Ms. Agatha Costas is a 42-year old woman, diagnosed with right sided metastatic breast cancer. She has lymphatic metastases in the right axilla and metastases in her liver and both lungs. The primary lesion was surgically removed as a lumpectomy three years ago but was identified as a particularly aggressive form of cancer related to the BRCA1 gene. Two months ago, Agatha began experiencing increased respiratory distress, fatigue, abdominal pain, chest heaviness and some confusion.
Agatha is divorced and has one child. Alec is 12 years old and is autistic. Agatha’s ex- husband moved back to Greece before Alec was born, where he has remarried and started a new family. There has been no contact for 12 years.
Prior to developing the metastases causing respiratory distress and confusion, Agatha worked as a part time patient care attendant (PCA) in a local nursing home, and has been the sole caregiver of Alec. Two months ago she decided to resign from work, to care for her son and herself with the assistance of her sister Irene. Agatha receives support from the local Greek community and Church in the form of meals and general house duties.
Current symptoms Agatha is experiencing include:
· itchy skin
· swollen abdomen
· shortness of breath on exertion (after ambulating for four/five metres)
· dry, persistent cough
· reduced appetite
· dry mouth
· oral thrush
· confusion and forgetfulness
Her current medications include:
· Nystatin oral solution 1ml four times a day pc
· Metoclopramide 10 mg three times a day 30 minutes before meals
· Salbutamol inhaler 2 puffs four times a day.
· Spironolactone 100 mg daily
· Prednisolone 10 mg twice a day
· Targin 10mg/5mg BD
· Endone 5mg PRN
Although Agatha has been educated about the prognosis of her condition, as a Greek Orthodox she believes that there is possibility of a miracle and is spending a lot of her time in Church, fasting when she can. Her Church community is continuing to cook and pray for her although they cannot get her to eat well and are very worried about her. Agatha is taking her medications intermittently when she remembers, focusing any spare time on her son Alec.
You are the community nurse and have been seeing Agatha at her home for three weeks.
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