Complex Case About John Smith


Task Description

This assessment task focuses on a complex case about a gentleman (John Smith) who is living with a life-limiting illness. You can view the full details about in the section below – see ‘John Smith Case Study Notes’.

For this assessment task, you will be required to develop a plan of care for John Smith following his transfer from acute care to home in the community. You are to select two key areas on which to focus and develop your plan of care decisions and/or actions using the highest level of evidence available. These 2 key areas do not necessarily need to be related to each other,

For your two key areas:

  1. a physical symptomin which a medication is commonly used to help decrease symptoms (ie pharmacological/medicationintervention should be explain in pathophysiological related to patient condition) and
  2. a psychosocial aspectof care(non-pharmacological intervention)
  • John is in the end of life. He wants to go home with the package (kindly research what can be the inclusion in home package during end of life).
  • Aside from the patient John, also consider as well the psychosocial issues of the family his wife and daughter.
  • John is in his deteriorating phase.
  • Consider the significance of pain in end of life and relate it to John condition.

You will need to incorporate selected research articles into your plan, while incorporating applicable pathophysiology and pharmacology into your discussion.

John Smith Case Study


  • Patient name:John Smith
  • Age:58
  • Next of Kin:Susan Smith (wife). John has a daughter (Jane, 31) who lives in Los Angeles. 
  • Consultant:Dr Parry.
  • Diagnosis:Stage IV Non-Small Cell Lung Cancer with bone and liver metastases. Diagnosed March 2017. Previously treated with chemotherapy and palliative radiotherapy. 

Patients Notes:

John is a 58-year-old male with advanced lung cancer. He has been an inpatient on Medical Ward 2 for five days. You are the nurse responsible for his care. John was admitted initially for treatment of a chest infection and symptom management of severe back pain and right-sided abdominal pain. 

On admission he was commenced on IV antibiotics for his chest infection and was reviewed by the palliative care nurse specialist who increased the dose of his analgesics for pain control. Since admission, John’s condition has progressively worsened and he is now in the deteriorating palliative care phase of his illness. John and Susan have spoken at length with medical and nursing staff about his wishes for end-of-life care. John has expressed his wish to go home with a package of care designed to enable John to die at home and to support Susan and Jane. Their daughter Jane is on her way home from Los Angeles and is hoping to arrive by the end of the week. An initial clinical assessment was conducted by the consulting palliative care nurse who visited John on the medical ward. This information is to be used in the referral to the community palliative care nursing team. 

His wife is anxious about John’s breathing and if it will worsen. She also wants to know how long John might have left to live as she is anxious their daughter Jane could miss saying goodbye to her father. John was commenced on a syringe driver of hydromorphone 20mg and midazolam 10mg to help manage his symptoms. 

His last vital signs were taken at 0800 today:

  • BP:114/58 mmHg
  • HR:90 bpm
  • RR:20 bpm
  • Temp:8
  • SpO2:94%

Regular Medication:

  • Hydromorphone 20mg + midazolam 10mg mixed in a syringe driver for pain/symptom management 24-hours. 
  • Movicol 2 sachet PO daily.

PRN Medications:

  • Hydromorphine 0.5mg subcut 4 hourly PRN pain/breathlessness
  • Midazolam 5mg subcut 4 hourly PRN anxiety/agitation/breathlessness
  • Coloxy and Senna 2 tabs tds PRN constipation
  • Microlax enema nocte.
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