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You are to read the case study then write an essay which outlines a patient-centred nursing care plan for Irosha.

The aim of the written care plan is to provide direction for indivualised care of the patient.  A care plan is organised identify the patient’s problems using health assessment date and organised to meet specific needs for the individual. The care plan is also a means to communicate/document the actions of the various nursing staff attending to and caring for the patient.

Case study

Irosha Vaderi is a 68 year old lady with metastatic breast cancer. Irosha was diagnosed with breast cancer 9 years ago and following treatment was considered in remission. Eight months ago Irosha sought advice from her General Practitioner following appearances of lumps near her mastectomy site. She reported shortness of breath and longstanding dry cough. Following a Positron Emission Tomography (PET) it was confirmed that the cancer has metastasized to her lungs. After several appointments with her oncologist an informed decision was made between the health care professionals, Irosha and her family that the treatment would continue as palliative care only.

Irosha has a subcutaneous cannula and syringe driver in situ, delivering morphine and metoclopramide. She is ordered oral Ordine liquid prn for breakthrough pain relief. Irosha is from Sri Lanka lives with her husband, son and daughter-in-law and four grandchildren. Her son is not coping with the Advance Care Directive. Irosha has a fungating chest wound with malodorous exudate. This wound requires dressing every few hours.


Here you briefly outline the role of the care plan and introduce the case study.


Based on the case study history select three priority needs or nursing problems. A nursing problem is different from medical diagnosis and describes either the physical, social, cultural, psychological, spiritual or potential health problem.  

Use the assessment data and literature using 3-5 references to support your selection of the three nursing problems. APA 6threference style. To do this, think about what are the key assessment data or things you have identified in the case study that tells you they are relevant to the problem/s? Set goals using Specific, Measurable, Attainable, Realistic and Timely (SMART) goals setting (goals and outcomes criteria). 

Identify the key nursing interventions that you will implement to achieve these goals.Outline the nursing actions, management or cares are you going to provide to achieve the goals. You may add what referrals you think are important and if any supporting resources are needed. You can discuss the storage of medications and the administration, but not the prescription of medications.

Describe what you think could be the expected outcomes for these nursing interventions (evaluation).  


Nursing care plans are allocated to all classes for thorough care patients, in mental health as well as for the community care. Nurses and students who are in the medical field stay up all the night getting patient-specific care plans ready for use in attending patients them the next day. Care plans give directions for the personalized care of a patient. This is because they flow from a patient’s exceptional list of diagnosis which is prepared according to personal unique needs. A care plan provides a continuity for care because it’s a way of communicating and establishing the activities of a continuously changing nursing workforce. A restructured plan is passed on to the nursing staff at a shift change and during nursing rounds as the patients’ needs are attended (Mayer, Birken, Check & Chen, 2015). Care plans help impart good record keeping as they clearly specify outlines what nursing actions to be taken and the directions the patient or the family members require to know. Care plans are guides for assigning staff to care for patients.

Lastly, care plan serves as compensation to Medicare and Medicaid as they have to come up with a plan in action, and other third-party insurers followed the suit. Insurance companies use medical records to guide what patients will be pay in return for the care given by the health center. In the case where no good records of nursing care, it is difficult to prove if care was accorded and thus no payments will be made by the patient. Care plans help students and nurses pull information from many scientific disciplines as they gain knowledge to critically solve problems as they occur (Yarbro, Wujcik & Gobel, 2016). This paper preparing a nursing care plan on Irosha who is a 68 years old lady and was diagnosed with breast cancer nine years ago and following treatment, she has to receive palliative care to ease the pain she is going through. It covers the nursing problems encountered by nurses when trying to take care of different patients and identifies key nursing interventions that can be implemented to these goals.

Upon assessment, Irosha was seen to have the following problems;

  1. Breathing problems and dry cough
  2. Lung metastases
  3. Pain

Irosha has cancerous tumors that initiate from somewhere else in the body and spread to the lungs. Irosha is experiencing breathing problems that have developed from lung metastases whose source is the breast cancer she has been suffering from. This is a nursing problem which has forced her to seek aid for easing her breathing complications. Through PET, it was established that Irosha has developed cancer in her lungs. With this in mind, the nurse allocated to observe Irosha during her palliative care will help her recover ease the pain and make her comfortable. The nurse will also accord her psychological, physical and social health is not impacted by these tumors by according her the right treatment and encouragement.

