Palliative Care in Cancer Patients

This assignment analyzes research papers focused on the impact and effectiveness of palliative care in managing symptoms, enhancing quality of life, and influencing end-of-life decisions for cancer patients. The provided articles delve into various aspects of palliative care, including its timing, setting, and influence on aggressive treatment choices. Additionally, they examine the prevalence of neuropathic pain in cancer patients and explore the mental health considerations associated with palliative care.

Running head: PALLIATIVE CARE FOR RAMESH
PALLIATIVE CARE FOR RAMESH
Name of the student:
Name of the university:
Author note:

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PALLIATIVE CARE FOR RAMESH
Answer 1:
Five important principles of the palliative care can be noted. It should respect the goals, likes and
also choices of the dying person. It should include proper emotional, social, medical and spiritual
needs of the person. It also supports the needs of the family members. It should help the patient
and the client to get proper access to all the needed healthcare professionals and also provision of
proper care settings (Roelnd et al., 2016). It should also build ways to provide efficient and
excellent care at the end of life.
The professional can provide holistic approach to palliative care by developing a care plan based
on cultural and spiritual beliefs of the patients and respecting them. The patient should be given
full scope to meet his spiritual needs according to the philosophy of life and its value believed by
him and family members. Sociological and psychological perspectives of the patient should also
be considered in order to provide an efficient palliative care.
Answer 2:
The disease mainly occurs through infection of Helicobacter pylori infection. It initiates a
sequence which passes from chronic non-atrophic gastritis to ultimately dysplasia. This is known
as Correa’s cascade. Three cascades are responsible. These are the proliferation/stem cell,
Wnt/beta-catenin pathways and NF-kappaβ. Improper interaction between these pathways results
in occurrence of the disease (Gomes, Calazani & Higginson, 2014).
The two needs are
 The patient should be helped with proper gastric outlet as he is facing issues with
obstruction of gastric outlet.

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 The patient has lost appetite which may impact nutrient content of his body. Therefore
proper nutrition incorporation through food and medications need to be maintained.
Answer 3:
For proper pain management, the nurse may take up celiac plexus block which reduces pain in
the upper abdomen by blocking the pain sensation in the bundle of nerves in an around stomach
and others. A neurolytic solution can be provided after 24 hours where an anesthesiologist had
injected a temporary, local anesthetic into the area where the nerves are affected.
The neurolytic solution used in the celiac plexus block method is designed to destroy the nerves
of the affected region and thereby prevent the patient from feeling pain in that part of the region
of the body. The patient may feel relief from the pain for an extended period of time which may
last for many days (Ferrel et al., 2015).
In order to handle medicine induced constipation, lifestyle changes include increasing dietary
fiber and fluid intake for the patient. Moreover, osmotic laxatives, emollient or lubricant
cathartics, Prostaglandins or pro-kinetic drugs and other medication blocks can be used.
Answer 4:
a. The patient does not eat meat and hence meat should be avoided in his diet.
b. The patient wants to be in association with his wife and daughter and they should be
involved in decision making.
c. The patient has suffered a lot of pain and does not want to live. This is evident from his
consent on do not resuscitate system. Hence this should be followed.

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d. Daughter has requested to perform prayers for her father to reduce his suffering and this
belief should be respected.
Answer 5:
Working together in an interdisciplinary team along with other healthcare experts, gives scope to
every professional for sharing information about the patient. These would help in the developing
a better palliative care plan as this will help in production of a better picture of the needs of the
patients (Wright et al., 2014). With the help of the palliative care team, physical, psychological,
social as well as spiritual needs can be maintained by proper holistic care approaches. Medical
professionals looking over Ramesh’s biological symptoms, social workers for carrying the daily
activities of the Ramesh, palliative care workers looking over physiological needs and others of
the patient will help in proper treatments.
Answer 6:
Ramesh’s wife and daughter had totally broken down seeing the symptoms of the patient.
Palliative care would be helping them to connect with the philosophical truth of lives and death
and will make them accept the truth in a proper way. It will help them in their phase of emotional
turmoil by empowering them of their inner strength to fight the adverse consequences and period
of grief and bereavement. Better the counseling done to them by the PC workers, better will be
their capability to adapt to with the changes in their life and acceptance of loss of a loved
member (Jang et al., 2015).
Answer 7:

