Activity 6 Case Study ONCOLOGY DUTY

MINDANAO STATE UNIVERSITY
COLLEGE OF HEALTH SCIENCES

Marawi City
BS Nursing
ACTIVITY 6
CASE STUDY
ONCO DUTY
NAME: MANGOTARA, SITTY AIZAH T.
SECTION: C
CASE STUDY FOR NSG125.6 (ONCO CONCEPT)
Mrs. A, an 88-year-old Japanese woman, was hospitalized with anemia, lower leg edema and
ascites. She was living alone while receiving care in a day-care center for older people. Mrs.
A’s only family was her daughter, who lived in the same town, but it was a day-care center
worker who brought Mrs. A to the hospital. The daughter arrived at the hospital later. The
physician said to Mrs. A: ‘Your hemoglobin level six months ago was 12, but now it is only 4.
Your anemia may possibly be caused by stomach bleeding so a thorough examination is
absolutely necessary. If not treated, terrible problems might occur, and no treatment means
you will likely die.’ The patient, however, refused the treatment by saying that she was too
old and the gastric camera was terrifying. The daughter also said, ‘I want to respect my
mother’s decision. I knew that her legs and her abdomen were swollen but because of her
age I did not want her to be brought to hospital. As far as she does not want treatment, I agree
with her.’ What should the nurses do and why?
According to Steven Edwards from the University of Wales Swansea, UK:
It seems reasonable to start by considering the patient’s choice: should the nurses simply
respect this? If patients refuse treatment it is normally difficult to justify compelling them to
have it. Is this situation an exception to that general rule? Three things could lead one to say it
is:
1) Since Mrs A is anemic, with a hemoglobin level of only 4 g/dl, is this affecting her
competence to make a decision about the situation? The nurse should give Mrs A more time to
think about it and try to do something about her anemia, for example, by offering a blood
transfusion or iron by another route. She may well accept this and then be in a better position
to make an informed decision about the option proposed by the doctor. She will certainly feel
better too.
2) The reasons given by Mrs A for refusing the treatment also need further exploration. Why
does she say she is too old? Does she think she simply does not deserve access to further
treatment because she is a ‘burden’ on others? Also, why is she terrified of the gastric camera?
Does she understand what this is? Again, these issues need to be explored with Mrs A in as
calm a context as possible. As a nurse, you need to educate Mrs. A about her condition and the
treatment.
3) Since nurses and doctors are generally caring people who want to do the best for their
patients, Mrs A’s refusal of the treatment may make them feel as though they have failed in
their duty to help her. The nurse’s and doctor’s caring instincts should lead them to pursue the
strategies described in points 1 and32 above to try to make sure she really does understand
what is being offered to her and why, and what alternatives may be available.
If after all this has been done, Mrs A still refuses the further investigations then this refusal
should be accepted with the clear message that, should she change her mind, she can return.
The nurses should support Mrs A in her decision if that is really what she wants. They should
also try to ensure she receives any other help she needs to address the anemia and enable her
to feel better in herself.
In addition to these ways of helping Mrs A, if it is possible, her daughter needs to be engaged
too. How does she feel about the situation? Does she really believe her mother is making the
right decision?
These kinds of responses seem to me to reflect the relevance of moral principles such as:
 One should care for the health and well-being of others;

 One should care about others’ autonomy or rights of self-determination;
 One should try to relieve the suffering of others.
In the case history presented above, there is a danger that the considerations captured in all
three of these points are at risk of neglect, which the nurses should address, perhaps by
beginning with some of the suggestions offered.
We can also base the nursing actions to do in the case of the patient with Martha Roger's
theory:
Martha Rogers’ theory is known as the Science of Unitary Human Beings (SUHB). The theory
views nursing as both a science and an art as it provides a way to view the unitary human being,
who is integral with the universe. The unitary human being and his or her environment are one.
Nursing focuses on people and the manifestations that emerge from the mutual human-
environmental field process.
The application of Science of Unitary Human beings consists of three application which are the:
clinical practice, nursing education, and research.
In clinical practice, nursing action is always focused on unitary human being and change the
energy field between human and environment. The importance should be on the management
of pain, supportive pyschotherapy and rehabilitation of the human being.
The nursing intervention to alleviate Mrs. A's anemic condition are the following:
 Assist the client/caregivers in developing a schedule for daily activity and rest.
 Administer prescribed medications, as ordered:
 Administer IM or IV iron when oral iron is poorly absorbed.
 Perform sensitivity testing of IM iron injection to avoid risk of anaphylaxis.
 Advise patient to take iron supplements an hour before meals for maximum absorption;
if gastric distress occurs, suggest taking the supplement with meals — resume to
between-meals schedule if symptoms subside.
 Inform patient that iron salts change stool to dark green or black.
 Advise patient to take liquid forms of iron via a straw and rinse mouth with water.
In nursing education, emphasis should be given on the understanding of the patient and self,
enrgy firled and environment. The nursing education you could provide for Mrs A are the
following:
 Stress the importance of frequent rest periods.

 Monitor hemoglobin, hematocrit, RBC count, and reticulocyte counts.
 Educate energy-conservation techniques.
 Encourage patient to continue iron therapy for a total therapy time (6 months to a
year), even when fatigue is no longer present.
 Educate the client and caregivers about anemia:
 Explain the importance of the diagnostic procedures (such as complete blood count),
bone marrow aspiration and a possible referral to a hematologist.
 Explain the importance of iron replacement/supplementation.
 Educate the client and the family regarding foods rich in iron (organ and other meats,
leafy green vegetables, molasses, beans).
In research, there is research into the importance of stratifying for the risk of significant disease
according to Hb level and the value of computerised tomography colonography in investigating
iron deficiency anaemia.
The nursing process in Martha Roger's theory includes three steps which are: pattern appraisal,
mutual patterning, and evaluation.
In pattern appraisal, the nurses validate the entire appraisal along with the client.
In mutual patterning, it is the mutual interaction between the client and nurse. Patterning can
be done by suggesting various alternatives, educating, empowering, encouraging, etc.
depending on the client's condition. Regarding Mrs A who refuses to have a treatment, as a
nurse, you should educate her and her daughter to have a treatment. Encourage and empower
the both of them to arrive a good decisuon. But, if they still refuse to undergo treatment after
that, you should respect their decision as a nurse.
As a nurse, provide therapeutic touches, meditation, guided imagery as the patterning activities
planned for Mrs. A. Advices are given for changing and improving the condition of Mrs A. There
is also involvement of family for the environment patterning.
In evaluation, it is done by repeating the pattern appraisal after the mutual patterning to
determine the extents of dissonance and harmony.

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MINDANAO STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES

According to Steven Edwards from the University of Wales Swansea, UK:

 One should care for the health and well-being of others;

 Stress the importance of frequent rest periods.

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