The case of Harold Shipman True Crime Nightmare

The Case Of Harold
Name of the Student
Name of the Tutor
Author Note
Name of the student Student Number 1

THE CASE OF HAROLD
Prevention and Screening
Question no. 1
The Australian government initiated a breast screening program called “BreastScreen” to
address the issue of breast cancer among the majority of Australian women. This program
allows free screening of mammograms, particularly for women aged over 40 years. This
breast screening helps to reduce the mortality rates from breat cancer through early detection
of the disease and also educating the people about the risk factors and health complications
that are associated with breast cancer and ways to overcome them(Armes et al, 2017)
Question no. 2
Screening tests are performed for early detection of cancer in suspected patients, so that early
treatment and prevention strategies can be performed for restricting the further spread of
cancer. The screening tests are available for lung cancer, breast cancer and colorectal cancer.
Breast cancer can be screened with the help of mammography which checks for the presence
of any tumor or abnormalities in the breast, followed by clinical examination of the breast
and observing for change in the breast size and shape. MRI test can be also performed to
detect the presence of lumps in the breast(Weber et al, 2019).
Colorectal cancer can be screened by performing colonoscopy which is used to detect the
presence of polyps or cancer in the colon by inserting a flexible tube called colonoscope into
the rectum. Fecal occult blood test helps in the detection of blood in the stool, which may be
an indication of colorectal cancer(Miranda et al, 2017).
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Diagnosis and Treatment
Question no. 3
The clinical manifestation of non-small cell lung cancer include coughing, sneezing and often
there is chest pain when a person coughs too much. There is a noticeable hoarshness in the
voice. The individual may also undergo rapid weight loss due to low apetite. The person also
feels shortness of breath and there is a chance of chronic lung problem like bronchitis and
pneumonia(Postmus et al, 2017).
Question no. 4
a) Lung cancer is caused by the abnormal and uncontrolled growth of cells in the lungs,
which invades the nearby tissues and forms tumors. There are two types of lung
cancer: small cell lung cancer and non-small cell lung cancer. The rate of spread of
small cell lung cancer is more than that of non-small cell lung cancer. The non-small
cell lung cancer is a type of epithelial cancer affecting the squamous epithelial cells of
the lungs, which spreads through the nearby lymph nodes and then further proceeds to
infect the other parts of the body(Reck & Rabe, 2017).
b) The diagnosis options available for Harold, who is suffering from non-small cell lung
cancer includes Chest X-ray, CT scan, PET scan, MRI and lung biopsy. CT scan
produces a detailed 3D image which helps the physician to understand the size and
location of lung cancer. PET scan is used to detect the structure of the lungs and the
nearby tissues and helps to understand the spread of cancer. MRI scan can also be
performed to detect the presence of tumor in the lungs(Zappa & Mousa, 2016).
The prognosis of lung cancer depend on which stage the cancer is present. Eraly
stages of lung cancer have better prognosis than the later stages. For non-small cell
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THE CASE OF HAROLD
lung cancer, stage 0-1 are more favourable for prognosis than the stages 2,3 or 4. Non
small cells lung cancer spread which spreads to the adrenal glands have better
prognosis when compared to its spread in the brain or liver. People who had
undergoes 5% of their weight before treatment initiation, has less favourable
prognosis than the people who did not lose enough weight(Yu et al, 2016).
c) The cancer patients living in the rural areas face many issues and difficulties
regarding proper access to high quality treatment due to their lower avaibility, along
with financial issues where the poor people cannot afford such high treatment cost.
There are also significant transportation barriers in the rural places and there are not
enough healthcare providers and palliative care specialists available for those rural
people(Jenkins et al, 2018).
Question no. 5
a) People who are treated with chemotherapy for treating cancer have been found to
suffer from hospital acquired infection, since chemotherapy lowers the immunity of
the individual greatly by decreasing the number of white blood cells required to fight
infection, making their immune syatem weak. So the chance of getting an infection or
sepsis increases for the individual(Pearce et al, 2017).
b) Harold who had been undergoing chemptherapy has started to show some side effects.
After the chemotherapy session were over, he used to feel very tired, fatigued and
weak. He also suffered a rapid weight loss due to poor appetite, was more likely to get
infected owing to lowered immunity. Also he suffred from hair loss and bowel
problems such as constipation or diarrhoea(Pyszora et al, 2017).
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THE CASE OF HAROLD
c) The nurses should encourage the patients to take part in physical activity and exercise
to overcome their fatigue and weakness, which will boost their energy and also
increase their appetite. Also they should suggest the patients to take short naps which
will restore their energy. The nurses should also give sufficient iron-rich foods and
nutrients in the patient’s diet, which will help in replenishing the WBC loss, by
production of new leuckocytes. Therefore, the immune system of the patient will be
strong and functional again. For dealing with bowel problems, the nurse should
encourage the patient to eat enough fruits and high fibre rich foods(Coolbrandt et al,
2018).
d) The nurses perform physical assessment of the patient checking for the physical
manifestation of the side effects of chemotherapy. The physical examinations include
checking for weight loss, using a distress thermometer to check the stress and anxiety
level of the patient along with activity tolerance to detect the level of physical activity
of the patient. Apart from physical examination, they also assess the psychological
impact of chemotherapy on the patient, evaluating the coping ability of the patient
against chemotherapy(Hirsch et al, 2017).
