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Complex Patient Health Issues: Patient With Cancer Assessment 1 Answer

Assessment item 1  Complex patient health issues

Objective(s):Learning objective: A, B, C, D and E

Graduate Attribute: 2.0, 4.0 and 5.0


Length:1500 word limit +/- 10%, excluding references

Task:This assessment item has 3 parts:

Students will review the specific case scenario materials provided for this assignment. Using this information students will identify and prioritise the patient’s complex health issues. Students will provide rationales for their prioritisation decisions which will be supported by current literature and related healthcare regulatory frameworks and health department policies.

  1. Identify a total of three patient health issues from ONE of the case scenarios that nurses can address within their scope of practice. You may include ‘risk for’ or ‘potential for’ health issues.
  2. Rank the three patient health issues that were selected in part 1 in order of priority. Provide a rationale for the order of the rankings. The rationale must be supported with current literature.
  3. Outline the nurse’s role in addressing the top three priority patient health issues using assessment, coordination of care and provision of care. Relate the discussion to nursing and healthcare regulatory frameworks and health department policies e.g. RN Standards for Practice, NSW health policy, National Safety and Quality Health Service (NSQHS) standards etc.

Students need to demonstrate their ability to identify and prioritise patient health issues that nurses can address within their scope of practice and rationalise the order of priority. This will enable students to articulate decisions they will need to make in clinical practice. In addition, students will be able to demonstrate their ability to write clearly and succinctly to reflect their understanding.

Palliative care case scenario

Patient name: Stephen Robertson

Handover report to Ward 7G Oncology Palliative care unit

MRN: 968 644DOB: 27.05.1952

Weight: 53kg Height: 170cm

BMI: 18.3 kg/m2 (underweight)


Stephen Robertson a 68 year old male presented to the Oncology ward three days ago following deterioration over the last week. Patient is in the terminal phase of cancer and is experiencing severe pain. Stephen and his family are not comfortable attending to end-of-life requirements at home. The patient wife and two children have accompanied the patient to the hospital for end of life care. The patient wife informs the nurse that the patient has not been sleeping well for the past week due to experiencing severe pain.


The patient is becoming less conscious and is no longer verbalising but opens eyes to pain. Vital signs prn have remained stable for the past three days. The patient is receiving regular subcutaneous morphine and hyoscine via an abdominal subcutaneous butterfly. The patient is NBM. Mouth care has been attended and Colostomy has minimal output.


Stephen has a four year history of Colorectal Cancer and has a Colostomy insitu following bowel resection surgery four years ago. Stephan developed terminal metastases in his lungs and brain three months ago. The patient medical notes contain the required documentation for an Advanced Care Directive (ACD) which includes a do-not-resuscitate order and no other acute medical response or treatment. Medical staff discussed advanced care planning with the patient and family during a previous medical admission for radiotherapy six weeks ago. Stephan lives with his wife and has two children with families of their own.


Observations taken at 10am this morning:

BP: 105 / 72 mmHg

HR: 64 beats per minute SpO2: 94% R/A

RR: 12 breaths per minute

On Auscultation: Fine crackles–bilateral lower lung fields Cool lower limbs

Temp: 36.4 OC (oral)

Glasgo Coma Scale (GCS): 10/15 (Eye = 2, Verbal = 3, Motor = 5) Pain score: 8/10

BGL: 4.8 mmol/L


Continue with end of life care and PRN subcutaneous morphine and hyoscine medications. Pain assessment and management

Colostomy care

Patient comfort measures for palliative care



For the improved quality of life, early palliative is effective. It enhances the awareness about prognosis and also shows a positive impact on the survival of advance cancer patient (Greer et al., 2013). In diseases like cancer or other critical illnesses, palliative care, and hospice centre play a pivotal role. A team of physicians, physiotherapist, occupational therapist, nurses and other health personnel work collaboratively along with the specialist of cancer so that they can provide palliative care which is a vital element of end- of- life care. The nurses have a critical role as they communicate with the patient directly and are responsible for monitoring the patient.

In this given scenario, the patient is in his terminal phase of cancer and experiencing severe pain. As per the given scenario, it has been observed that the patient's vitals are stable but having severe pain and also that output of stool from the colostomy is lesser.

Three patient health issues 

Stephen Robertson is a 68-year-old male in the terminal phase of cancer and is experiencing severe pain. The patient is admitted to the hospital for end of life care. The observation of the patient depicts that his vital statistics are quite normal, but, he is experiencing severe pain. As a student nurse, after assessing the vital parameters and present complaints, I will plan the following intervention as per their health issues: 

1. Pain managementThe pain score of the patient is 8/10, which is relatively high.  The patient is becoming less conscious and is not verbalizing but opens eyes to pain. Cancer pain is one of the noteworthy clinical issues related to the disease. The pain could be for various reason ranging from surgery, therapies or disease itself (Chwistek, 2017).  Henceforth, pain management is an integral part of cancer treatment. Especially in elderly patients, it becomes imperative to relieve pain. Assessment of the site of pain and its treatment for relieve is an imperative aspect of management. In the given scenario, the patient and its family members are expecting the proper and adequate management of the pain. In the metastatic cancer condition, mostly patient experience pelvic pain due to metastases symptoms, and hence pain management is a significant health issue (Dixon et al., 2003).