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Although, no members should be allowed in the ventilation ward, the nurse can allow the
patient’s daughter to maintain a safe distance from her father and conduct her spiritual prayers.
However care should be taken, that such rituals should not hamper the hygienic maintenance of
the room. It should not be disturbing or harming to the patients’ health. Proper infection control
methods should be employed (Hui et al., 2014). If the daughter is not allowed inside, it might
harm her dignity and autonomy where she might believe that her offering of prayer might have
saved her father. In order to avoid such consequences, the nurse should undergo critical thinking
and proper reasoning to come up with proper ideas.
Answer 8:
Communication techniques:
 A face to face communication session should be arranged with the family members in
order to empower them in overcoming their emotional turmoil while seeing their patient
suffer like this. The meeting will help them with strategies which will help them to be
strong and help their patient to suffer less by providing proper companionship to him.
 Secondly, a written brochure can be provided to them with proper strategies about the
different activities that can conduct with the patient in order to keep him happy. The
brochure would also help them to control their grief and engage themselves in proper
communication with their patient in order to make him happy in his end stages (Kamal et
al., 2014).
Support services:
 Social care support should be provided to him to help him to conduct his daily activities.

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 Psychological counseling mainly in domains of spiritual and emotional needs of the
patient is necessary to relieve him from suffering, fear, pain and others (Roberto et al.,
2016).
Answer 9:
The information about the changes that should be informed to the family member is:
 Decrease in the intake of fluid and food that Ramesh had taken in the last days.
 Congestion that is appearing of gurgling sound was also audible.
 Changes in breathing were also heard
 Restlessness was also noticed like continuous movement of the limbs
 Incontinence was also noticed when he lost control of his feces and urine in absence of
his wife.
 Besides drooping of saliva was also noticed
Answer 10:
During the time of dying, different cells die at different speeds. Cut off of oxygen to brain lead to
death of cell in the brain. Blood is cut off to the heart, resulting in heart attack. Decrease in fluid
intake leads to dehydration of the body. Decrease in blood perfusion results in renal failure.
Neurological downfall occurs with deceasing level of consciousness, Loss of Ability to Swallow,
Terminal Delirium, Changes in Respiration and Loss of Sphincter Control. Pain is also
associated with death. The family members should understand each of the phases of dying so that
they can understand situations that their patient is going through. This will help them as this will

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make them feel that they were present with the patient in each of his end activities and that no
confusion or apprehensions remain within them during the last hours of the patient.
Answer 11:
Ramesh could not drink the water given by his wife which showed he has swallowing problems.
Moreover he also had gurgling noise while respiring.
For respiration management, the family members should be educated and supported to
understand that the unresponsive patient is not experiencing breathlessness and suffocating.
Oxygen actually prolongs the dying process. Low dose of opioids or benzodiazepines can help in
management of breathlessness (Dionne-Odom et al., 2015). For management of the loss of
ability to swallow, oral intake should be ceased. Proper repositioning should be also done to
clear accumulated fluids. Suctioning should be avoided.
Answer 12:
Physical aspects that need to be associated with non-healing wound management of Ramesh are
the maintenance of meladour, pain, exudates, bleeding, infection, pruritus, nausea and anorexia.
Psychological aspects include depression, denial, embarrassment, fear, body image alteration.
For proper management, cleansing using saline via pressure from syringe can be done through
19-gauge needle (Greer et al., 2013). Debriding necrotic tissue, controlling exudates using
absorbent hydrocolloid dressings, using systematic antibiotics based on culture, providing