A breast cancer patient goes through treatment process such as chemotherapy, injections among others that cause pain in their bodies (Dougherty & Lister, 2015). In this case study, Irosha has lumps and a subcutaneous cannula and a syringe driver in situ which and the nurse aims to relieve the pain she is going through in palliative care. In addition, she has a chest wound that needs dressing after few hours to relieve the pain and facilitate faster healing. This information on the levels of pain Irosha is going through, will help the palliative care nurse to evaluate the best palliative care measures to adopt on Irosha to reduce the pain at home.

Patient Assessment and Problems

The palliative care nurse will take into consideration Irosha’s past medical history since she began the treatment process till she was put on palliative care. The past medical record will help identify if Irosha is allergic or resistant to certain medicines and administer a different dosage. The nurses will also make regular visits to Irosha’s home to follow up whether she is doing well under the palliative care.

Palliative care nurses will employ a number of methods to assess and elicit Irosha’s problems in a number of different assessment tools that have been put into practice by nurses in the society. Cedar, White & Atwal (2018) states that nurses use their interpersonal skills to initiate ground-breaking conversations with terminally ill patients in a friendly and informal manner. Through this technique, nurses will be able to break down any barriers that may come in between them and Irosha by building their trust in her. Structured assessment tools insist on how they should be used alongside the patient via a list of questions that will help Irosha think about her personal needs while in palliative care (McIlfatrick et al., 2017). Nurses are trained on how to talk to patients and make them accept their conditions to avoid stress and other psychological torture that they may be going through. In her condition, Irosha is going through a lot of physical, social and psychological pain. Studies show that female cancer patients need motivation and encouragement to undergo through a speedy recovery (Edvardsson Watt & Pearce, 2017). To ensure that the above nursing problems are addressed, nurses will come up with a strategy for assessing Irosha’s progress.

Nurses and the healthcare staff should improve their performance and make sure that patients living with breast cancer have been provided with adequate knowledge about the disease and educate the society on some precaution measure which they can put in place to reduce the diseases (Butow et al., 2015). The breast cancer patients should be given some guidance throughout the treatment process and their families should be aware of what is expected of them towards their cancer patients. According to a recent study conducted, breast cancer is among the top killer diseases among women their mortality level due to the infection has increased progressively. Breast cancer is also termed as the most feared type of cancer among women (McAlpine, Joubert, Martin-Sanchez, Merolli & Drummond, 2015). This is because of its psychological effects on the patients and the existing fear caused by the diseases as a lot of people lack adequate knowledge about it across the world.

Irosha should be informed about the disease and how she is supposed to go through some medications which can help reduce pain as well as informing her family to give her some emotional support which is essential so that she can’t feel lonely and isolated by her community (Kuijpers, Groen, Aaronson & van Harten, 2013). Through their skills, the nurse attending to Irosha in palliative care will open up talks with her and inform her that her condition is not the end of the world to her as there are many people who have gone through the same.

Palliative Care Interventions

The nursing team at this phase needs to give her some guidance according to the process, length and type of treatment she has to go through the healing process and the side effects of the treatment. It is necessary to inform Irosha about other features which are bra and external breast prostheses (Holm et al., 2017). The mutilation of the breast women needs maximum care and devotion because it is an essential organ which reflects life, food, pleasure, and warmth. It is vital for patients to be provided with information regarding their treatment and implications as required by the health professional guidance.  

According to Watts et al., (2015), nursing care has to involve measures to guard against distress reported in Irosha’s case after realizing that she had cancer. She should also be provided with all important information regarding breast cancer to help her be prepared with the surgical procedures that will be focused on bringing back her normal situation and physical independence. Irosha should also be provided with the schedule outlining following visits that she will make to the clinics (Tinetti, Naik & Dodson, 2016). Having gone through the surgery and released to proceed with palliative care, the nurse should mark Irosha’s postoperative period and observe whether there is the possibility of similar recurrences in the future.

