Visiting Nurse Journal


My new patient isn’t doing very well. There is so much going on with her. She’s having trouble swallowing and her lungs remain totally congested. More cancer treatments loom in her future. Although I am seeing her everyday, alot of my work is done behind the scenes.

All the way back to the office I’m thinking about what I need to do for her.  With her dysphagia (trouble swallowing), nutrition is a big concern. Today she showed me a cup of cranberry juice that was thickened to the consistency of honey. This is the kind of fluid she was advised to drink. Unfortunately, she hates it because it makes her nauseated.  I don’t know much about thickened fluids so I do some research. I want to know what the alternatives are. I call our speech therapist and dietician. They can see her early next week. I find a patient information sheet online that is useful. They have recipes for nourishing and tasty shakes that meet the requirements of her special diet. I’ll bring it to her tomorrow.

I get a piece of scrap paper out and start to write down some of the things I need to do. I’m going to call her doctor and let her know that I’m worried. I stop into the social workers office. I need her to see the patient real soon. With her dismal prognosis, I need the social worker to see what kind of support the patient and her family need. My clinical supervisor joins the social worker and I and suggests I check her throat tomorrow to make sure she doesn’t have thrush. Oral thrush is real common in cancer/radiation patients.

I think of her house. It is a small two-story house not set up very well for a sick person. There’s no bathroom on the main floor. Her rooms are crowed with furniture. No room for a wheel chair or oxygen tanks. Right now she sleeps upstairs but as her disease progresses, she just may have to have a hospital bed downstairs. So I decide to call the occupational therapist. She’s the one who can evaluate the living conditions and make recommendations for a safe and effective environment.

I know the cancer has spread to her brain but I don’t know where. I pull out her hospital record and find she has lesions in her occipital and parietal areas. I do another look-up on the internet. Just what can I expect for symptoms, I wonder. I soon find out that headaches, confusion, trouble swallowing are the symptoms that I can expect to see. She already has the trouble swallowing. The disease is moving so fast.

It is almost 6pm before I turn off my computer and put away her chart. Right now I have a plan of care for the immediate future. There is always so much planning, researching, and setting up interventions for on-going problems. When I show up at her doorstep I want to be ready to give her my best. Before I finish with this case, I’m sure I will also have given her a part of my heart. That’s the way it goes.

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