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Joshi Kamakani – 70 year old male with metastatic prostate cancer. Joshi is a retired engineer that the Palliative Care home care team and the NP has been looking after him at home for the last two months. Joshi was diagnosed with inoperable prostate cancer three years ago and has been treated with ablative hormone therapy.
His wife called you yesterday stating that he is in a lot of pain and therefore spends most of his time on the couch. He cannot get around on his own and is very fatigued.
Past medical History:
HTN
GERD
Medications:
Prednisone 5mg PO BID
Leuprorelin 22.5 mg IM every 3 month
Hydrocholorthiazide 25mg daily
Pantoprazole 40mg PO daily
Morphine slow release 100 mg q12h
You are a home health nurse taking care of Joshi. Use the resources available in your community to create the following care plan.
1. What are the 3 priority questions you will ask Joshi and his wife during the patient interview? (You may only ask 3 questions, so make sure you are focusing on the priority of care)
2. What are your 3 priority safety concerns for Joshi?
3. Create a plan of care to address the needs of Joshi and his wife.
Priority questions for Joshi and his wife:
Are you experiencing any pain or discomfort that is not being adequately managed with the medication currently prescribed?
Are you experiencing any changes in your appetite or weight?
Are you experiencing any confusion or difficulty with daily activities such as bathing, dressing, and grooming?
Priority safety concerns for Joshi:
The risk of falls due to his fatigue and inability to ambulate
The risk of medication errors due to confusion or difficulty swallowing
The risk of depression or anxiety due to his prognosis and decreased mobility
Plan of care to address the needs of Joshi and his wife:
Conduct regular pain assessments and adjust medication as needed to ensure adequate pain management.
Assess for any changes in appetite or weight and provide appropriate interventions such as tube feeding or oral care.
Assess for any cognitive or functional changes and provide appropriate interventions such as home health aides or adult day care.
Provide education on pain management, medication safety, and wound care.
Provide emotional support and resources for Joshi and his wife, such as counseling or support groups.
Assist with activities of daily living such as bathing, dressing, and grooming to prevent further decline in functional abilities.
Provide support for the family to ensure they are able to provide adequate care and manage their own emotional needs.
Coordinate with the oncology team and community resources for any additional interventions such as hospice care if needed.
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For some, the etiology of substance abuse disorders is the result of a genetic predisposition (biological), whereas others might argue that addiction or abuse is the result of using substances as a coping mechanism that will act as a reinforcer (behavioral learning).
Why might an adolescent with a maternal and paternal family history of alcohol and drug abuse problems be concerned that they will develop a substance use disorder or addiction?
What recommendations do you have for the adolescent in helping to reduce the risk of developing a substance use disorder?
Be sure to also address stress, coping and peer relationships in your response.
Adolescents with a family history of substance abuse may worry about developing addiction due to genetic predisposition and learned coping behaviors.
Adolescents with a familial history of alcohol and drug abuse problems face an increased risk of developing a substance use disorder or addiction. Firstly, genetic factors can contribute to a higher susceptibility to substance abuse. Research suggests that certain genetic variations may make individuals more vulnerable to the effects of drugs and alcohol, increasing the likelihood of developing a substance use disorder.
Secondly, growing up in an environment where substance abuse is prevalent can also influence an adolescent's risk. The learned behaviors and coping mechanisms associated with substance abuse within the family can be passed down through generations. Adolescents may observe family members using substances as a means of coping with stress or emotional difficulties, leading them to perceive substance use as a potential solution or reinforcement.
To help reduce the risk of developing a substance use disorder, it is important for the adolescent to take proactive steps. Firstly, fostering healthy coping mechanisms for managing stress is crucial. Encouraging the adolescent to engage in activities such as exercise, hobbies, and social support networks can provide alternative ways to cope with stressors without resorting to substance use.
Additionally, building strong peer relationships can be beneficial. Positive peer influences and supportive friendships can serve as protective factors against substance abuse. Encouraging the adolescent to seek out healthy friendships and engage in activities that do not involve substance use can help reduce their risk.
Lastly, open communication within the family is essential. Creating a safe and non-judgmental environment where the adolescent feels comfortable discussing their concerns and experiences can facilitate early intervention and support. Providing education about the risks of substance abuse and maintaining ongoing dialogue can help the adolescent make informed choices and seek help if needed.
In summary, an adolescent with a family history of alcohol and drug abuse problems may be concerned about developing a substance use disorder due to genetic predisposition and learned behaviors associated with substance abuse. To reduce the risk, it is important to focus on healthy coping mechanisms, positive peer relationships, and open communication within the family.
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