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The patient is a 75-year-old male widower and lives alone. The patient has chronic Lung Adenocarcinoma of the left lung with metastasis to the brain, spleen, and liver. Mr. Jones has a medical history of chronic obstructive pulmonary disease, atrial complication, hypertension, and a tobacco smoker for the past 55 years. According to Alberg, Brock, and Samet (2005), patient history complications have a likelihood of contributing to chronic Lung Adenocarcinoma.
Spira and Ettinger
The article by Spira and Ettinger (2004) gives the best evidence for the intervention strategies to the patient. Mr. Jones has A&Ox3 alertness and orientation. The diagnostic intervention helps to determine the mental status of the patient, whereby A&Ox3 means the patient can identify a person, place, and time (Shah & Kelly, 2003). The nail beds and lips are cyanotic due to a lack of oxygen in the blood.
The chronic obstructive pulmonary disease of Mr. Jones could have contributed to cyanosis (Marchevsky & Wick, 2011). Heart failure and reduced airflow in the lungs would be the likely cause of low respiratory rate and shortness of breath (Spira & Ettinger, 2004). Mr. Jones received Morphine when hospitalized for close monitoring since overdose or misuse of the narcotic would lead to addiction or death. On the other hand, the patient got Percocet for pain management at home because the drug is non-narcotic and can be taken orally (Spira & Ettinger, 2004).
The patient received the intervention of gas exchange to eliminate carbon dioxide at the lung alveolar and increase oxygenation through a nasal cannula. The patient needs comfort measures since the alveoli airways may not automatically expand with each breath. Lack of patient comfort leads to respiratory distress and pain (Spira & Ettinger, 2004). Mr. Jones has used narcotics for a long period for pain management. Narcotics have a side effect of the development of narcotic bowel syndrome.
The narcotic bowel syndrome is characterized by a partial abdominal obstruction, hence the need for elimination. The patient receives an intervention in impaired home management related to the chronic cancer pain majorly due to his outward expression and inadequate support system at his home. Mr. Jones got a prescription for Duragesic in the management of his severe chronic pain due to chronic lung adenocarcinoma (Spira & Ettinger, 2004). The patient got a referral to a multidisciplinary team comprising of medical doctors, counselors, volunteers, and home health aides. The team ensured an improved life and decreased hospital admissions for the patient (Marchevsky & Wick, 2011).
Huber and Stratakis
The article by Huber and Stratakis (2004) gives the best evidence for the alternative intervention to the patient. Targeted therapy would be the best alternative to lung adenocarcinoma intervention (Huber & Stratakis, 2004). Targeted therapy is a therapeutic mechanism that eliminates cancer by identifying the cancer genes, proteins, and tissues contributing to cancer proliferation.
The targeted therapy utilizes the principle of molecular probes and biomarkers that stops angiogenesis and blocks the epidermal growth factor receptors. Huber & Stratakis (2004) support the efficiency of the alternative intervention since it eliminates cancer with minimal side effects, it is fast, sensitive, easy to interpret, and easily automated.
Owonikoko et al.
The best evidence applicable to the patient that explains the relevance of the outcome is according to Owonikoko et al., (2007). Owonikoko et al., 2007 explain that hospice care should ensure the outcome of medications and diagnosis to the patient is effective and safe. According to Mr. Jones’s case study, the hospice team ensured daily monitoring of the morphine sulfate and Duragesic for pain management to avoid overdose and addiction. The expected outcome of the multidisciplinary team to the patient is prolonged life and improved health care. The hospice nurse ensured the safety and recovery of Mr. Jones in his terminal illness. The daily monitoring of Mr. Jones’s pain scale after intervention measures aimed at giving data on the progressive decrease in pain (Owonikoko et al., 2007).
References
Alberg, A. J., Brock, M. V., & Samet, J. M. (2005). Epidemiology of Lung Cancer: Looking to the Future. Journal of Clinical Oncology, 23(14), 3175-3185.
Huber, R. M., & Stratakis, D. F. (2004). Molecular Oncology—Perspectives in Lung Cancer. Lung Cancer, 45, S209-S213.
Marchevsky, A. M., & Wick, M. (Eds.). (2011). Evidence Based Pathology and Laboratory Medicine. New York, NY: Springer Science & Business Media.
Owonikoko, T. K., Ragin, C. C., Belani, C. P., Oton, A. B., Gooding, W. E., Taioli, E., & Ramalingam, S. S. (2007). Lung Cancer in Elderly Patients: An Analysis of the Surveillance, Epidemiology, and End Results Database. Journal of Clinical Oncology, 25(35), 5570-5577.
Shah, S. M., & Kelly, K. M. (2003). Principles and Practice of Emergency Neurology: Handbook for Emergency Physicians. New York, NY: Cambridge University Press.
Spira, A., & Ettinger, D. S. (2004). Multidisciplinary Management of Lung Cancer. New England Journal of Medicine, 350(4), 379-392.
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