Question no. 6
a) The average and normal serum calcium level in an adult is 2-2.5 mmol/L. A high
level of serum calcium gives rise to hyperglycemia in a patient. Often people having
lung cancer have an increased risk of hyperglycemia, caused by excessive presence of
calcium in the diet. Hyperglycemia leads to loss of appetite in patients, along with
feeling of nausea and vomiting. The person feels abdominal pain, along with
headaches, also there the patients feels tired or fatigued. In serious condition, the
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person may suffer from irregular heartbeat icreasing their chance of getting heart
attack and some people can also go to coma due to loss of consciousness(Egusa et al,
2017).
b) The nurses should encourage the patients with high calcium serum levels for
increased fluid intake and ambulation. The fluid should be rich in sodium since
sodium helps to increase the elimination of calcium from the renal system. The
cardiac rate along with the level of calcium in the blood serum should be monitored
regularly. The nurse should eliminate foods rich in calcium for the diet of patients
since it wil further increase the amount of calcium in the serum, maintain adequate
hydration and mobility(Mottaghitalab et al, 2019).
Question no. 7
The short term goals for Harold is to perform lots of physical activity and exercise, it will
prevent him for getting tired and weak after chemotherapy. He should consider brisk walking
everyday for a considerable amount of time, maybe for 15-20 minutes. It will help in
maintaining a healthy and fit body, improve blood circulation throughout the body.
Furthermore, he should quit smoking completely as it will worsen his condition(Sanchez et
al, 2018).
Patient centered psychosocial care
Question no. 8
The nurse should indulge in an open conversation about smoking with Harold and make him
aware of the potential health risks that are associated with smoking. They should ask Harold
if he knows about the ill-effects of smoking,advice him to quit smoking. Not only advicing
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will help, the nurses should actively take part in this smoking cessation mission, assist and
motivate Harold to slowly and gradually abstain from smoking(Vitzthum et al, 2020).
At first the nurses should inform Harold that his problem of lung cancer is associated with
smoking, tobacco is one of the risk factors in lung cancer and may worsen his condition, so
he should consider quitting smoking. They should enquire him about his smoking status, ask
him whether he is willing to quit smoking or not. If Harold is willing to quit smoking, then
the nurses should advice and assist him with quitting smoking by bringing a positive change
in his lifestyle, also explaining the effects of passive smoking. The nurses should also assure
Harold and say that they are there with him always and he can seek their help anytime he
wants without any hesistation(Planchard et al, 2018).
Question no. 9
Often the cancer patients go through “financial toxicity” which results from excessive
concern about financial problems. The same thing happened with Harold also, his condition
was worsening day by day as he was feeling distressed and anxious about economic problems
that his family is going to face after his treatment gets over. The nurse should address this
issue with empathy and compassion and assure him to lessesn his financial concerns with the
help of supportive care, ask him to speak freely about his financial issues without any
hesitation and embarrassment, they should also ensure emotional empowerment of Harold,
inform him about the health insurance policies and Medicare coberage that are available for
him(McGrath, 2017).
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Support for people at the end stage of life
Question no. 10
a) Palliative Care is a specialized, interdisciplinary medical care approach given to
patients suffering from a serious illness. It helps to improve the quality of life of the
patient as it is focussed on providing relieve from the stress and symptoms, the
individual faces. This is done through early identification and immediate assessment
of pain and other health issues. This treatment procedure has no side effects and
allows slow and steady emotional and spiritual healing of the person suffering from a
life threatening disease, at the same time ensuring patient satisfaction. The primary
aim of the palliative care is to make the patient feel relaxed and comfortable reducing
their levels of stress and anxiety. Palliative care is suggested for patients suffering
from cancer. The cancer patients usually undergoes lots of painful experiences such
as severe pain and emotional stress. Palliative care helps to release those stress and
brin g happiness and peace back into the patient’s life by providing high quality
compassionate and supportive care(Novello et al, 2016).
b) The palliative care team consists of health profesionals, nurses, medical staffs, general
practitioners, palliative care specialists, cancer specialized, counsellor or psychologist
who work together to offere services assisting the cancer patients along with their
families and provide them mental and emotional support, boosting their confidence
and assuring them with positive thoughts(Wilson et al, 2016). The palliative care
specialist or physician prescribes medicines to reduce the pain, depression or
emotional distress, anxiety and breathlessness of the patient, they communicates with
the general practitioners or cancer care specialists to check whether the patient is
receiving co-ordinated care, they assist the patient with care and treatment choices
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along with referring the patient and family members to a psychologist or councellor,
who delivers emotional support and bereavement care to them The cancer care
specisalists are oncologists, surgeons or haematologist who helps to diagnoses the
advancement or progress of cancer, and then refers the patient for palliative care.
They assist the patient in managing the symptoms of cancer through immunotherapy,
radiation therapy, chemotherapy or surgery
c) Thoracic pain or dyspnea is very common for people suffering from lung cancer,it
occurs due to disruption in the normal air flow in the lugs, as cancer spread through
the lungs(Altilio et al, 2019). It can also take place when the lung does not get enough
oxygen supply, resulting in shortness of breath. The reasons for shortness of breath is
due to the formation of tumor in the lungs which blocks the airways, thus hindering
the free flow of air through the lungs, leading to worsening breathlessness(Tung et al,
2019).
d) The first step in the palliative pain management is the assessment of pain, then the
nurses may prescribe NSAID such as morphine or ibuprofen which helps in the
alteration of the pain sensation in the brain, thus reducing the severity of pain in such
patients. If the pain continues to get worsem the nurse should provide weak opioid
medicine such as hydrocodone which acts as a pain reliever. And even if there is still
signs of pain, then a stronger dose of opioid is prescribed. Apart from these, the nurse
can give anti-depressants or anti-convulsants which can ease the pain(Oun et al,
2018).
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