Situation: Mrs. J is a 44-year-old woman with advanced cholangiocarcinoma. She has been admitted to the hospital with a new onset of back pain, nausea, and vomiting. She is suffering pain from new spinal metastasis, nausea continuous, emesis daily, partially digested food, postprandial bloating, and early satiety. She has already undergone surgery and a course of radiation therapy Other pertinent findings: well-hydrated; abdomen soft, mild distension, non-tender to palpation; denied abdominal pain; no abdominal masses; normal bowel sound; normal neurological exam. Current antiemetic order: ondansetron (Zofran) 4mg IV or PO Q 4-6 hrs prn. Continued despite no relief of N&V.
She has a variety of needs related to symptom management, the trajectory of her disease process, and broader treatment options/palliative care concerns.
1. Describe recommendations for prioritizing this patient’s needs – i.e. what issue(s) should be tackled first, second, third, fourth, fifth etc),
2. Describe how they should be addressed, and what other members of the interdisciplinary team should be called upon for the needs beyond area of practice of a nurse.