Joe Murphy is a 58 year old male diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Two years ago he noticed a
Posted: Mon Oct 04, 2021 9:18 am
Joe Murphy is a 58 year old male diagnosed with Chronic
Obstructive Pulmonary Disease (COPD). Two years ago he noticed a
silvery patch on his tongue but did not immediately seek medical
attention. He continued his pack a day smoking habit as well as
chewing tobacco.
About six months ago Joe sought medical attention after he
developed the following symptoms: a feeling that something was
caught in his throat, difficulty chewing and swallowing, difficulty
moving his tongue, difficulty articulating words and numbness of
his tongue.
He was diagnosed with an oral squamous carcinoma on the anterior
two thirds of his tongue and the floor of his mouth. It was found
to have metastasised to his cervical lymph nodes. He immediately
underwent a surgical resection of his tongue with extensive
resection of bone and soft tissue.
Question One
The malignancy progressed rapidly despite
treatment, resulting in the following distressing symptoms:
the loss of his tongue made speech completely
unintelligible, there was also extensive loss of
teeth making it very difficult to swallow, severe
facial disfigurement, the necrotic non-healing oral ulcer
caused severe mal-odour, as well as significant facial
pain.
At first, Mr Murphy's symptoms were relatively well
controlled with:
Discuss why this combination of medication has been
prescribed?
(Note: Your answer should take into consider Joe's medical
history and all medication received. Remember to
incorporate latest evidence based practice in your answer)
Word Count: 200-300 words
Question Two
Mr. Murphy did quite well on this regimen for several
weeks, but as the disease progressed, his pain worsened culminating
in admission to the hospital for symptom control. Upon
admission, numerous interventions were attempted in an effort to
ease Joe’s pain, including:
Unfortunately, none of the treatments alleviated or attenuated
his sense of severe pain.
Consider the changes made to the medication regime -
what was the rationale for these changes?
(Note: Your answer should take into consider Joe's medical
history and all medication received. Remember to
incorporate latest evidence based practice in your answer)
Word Count: 200-300 words
Question Three
Over the next week, Joe’s pain worsened despite aggressive pain
management. He was clearly suffering greatly and this caused severe
distress to his family who could not bear to see him suffer in
this manner. Since his pain was unendurable and refractory
to all palliative measures, palliative sedation was proposed as a
humane and compassionate approach to allay his suffering.
After explanation of the procedure, both he and his
family readily agreed to deep and continuous palliative sedation.
An informed consent document was signed and a note describing the
indications and plans for palliative sedation was recorded in the
patient’s chart.
He died 4 days later, sedated, peaceful, and with his family at
his bedside.
Incorporating your knowledge of this medication, discuss
the process used to titrate the midazolam infusion and ensure
adequate sedation.
(Note: Your answer should take into consider Joe's medical
history and all medication received. Remember to
incorporate latest evidence based practice in your answer)
Word Count: 200-300 words
Obstructive Pulmonary Disease (COPD). Two years ago he noticed a
silvery patch on his tongue but did not immediately seek medical
attention. He continued his pack a day smoking habit as well as
chewing tobacco.
About six months ago Joe sought medical attention after he
developed the following symptoms: a feeling that something was
caught in his throat, difficulty chewing and swallowing, difficulty
moving his tongue, difficulty articulating words and numbness of
his tongue.
He was diagnosed with an oral squamous carcinoma on the anterior
two thirds of his tongue and the floor of his mouth. It was found
to have metastasised to his cervical lymph nodes. He immediately
underwent a surgical resection of his tongue with extensive
resection of bone and soft tissue.
Question One
The malignancy progressed rapidly despite
treatment, resulting in the following distressing symptoms:
the loss of his tongue made speech completely
unintelligible, there was also extensive loss of
teeth making it very difficult to swallow, severe
facial disfigurement, the necrotic non-healing oral ulcer
caused severe mal-odour, as well as significant facial
pain.
At first, Mr Murphy's symptoms were relatively well
controlled with:
Discuss why this combination of medication has been
prescribed?
(Note: Your answer should take into consider Joe's medical
history and all medication received. Remember to
incorporate latest evidence based practice in your answer)
Word Count: 200-300 words
Question Two
Mr. Murphy did quite well on this regimen for several
weeks, but as the disease progressed, his pain worsened culminating
in admission to the hospital for symptom control. Upon
admission, numerous interventions were attempted in an effort to
ease Joe’s pain, including:
Unfortunately, none of the treatments alleviated or attenuated
his sense of severe pain.
Consider the changes made to the medication regime -
what was the rationale for these changes?
(Note: Your answer should take into consider Joe's medical
history and all medication received. Remember to
incorporate latest evidence based practice in your answer)
Word Count: 200-300 words
Question Three
Over the next week, Joe’s pain worsened despite aggressive pain
management. He was clearly suffering greatly and this caused severe
distress to his family who could not bear to see him suffer in
this manner. Since his pain was unendurable and refractory
to all palliative measures, palliative sedation was proposed as a
humane and compassionate approach to allay his suffering.
After explanation of the procedure, both he and his
family readily agreed to deep and continuous palliative sedation.
An informed consent document was signed and a note describing the
indications and plans for palliative sedation was recorded in the
patient’s chart.
He died 4 days later, sedated, peaceful, and with his family at
his bedside.
Incorporating your knowledge of this medication, discuss
the process used to titrate the midazolam infusion and ensure
adequate sedation.
(Note: Your answer should take into consider Joe's medical
history and all medication received. Remember to
incorporate latest evidence based practice in your answer)
Word Count: 200-300 words