesic she has are not effective for pain relief. Needless to say, paracetamol and Nasoprin are weak analgesic. According to, the patient was given strong opiods namely morphine. The starting treatment constituted oral sustained release with rescue doses of oral immediate release morphine for breakthrough pain. The opoids were in small doses as follows (2.5mg morphine, 0.5mg of hydromorhine and 1.25mg of oxycodone(Mc Guire,Yarbo&Ferell, 2008, p.117). The oral route was the preferred route for the patient because of her ability. The opoid intake was monitored in 24hours then divided by six to ascertain the dose for regular and breakthrough administration. Once the pain relief is established, sustained release preparations was substituted to allow bd modified release preparation of oral oxycodone or hydromorphone. At this stage, any breakthrough pain that occurred which was not associated with unusual activity was treated by administration of one sixth of the total daily dose. However, it must be noted that the use of the opoids come with several side effects.
Side effects
The patient exhibited various side effects upon administration of the opoids. For example, she became sedated. It is appropriate to warn the patient before hand of its occurrence. Nevertheless, it subsided within few days. The patient also became nauseated and experienced vomiting. The nurse expected it to subside within three days but it did not. It was prevented by administ...