In the patient with terminal lung cancer, the focus of nursing care is on which of the following nursing inte… - Chitranjjan National Cancer Institute Kolkata - 2021

Chitranjjan National Cancer Institute Kolkata - 2021

Medical & Surgical Nursing

Medium

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

In end-of-life care for terminal cancer, the primary goal is to ensure comfort and enhance the quality of remaining life.
Pain is one of the most prevalent and distressing symptoms in advanced cancer, and its effective management is the cornerstone of palliative care.
Uncontrolled physical pain is a significant source of suffering that can prevent the patient from addressing other important psychological, social, or spiritual issues.
Prioritizing pain control aligns with Maslow's hierarchy of needs, where fundamental physiological needs (like freedom from pain) must be met before higher-level needs can be addressed.

Option A: Preparing a will is a legal and administrative task, not a clinical nursing intervention. While a nurse might facilitate access to resources, it is not the primary focus of nursing care.
Option B: In the terminal phase, forcing nutrition can cause physical distress such as nausea, bloating, and fluid overload. The patient's metabolic needs are decreased.
Option C: While emotional support is vital, it is considered a secondary priority to managing severe physical pain. It is difficult for a patient to engage emotionally or psychologically when they are in significant physical distress.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prioritization of Nursing Interventions in Palliative Care to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in palliative care is symptom management and patient advocacy. This includes performing regular pain assessments using a standardized scale and advocating for changes in the pain regimen if it is ineffective.
Effective pain management involves administering medications 'by the clock' (on a schedule) rather than just 'PRN' (as needed) to prevent breakthrough pain and maintain a consistent level of comfort.
Nurses must also be vigilant in assessing and managing the side effects of opioids, such as constipation, nausea, and sedation, to improve the patient's tolerance and overall well-being.

How to Approach the Question

First, identify the context of the question: the patient has a 'terminal' illness. This immediately signals that the focus of care is palliative (comfort-oriented), not curative.
Next, analyze the options based on the principles of palliative care and prioritization frameworks like Maslow's hierarchy of needs.
Recognize that physiological needs (like breathing, comfort, and freedom from pain) are foundational and must be addressed before higher-level psychological or social needs.
Evaluate each option: Is it a physiological or psychological need? Is it a nursing priority or an administrative task?
Compare the high-priority needs. While emotional support is important, uncontrolled pain is a severe form of physical distress. Conclude that managing pain is the most immediate and fundamental nursing priority to provide comfort.

Concept Tested & Keywords

Concept Tested: Prioritization of Nursing Interventions in Palliative Care
Stem keywords: terminal lung cancer, nursing care, nursing interventions
Lead-in keywords: focus
Clinical cues: The term 'terminal' indicates that the goal of care has shifted from curative to palliative (comfort-focused).

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