PATIENT Dilemma
Chemotherapy/End of Life
STUDENT Worksheet
Ken Johnson, 52 years old
Overview
Holistic nursing care entails caring for not just the physical needs of every patient, but also the soul (emotional)
and the spirit. In this dilemma, a patient with a stage IV lung cancer has a strong faith and belief system, but his
illness is beginning to cause him to question his faith. How the nurse can practically support and care for his
emotional and spiritual needs in this context is the essence of this patient dilemma.
© 2015 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000840725322 from CourseHero.com on 01-29-2022 04:19:09 GMT -06:00
https://www.coursehero.com/file/85235287/Chemo-Case-Studydocx/
, Clinical Dilemma Activity: STUDENT
Chemotherapy/End of Life
I. Scenario
History of Present Problem:
Ken Johnson is a 52-year-old who was diagnosed with stage IV small cell lung cancer two years ago. He has been
managed with a daily oral chemotherapeutic drug that had kept his tumors in both lung fields and lymph nodes in
remission. He had a repeat CT scan last month that revealed that every tumor had grown dramatically in size and that he
would need to undergo aggressive intravenous chemotherapy to have any hope of long-term survival.
Personal/Social History:
Ken has a strong Christian faith and acknowledges that he feels that God has used the numerous people who are praying
for him as well as the medical care he has received have kept him alive. He has a supportive wife and two teenage sons.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
52 yr old, diagnosed with lung cancer two years The patient has an aggressive form of cancer, which does have a high
ago. Has been managing with an oral mortality rate. His cancer is currently being treated with chemo and is in
chemotherapy that has kept him in remission. remission.
CT scan last month revealing that the tumors Before, his illness was being successfully treated, but now things have
have grown in size and he would need to do IV changed. This type of cancer is the most aggressive, causing the growth of
chemotherapy for hopes of long term survival. these tumors. If the Pt does not undergo the treatment, his chances of
survival are low.
RELEVANT Data from Social History: Clinical Significance:
The pt has a strong Christian faith, and also The pt’s faith is a huge factor and important to him, so healthcare team
belives the care he has been given has kept him should keep that in mind and do whatever may be necessary to respect the
alive, as well as the power of prayer. patient/familys wishes.
He has a supportive wife, and two sons. The nurse should note that the patient has support from family.
II. The Dilemma Begins…
Current Concern:
Ken comes to receive his second dose of intravenous chemotherpy. Instead of the optimistic attitude and bright affect he
had last week, Ken is withdrawn and has a flat affect. When asked how he is doing, he replies, “The past three weeks have
been so hard. I had no idea how painful chemo would be and how persistent the nausea and vomiting have been. I have no
strength. I have been praying, other people have been praying for me and I thought I was going to be healed. I know God
can heal and do the impossible. I have two sons who still need a father. Why has God chosen not to heal me? I don’t know
how long I can do this…”
What data from the current concern is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Current Concern: Clinical Significance:
Compared to last week, Pt went from being Healthcare team should notice this and pay attention to patient changes and
hopeful to withdrawn. communication, even if that means nonverbal as well. This is still a type of
communication and shows the state that the patient is in.
When asked how he is doing, he replies, “The IV chemo is known to cause side effects, in which is difficult to prepare
past three weeks have been so hard. I had no for. Some include: severe nausea/vomiting, fatigue, loss of body hair,
idea how painful chemo would be and how ulcers in the mouth, etc.
persistent the nausea and vomiting have been. I
have no strength.”
I have been praying, other people have been
This study source was downloaded by 100000840725322 from CourseHero.com on 01-29-2022 04:19:09 GMT -06:00
https://www.coursehero.com/file/85235287/Chemo-Case-Studydocx/
Chemotherapy/End of Life
STUDENT Worksheet
Ken Johnson, 52 years old
Overview
Holistic nursing care entails caring for not just the physical needs of every patient, but also the soul (emotional)
and the spirit. In this dilemma, a patient with a stage IV lung cancer has a strong faith and belief system, but his
illness is beginning to cause him to question his faith. How the nurse can practically support and care for his
emotional and spiritual needs in this context is the essence of this patient dilemma.
© 2015 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000840725322 from CourseHero.com on 01-29-2022 04:19:09 GMT -06:00
https://www.coursehero.com/file/85235287/Chemo-Case-Studydocx/
, Clinical Dilemma Activity: STUDENT
Chemotherapy/End of Life
I. Scenario
History of Present Problem:
Ken Johnson is a 52-year-old who was diagnosed with stage IV small cell lung cancer two years ago. He has been
managed with a daily oral chemotherapeutic drug that had kept his tumors in both lung fields and lymph nodes in
remission. He had a repeat CT scan last month that revealed that every tumor had grown dramatically in size and that he
would need to undergo aggressive intravenous chemotherapy to have any hope of long-term survival.
Personal/Social History:
Ken has a strong Christian faith and acknowledges that he feels that God has used the numerous people who are praying
for him as well as the medical care he has received have kept him alive. He has a supportive wife and two teenage sons.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
52 yr old, diagnosed with lung cancer two years The patient has an aggressive form of cancer, which does have a high
ago. Has been managing with an oral mortality rate. His cancer is currently being treated with chemo and is in
chemotherapy that has kept him in remission. remission.
CT scan last month revealing that the tumors Before, his illness was being successfully treated, but now things have
have grown in size and he would need to do IV changed. This type of cancer is the most aggressive, causing the growth of
chemotherapy for hopes of long term survival. these tumors. If the Pt does not undergo the treatment, his chances of
survival are low.
RELEVANT Data from Social History: Clinical Significance:
The pt has a strong Christian faith, and also The pt’s faith is a huge factor and important to him, so healthcare team
belives the care he has been given has kept him should keep that in mind and do whatever may be necessary to respect the
alive, as well as the power of prayer. patient/familys wishes.
He has a supportive wife, and two sons. The nurse should note that the patient has support from family.
II. The Dilemma Begins…
Current Concern:
Ken comes to receive his second dose of intravenous chemotherpy. Instead of the optimistic attitude and bright affect he
had last week, Ken is withdrawn and has a flat affect. When asked how he is doing, he replies, “The past three weeks have
been so hard. I had no idea how painful chemo would be and how persistent the nausea and vomiting have been. I have no
strength. I have been praying, other people have been praying for me and I thought I was going to be healed. I know God
can heal and do the impossible. I have two sons who still need a father. Why has God chosen not to heal me? I don’t know
how long I can do this…”
What data from the current concern is important & RELEVANT; therefore it has clinical significance to the nurse?
RELEVANT Data from Current Concern: Clinical Significance:
Compared to last week, Pt went from being Healthcare team should notice this and pay attention to patient changes and
hopeful to withdrawn. communication, even if that means nonverbal as well. This is still a type of
communication and shows the state that the patient is in.
When asked how he is doing, he replies, “The IV chemo is known to cause side effects, in which is difficult to prepare
past three weeks have been so hard. I had no for. Some include: severe nausea/vomiting, fatigue, loss of body hair,
idea how painful chemo would be and how ulcers in the mouth, etc.
persistent the nausea and vomiting have been. I
have no strength.”
I have been praying, other people have been
This study source was downloaded by 100000840725322 from CourseHero.com on 01-29-2022 04:19:09 GMT -06:00
https://www.coursehero.com/file/85235287/Chemo-Case-Studydocx/