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adjuvant treatment like chemotherapy and radiotherapy can all be done. Besides, nanocrystalline
silver dressings and honey-based dressing can be done.
Answer 13:
When the condition of the patient is deteriorating, it must be seen that whether the patient is able
to make his own decisions. If the patient is unable to make any decisions, then ACP guidelines
deliver service to ACD guidelines. Then the part of taking decision will be shifted to responsible
family members and take activities according to his or her wish (Jaiswal, Alici & Breitbert,
2014).
Answer 14:
The dignity of the person can be maintained by asking for informed consent before applying any
care intervention for him. Not only that, he should be included in all decisions made about him
by actively discussing him of the benefits and disadvantages. During his death, any advanced
care directives made by him should be maintained. Ramesh had requested not to resuscitate him
when he is deteriorating (Wilson et al., 2016). It should be followed if such condition arises for
his dignity. Moreover if any patient has requests, it should be followed out after his death, the
similar can be done to assure maintenance of dignity.
Answer 15:
When all the organs of the patient were failing, the transferring of him to ventilation should not
have been done. He had requested not to resuscitate or take any interventions when his
conditions would be deteriorating. However the doctor was torn apart between dignity and
beneficence for the patient. As a result, he chose his duty of saving the person till the last

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moment. It was a breach in maintaining rights of patents. This was an ethical dilemma. If I had
been in the doctor’s place, I would have discussed the scenario with his wife and daughter and
had not breached his dignity.
Answer 16:
The care giver would be responsible to manage for the death certificate issue from the
organization and would complete all the documentation procedure for the patient. One copy
should be kept in the care center for further references and another copy should be given to the
patient family to ensure transparency of the work.
Answer 17:
There are certain rules that need to be followed by the care giver according to the culture of the
patients. Since, he has been Hindu; the body should be first washed by close relatives with the
eldest child taking the lead role. A small lamp and incense sticks should be burnt near him/. The
family members will be asked about their preferred position of the body after death. All the
personal belongings should be left in place and should be advised to family members to remove
them necessarily (Blackhall et al., 2014). According to the culture, the body should be
immediately cremated after death. All these should be followed to provide respect to the family
and the expired patient.
Answer 18:
Bereavement care is usually provided by different support services where individuals who have
lost their close ones are cared for. They help in providing the family members with strategies to
overcome emotional turmoil, grief and sadness. They help in offering compassionate service by

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PALLIATIVE CARE FOR RAMESH
providing them with mental and emotional support. They also reassure them of a proper life
overcoming the grief. They provide information and guidance about how to cope with the
present loss.
For bereavement care, the family members should be booked care sessions by community
services. They can also keep in touch with palliative care workers who conduct physiological
sessions empowering them to overcome the stressful conditions of loss (Wiener et al., 2015).
People who need such care can search the internet to come in contact with such support facilities.
Moreover newspapers also contain such care services numbers and can be summoned from there.
Answer 19:
I would try to make them understand that death is a natural process which comes to very human
being and therefore they should also try to look the positive side of the death incidence. They
should feel better if they are known that the death had given Ramesh, peace from all the
suffering. At the same time, I would also empower them by stating that they have been
responsible family members and given their best support in the last moments. These are
necessary to prevent them from feeling less guilty.
Answer 20:
Seeing such suffering of patients may affect me spiritually, emotionally and mentally. Therefore,
I would try to read resources that help me cope with this stress. Moreover I will attend spiritual
motivational classes so that I can prevent myself from being affected. I will also discuss any
issues with my mentors who can rightly guide me to look for the better aspects of life.
Answer 21:

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Advanced care planning and advanced care directives state professionals to follow wishes of
patients which in most cases instruct them to not save patient. This is against their principles of
beneficence which instructs them to provide the best and safest care to save life of patients.
Another ethical issue is that often in many cases, patient tends to lose the capability of decision
making and this when conducted by nurse may result in ethical implication as family members
may feel that their permission was not taken.
Answer 22:
Carolyn is a new nurse who has been affected by the traumatic death of Ramesh which had made
her emotional and had created stress in her. Therefore debriefing would help her to acknowledge
the shared stress, accept response to that stress, to affirm the human suffering and or give
strategies to overcome the stress. Good communication with a proper tone and instilling
confidence and power in the broken-down nurse to look for the better aspect of helping human
kind in the profession should be done (Zimmerman et al., 2014). The nurse should be advised
with the philosophical truth of life so that she can prepare herself for more such challenging
events in the future.

