Geoff Holder Case Study - Nursing Assignment Help

Assignment Task :

Case Scenario 
History 
Geoff Holder, a 52 year-old owner/operator of a pest control franchise, has been admitted to the medical ward. He was admitted from home via the emergency department, and arrived on the ward at 0200hrs this morning. 
Geoff has a history of Diabetes Mellitus Type II which has been previously well controlled by diet and exercise. He was diagnosed with pancreatic cancer six months ago and underwent a Whipple’s procedure with initially good outcomes. Geoff lives at home with his wife and eight year old son: his daughter from a previous marriage lives with Geoff’s ex-wife and attends university, studying education. Geoff has increased contact with his daughter since his diagnosis and she has dinner / visits with his family at least once a week. 
Geoff’s father died aged fifty in hospital from liver cancer, after a history of heavy alcohol and cigarette use. Geoff was twenty years old and recalls him experiencing significant pain before he died. Geoff’s mother has dementia and has lived in a residential dementia unit for two years. Geoff has limited contact with his only sibling, a brother who lives in Perth. 
Since his diagnosis of  pancreatic cancer six months ago and after his Whipples procedure which initially was successful Geoff was able to continue working from home, but now is extremely fatigued, cannot undertake activities of daily living and has increased pain, his diabetes is also now  not well controlled. 
He presented to the emergency department at 1800hrs for pain control and reluctantly consented to admission for review by the palliative care team today. He has not accepted community services, including community palliative care services, to date. 
His medications from home (Ordine) have been brought in and are locked in the controlled drugs cupboard. He has an Acute Resuscitation Plan and is not for active resuscitation. His care has been managed by the GP since his discharge after the Whipple’s procedure. 
Since being on the ward he has had two episodes of break through pain (9/10) that he was given oral analgesia for, the first at 0230hrs of 5 mg of Ordine and another 5mg of Ordine at 0500hrs. This reduced his pain to a score of 4/10, but the pain continues to worsen. He says his pain score goal is to remain below 3/10. He has been too fatigued to mobilise to the toilet. His blood sugar level was 8.2mmol/L at 0600 hrs, and this is being checked three times daily.
He is for review by the palliative care team later in the day.
 

1. Apply the principles of palliative care to complete a holistic symptom assessment using the Symptom Assessment Scale and the information provided for Geoff in the case study above.  List below the areas which are of concern  
2.    
a. Discuss and identify how you would assess Geoff’s pain – review the Brief Pain Inventory form and then list the areas below of concern and the score 
b. What strategies can you implement to address the pain ?
c. What can you suggest to help Geoff with his constipation 
 

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