Assessment of an Adult with Complex Health Needs

PMH & Current Problem

Nursing Action

for the Future

-Lumpectomy at age 16

-Cesarean Section at age 30

-Cervical cancer at age 35

-Stage III Breast cancer, bilateral radical mastectomy and TRAM flap at age 45

-Radical hysterectomy and partial nephrectomy due to (misdiagnosed) tumors at age 54

-Abdominal wall repair and mastectomy reconstruction at age 57

- Utilize case management teams for adults suffering from complex health needs!

Assessment of an Adult with Complex Health Needs

PSU. 465. Christine Fitzpatrick, Monet Grant, Schylo Lease

Pathophysiology

Conclusions and Recommendations

-“There is no single, specific cause of breast cancer. A combination of genetic, hormonal, and possibly environmental factors may increase the risk of its development” (Hinkle & Cheever, 2014, p. 1692).

-“Age of first diagnosis of cancer plays a crucial role in the development of second primary cancer. Several studies confirmed… patients diagnosed with breast cancer before the age of 50 are more susceptible to develop second primary cancer later in life” (Marcu, Santos, &, Bezak, 2013, p.61).

-Miscommunication of malignancy lead to eventual development of uterine and renal cancer.

- Case managers should be a part of every patient’s healthcare team, especially those with complex healthcare needs

- Some roles of a case manager are to coordinate care, facilitate continuity of care, improve efficiency of care and utilization of resources, enhance quality of care, and advocate for the patient and their family (Sommer, Johnson, Roberts, Redding, & Churchill, 2013).

- Proper discharge planning. “Discharge planning serves as a starting point for continuity of care” (Sommer, Johnson, Roberts, Redding, & Churchill, 2013, p. 42).

Introduction

References:

Arnett, J., Henry, B., & Fankell, A. (2014). Managing late effects of breast cancer treatment. Clinical Journal of Oncology Nursing. 18(5), 32-35.

BreastCancer.org (2017). Tram Flap. Retrieved from http://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/tram

Doenges, M., Moorhouse, M., & Murr, A. (2013). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (4th ed.) (pps. 138-144, 543-545, 662-664, 671-674). Philadelphia: F.A. Davis Co.

Dunne, M., & Keenan, K. (2016). Late and long-term sequelae of breast cancer treatment. American Journal of Nursing. 116(6), 36-44.

Hinkle, J.L., & Cheever, K.H. (2014). Assessment and Management of Patients with Breast Disorders. In Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th ed.) (p. 1692–1708). Philadelphia: Lippincott Williams & Wilkins.

Hubbard, Kin. Retrieved from https://www.brainyquote.com/quotes/quotes/k/kinhubbard377672.html

Marcu, L.G., Santos, A. & Bezak, E. (2014). Risk of second primary cancer after breast cancer treatment. European Journal of Cancer Care. 23, 51-64.

Sommer, S., Johnson, J., Roberts, K., Redding, S., & Churchill, L. (2013). Coordinating client care. In Nursing Leadership and Management (pp. 35-47). Leawood, KS: Assessment Technologies Institute.

Lot's of folks confuse

bad management with destiny.

-Kin Hubbard

Treatments

Nursing Care Plans Continued

-Readiness for enhanced self concept as evidenced by accepts strengths and limitations, expresses willingness to enhance self-concept, expresses confidence in abilities

-Caregiver role strain as evidenced by insufficient time and physical energy, insufficient finances, and deficient knowledge about community resources

- “Chemoprevention is the main modality that aims to prevent the disease” (Hinkle & Cheever, 2014, p.1693).

- “Radiation therapy is used to decrease the chance of local recurrence in the breast by eradicating residual microscopic cancer cells” (Hinkle & Cheever, 2014, p.1701)

- Our patient received tamoxifen as well as adjunctive beam radiation. Along with having a radical bilateral mastectomy, radical hysterectomy, and partial nephrectomy.

Side/Adverse Effects of Treatment

Nursing Care Plans

Family’s Perceived Barriers

Patient and Family

Perceived Barriers

Barriers from the

client's perspective

Team's Perceived Barriers

-Readiness for enhanced nutrition as evidenced by expresses knowledge of healthy food and fluid choices, and expresses willingness to enhance nutrition

-Readiness for enhanced self care as evidenced by expresses desire to enhance self-care, expresses desire to enhance knowledge for strategies for self-care, and expresses desire to enhance independence in

maintaining health and well-being.

- Hair loss, fatigue, nausea, vomiting, infections

- TRAM (transverse rectus abdominal myocutaneous) flap

- Numerous hernias, collapsed lung, eventual abdominal wall repair, and nipple-areola reconstruction

-The patient’s closest family consists of adult children, young grandchildren, and a future son-in-law

-Patient’s daughter’s barriers to care

-Patient’s family’s barriers to care

-Our perceived barriers were very similar to the ones perceived by the patient and her family

-Fatigue and poor self-image

-Caregiver role strain

-Knowledge deficits

-Lack of designated case management nurse or team

-Knowledge deficits of surgical options, procedures, and post operative complications

-Limitations to daily obligations

-Poor self image

-Both felt a lack of knowledge

-Both were affected by limitations in patient’s ADLs

-Both felt effects of patient’s poor self-image