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References:
Blackhall, L., Read, P., Davis, M., & Stukenborg, G. (2014). Making My Course Better: Using
Patient Reported Outcomes to Integrate Palliative Care Acrossthe Spectrum of Care for
Patients with Advanced Cancer (FR417). Journal of Pain and Symptom
Management, 47(2), 425-426.
Dionne-Odom, J. N., Azuero, A., Lyons, K. D., Hull, J. G., Tosteson, T., Li, Z., ... & Hegel, M.
T. (2015). Benefits of early versus delayed palliative care to informal family caregivers
of patients with advanced cancer: outcomes from the ENABLE III randomized controlled
trial. Journal of clinical oncology, 33(13), 1446-1452.
Ferrell, B., Sun, V., Hurria, A., Cristea, M., Raz, D. J., Kim, J. Y., ... & Koczywas, M. (2015).
Interdisciplinary palliative care for patients with lung cancer. Journal of pain and
symptom management, 50(6), 758-767.
Gomes, B., Calanzani, N., & Higginson, I. J. (2014). Benefits and costs of home palliative care
compared with usual care for patients with advanced illness and their family
caregivers. Jama, 311(10), 1060-1061.
Greer, J. A., Jackson, V. A., Meier, D. E., & Temel, J. S. (2013). Early integration of palliative
care services with standard oncology care for patients with advanced cancer. CA: a
cancer journal for clinicians, 63(5), 349-363.
Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of
timing and setting of palliative care referral on quality of end‐of‐life care in cancer
patients. Cancer, 120(11), 1743-1749.

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Jaiswal, R., Alici, Y., & Breitbart, W. (2014). A comprehensive review of palliative care in
patients with cancer. International Review of Psychiatry, 26(1), 87-101.
Jang, R. W., Krzyzanowska, M. K., Zimmermann, C., Taback, N., & Alibhai, S. M. (2015).
Palliative care and the aggressiveness of end-of-life care in patients with advanced
pancreatic cancer. Journal of the National Cancer Institute, 107(3), dju424.
Kamal, A. H., Gradison, M., Maguire, J. M., Taylor, D., & Abernethy, A. P. (2014). Quality
measures for palliative care in patients with cancer: a systematic review. Journal of
oncology practice, 10(4), 281-287.
Roberto, A., Deandrea, S., Greco, M. T., Corli, O., Negri, E., Pizzuto, M., & Ruggeri, F. (2016).
Prevalence of neuropathic pain in cancer patients: pooled estimates from a systematic
review of published literature and results from a survey conducted in 50 Italian palliative
care centers. Journal of pain and symptom management, 51(6), 1091-1102.
Roeland, E. J., Triplett, D. P., Matsuno, R. K., Boero, I. J., Hwang, L., Yeung, H. N., ... &
Murphy, J. D. (2016). Patterns of palliative care consultation among elderly patients with
cancer. Journal of the National Comprehensive Cancer Network, 14(4), 439-445.
Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak:
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cancer. Clinical oncology in adolescents and young adults, 5, 1.
Wilson, K. G., Dalgleish, T. L., Chochinov, H. M., Chary, S., Gagnon, P. R., Macmillan, K., ...
& Fainsinger, R. L. (2016). Mental disorders and the desire for death in patients receiving
palliative care for cancer. BMJ supportive & palliative care, 6(2), 170-177.

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Wright, A. A., Zhang, B., Keating, N. L., Weeks, J. C., & Prigerson, H. G. (2014). Associations
between palliative chemotherapy and adult cancer patients’ end of life care and place of
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