2. Care of colostomy: The patient has a history of colorectal cancer and has a colostomy insitu following bowel resection surgery four years ago. Thus, looking at the case, it becomes significant to take care of the patient’s bowel movement. To improve the functional status management of the problem is essential as the colostomy has minimal output. If required, the nurse can perform colon irrigation along with the care of the colostomy. This procedure helps in regulating the bowel movement and maintains the integrity of the skin, respectively. The purpose of colon irrigation is to cleanse of the colon by the faecal material can be done. (María Laura Márquez, 2018). Being a student nurse taking care of peristomal skin is important for health and also for the quality of life (Rapp et al., 2007).

 3. Communication about the end of life care: Every year, a large number of patients die due to critical illness. Such patients require care to lead a better life during their end days. End of life care helps the patient to live a quality life with dignity until they die. Nurses can also work to support the caregivers and the families of the patient (Keeley, 2017). In the life-threatening situation of the patient, it is beneficial to communicate with the patient and his family member about end-of-life care (Brighton & Bristowe, 2016). Hence, subsequent treatment decision can also be influenced by communicating about end-of-life care.

Issues in order of priority

As per above mentioned three health issues of the patient as a student nurse, I will prioritize them as following-

1) Firstly, Pain management is extremely important. As per the obtained data, it shows that patient is having severe pain which scored 8 out of 10 in thpain rating scale. It shows the patient is having severe pain because of the metastasis condition. It is very well documented that failure in pain management reflects the liability of physician potentials in palliative care (Dixon et al., 2003). Relieving the pain could improve his quality of life as the patient is in immense pain and is also not verbalizing due to pain (Chwistek, 2017). 

2) Care of colostomy: In the given scenario patient had undergone colostomy. Medical data suggest that colostomy has a minimal output which indicated the risk of obstruction of the faecal material (Otsuka  et al., 2015). So as a student nurse I will report the same to the registered nurse for the same and enquire about the colon irrigation so that colon can become free from the obstructed faecal material and the rate of suture failure can also be decreased as it may result into the complications. (Brinkman et al., 2014) It is of immense importance because it is immensely important in critical patients to have proper bowel movements and urine output. Otherwise, it may lead to other life-threatening complications.

3) Communication about end-of-life care is also vital as the patient is in palliative care that is the end care or hospice care. The patient’s dealing with a critical illness go through a lot of trauma. End of life care and communication may help in dealing with the pain and issues related to the situation. Moreover, studies suggest that initiating communication about end-of-life care is beneficial in the early phase (Jung & Kim, 2015). In a study, it was found that in outpatients who were suffering from cancer, at the time of hospitalization 79% of the patients were capable out of which 40% among these patients lost their tendency before the initiation of discussion about end-of-life care. (Park et al., 2015Hence, before the patient condition turns too worse, it will be better to prepare the patient’s family members for the death along with the maintenance of hope (Shirado et al., 2013).

The Nurse’s role

Working as a team along with the medical providers and existing clinical members a nurse should focus upon the care and management of the patient's present complains through the advance plan of action so that quality of life can be improved. ("Nursing and Midwifery Board of Australia - Registered nurse standards for practice", 2020) Patient, family member, and also the hospital review committees wanted to get rid of the pain by getting appropriate and adequate management for the same like Joint Commission on Accreditation of health care organizations (Dixon et al., 2003). As in the patient’s prescription subcutaneous morphine and hyoscine, injection is ordered, which are effective in the management of pain. Being a nurse, I have to accept and acknowledge the pain of the patient and also assess the site and source of pain. ("National Quality Standard", 2020) With the help of the pain assessment tool, it is my responsibility to reassess the pain at regular intervals. After analyzing the state of pain, I will plan for the intervention along with the coordination of physician and RN and later on the evaluation of the implemented strategies for the pain will be evaluated.

After observing minimal faecal output, colostomy irrigation can be suggested. Hence by cleansing the colon toxins will also get removed, which enhance the immunity of the patient and also it improves the health condition of the patient. Colon irrigation is one of the non- pharmacological mean of cleansing the colon, which increases the level of comfort of the patient. 

End-of-life care, communicating about this also suggests and helps in deciding for the subsequent treatment (Mack, 2012). According to WHO palliative care is the care which requires team care to fulfil the needs of the patients and their family too, which includes counselling grief if it's needed. (WHO, 2019) By this, I can assess the preparedness and preferences of the patients, which is an important aspect of palliative care. Though, this communication has many potential barriers while discussing the end-life care. In this management empathy, sensitivity should be considered while providing holistic care to the individual (Brighton, 2016). 


Cancer is a leading cause of death globally, and the number of cancer cases is increasing every day (WHO, 2019). Cancer patient requires advanced medical care along with psychological support. The cancer patient and the caregivers go through immense trauma throughout their treatment journey. The role of health professionals and nurses becomes pivotal at the end stage of the disease or at the end of life situation. Especially in palliative care, it is imperative to look at every aspect to improve the quality of life of the patient.  As a nurse performing with the existing clinical staff and medical providers, it is to provide patient-centred care so that symptoms can be managed. By the mean of education and support, nurse can be the resource for the family members and the patient himself. ("Nursing and Midwifery Board of Australia - Registered nurse standards for practice", 2020)

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