A positive impact for patients leaving with breast cancer has been recognized with nursing care intervention which seems to reduce the subjective distress to the patients. As the powerful memories which the patient had before been diagnosed with breast cancer break through the defense mechanism, intrusion seems to occur. Breast cancer patients seem to have some stress situations which are most of the time followed by repetitions of thoughts, emotions and behavior changes like isolating themselves from the community. In these case, the nursing care intervention will play a huge role in educating the society on how to take care of breast cancer patients and the individuals have also been given some guidelines which can enable them to overcome their fears and distress (Mcmillan et al., 2016).

With the help of nursing care intervention breast cancer patients have been liberated from depending on the nurses to take care of their health situation to a level where they are able to manage their own health complication and they are also been to cope with isolation they may experience from family members and the society. Active breast cancer patient education and some importance timing are termed as the key to a successful nursing intervention which reduces the side effects and stress which a patient is supposed to most of the time go through while undergoing through the treatment and the recovery process.


Health care specialists and nurses should keep in mind that they should respond with respect to patients suffering from breast cancer.  They should diagnose variances and expressions of each human being. It is the responsibility of the nurses and other health professional to build work that focuses its attention on the patients and their needs. Family members and the community at large should be educated on how to take care of breast cancer patients and not isolate them but sower them with love to feel like part of the community. Nurses’ should use their expertise and skills as well as their systematic familiarity of medical oncology and they should also be aware of the patient’s personal experiences with the breast cancer by asking them or seeking information from their family members


Butow, P., Price, M. A., Shaw, J. M., Turner, J., Clayton, J. M., Grimison, P., ... & Kirsten, L. (2015). Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psycho?Oncology, 24(9), 987-1001.

Cedar, S. H., White, M., & Atwal, A. (2018). The efficacy of complementary therapy for patients receiving palliative cancer care. International journal of palliative nursing, 24(3), 146-151.

Coyle, D., Grunfeld, E., Coyle, K., Pond, G., Julian, J. A., & Levine, M. N. (2013). Cost effectiveness of a survivorship care plan for breast cancer survivors. Journal of oncology practice, 10(2), e86-e92.

Dougherty, L., & Lister, S. (Eds.). (2015). The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.

Edvardsson, D., Watt, E., & Pearce, F. (2017). Patient experiences of caring and person?centredness are associated with perceived nursing care quality. Journal of advanced nursing, 73(1), 217-227.

Holm, M., Årestedt, K., Carlander, I., Wengström, Y., Öhlen, J., & Alvariza, A. (2017). Characteristics of the family caregivers who did not benefit from a successful psychoeducational group intervention during palliative cancer care: a prospective correlational study. Cancer nursing, 40(1), 76-83.

Kuijpers, W., Groen, W. G., Aaronson, N. K., & van Harten, W. H. (2013). A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. Journal of medical Internet research, 15(2).

Mayer, D. K., Birken, S. A., Check, D. K., & Chen, R. C. (2015). Summing it up: an integrative review of studies of cancer survivorship care plans (2006?2013). Cancer, 121(7), 978-996.

McAlpine, H., Joubert, L., Martin-Sanchez, F., Merolli, M., & Drummond, K. J. (2015). A systematic review of types and efficacy of online interventions for cancer patients. Patient education and counseling, 98(3), 283-295.

McIlfatrick, S., Connolly, M., Collins, R., Murphy, T., Johnston, B., & Larkin, P. (2017). Evaluating a dignity care intervention for palliative care in the community setting: community nurses’ perspectives. Journal of clinical nursing, 26(23-24), 4300-4312.

Mcmillan, K., Butow, P., Turner, J., Yates, P., White, K., Lambert, S., ... & Lawsin, C. (2016). Burnout and the provision of psychosocial care amongst Australian cancer nurses. European Journal of Oncology Nursing, 22, 37-45.

Tinetti, M. E., Naik, A. D., & Dodson, J. A. (2016). Moving from disease-centered to patient goals–directed care for patients with multiple chronic conditions: Patient value-based care. JAMA cardiology, 1(1), 9-10.

Watts, K. J., Good, L. H., McKiernan, S., Miller, L., O’Connor, M., Kane, R., ... & Musiello, T. (2016). “Undressing” distress among cancer patients living in urban, regional, and remote locations in Western Australia. Supportive Care in Cancer, 24(5), 1963-1973.

Yarbro, C. H., Wujcik, D., & Gobel, B. H. (2016). Cancer nursing. Jones & Bartlett Publishers.

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