The patients medicinal predicament is an advanced esophageal carcinoma. The history of the patient is that she is fifty- five years old and was admitted to a Los Angeles health Center due to some weeks of dysphagia. She was not able to swallow anything starting with stable and then now liquids as reported by her husband. Endoscopy was done and revealed a mass which was most likely an advanced carcinoma. The prognosis is poor since the treatment options were limited and surgery was unlikely to be curative. This problem is chronic as it cant be reversed. The goal of therapy, in this case, is to slow cancer, ease symptoms and improve the quality of life. The probability of success in this client is very minimal as the carcinoma has significantly advanced as regards the doctors endoscopy results. In the case of therapeutic failure, the plan will be supportive care; the physician will suggest treatment that will help ease the symptoms but not to treat cancer. The patient can benefit from medical as well as nursing care through palliative surgery in that surgeon along with gastroenterologists introduces a feeding tube for her to receive nutrition directly to the stomach. Harm may be avoided by providing diligent nursing care so that to reduce aspiration of stomach contents as well as skin breakdown problems. Also, damage may be prevented by managing side effects associated with feeding tube insertion.
The patient is psychologically capable and lawfully proficient as she tells her children that she did not want surgery to be performed. Her husband is the suitable stand-in because the patient said that she understood that surgery was unlikely to be cured, but she wished to proceed regardless. The children refused to say that that was not her decision but their fathers decision since she had told them. The husband is not using the correct standards of making decisions. The patient has expressed prior preferences although she is not unwilling to cooperate with medical management, she is in fear of acquiescing to her husbands desires. The patients right to choose is violated as her husband is the decision maker for her despite the fact that he knows that there are minimal chances of recovering and may as well result in death.
There are no prospects irrespective of treatment for the patient to return to a normal life. If treatment goes through well, the physical deficits associated with her management are related to feeding through the feeding tube. She in danger of aspirating the stomach contents into her lungs which may lead to aspiration pneumonia which may result in death. She is also at the risk of skin abrasion and infections that can lead to sepsis. Biases that may prejudice assessment of the patients quality of life are not identified. Her current state, advanced esophageal carcinoma is such that many would judge living in it undesirable. There is no as well as rational to forego treatment as her husband tells the doctor that he have discussed with her wife and that his wife needs everything possible to be done as she is young to let her go. As regards comfort and palliative care, there is no plan for it.
Family matters that may enhance management decisions are seen as the central conflict. There is disagreement between the children and their father concerning the illness of their mother. There are no provider issues that may influence management. Financial factors are not mentioned but cultural issues are there as the doctor says they would ask children privately about the East African cultural norms as well as their parents relationship and know there are any differences. Limits of confidentiality are seen when the patient tells the doctor that she cant decide alone and she requested for her husband plus children to be there. Allocation of resources is not mentioned in the case. The law affects the management decision as the surgery was postponed until when the patients wishes were clear, and there is no conflict of interest on the part of the provider.
The patient was admitted following several weeks of dysphagia. The doctor makes a diagnosis of esophageal cancer which is eventually confirmed by an endoscopy which revealed the patient had a mass which was possibly advanced cancer. In this case, management options are limited, and surgery could not cure it. The dilemma comes in when the husband to the patient says that he should perform anything possible for him to make sure that her wife survives yet he just knew that surgery could worsen the situation. The patient tells her children that she didnt like surgery although she was being moved by the decision of her husband. The children told this the doctor, and it's then that the physician too realized that he had never heard directly what the patient wanted to be done and was not sure if the victim knew the extent of her condition. Thus the doctor came to a decision of postponing the surgical procedure until when the patients desires were clear.
The problem is esophageal cancer. Alternatives for treatment are surgery, radiotherapy, chemotherapy as well as photodynamic therapy. Surgery is the standard management method but in early stages and cannot be applied in advanced stages. Radiation, chemotherapy and photodynamic may be used to alleviate symptoms of advanced cancer, for instance, dysphagia. Photodynamic is the best option as it uses a special drug which is a laser to kill cancer cells and it as well relieves symptoms of difficulty in swallowing. I recommend that the best means to obtain the information required as regards one's condition is asking their physician. They have to make confident that they inquire if the treatment will alter your daily existence. Also, they should find out how their diet may have to modify. They should too request on how successful the management is and learn about the dangers and likely side effects.
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