Difficult terminal patient

On my cardiopulmonary prac I was treating an elderly man post AP resection. I was donated this patients as he was a larger man who was difficult to motivate. Through-out the time I treated this man, he received some bad new, the cancer he was originally treated for had in fact spread to his liver and was now terminal.

It was difficult to continue treating this man as he was originally unmotivated and uncompliant in his treatment. The bad new made it more difficult and treatment aims had to change post news.

Before a lot of the motivating factors included the normal cardio spill, ie walking helps lungs re-inflated ect ect. But with the news that he only had months to live the normal motivating factors were inadequate to get this man out of bed. Before I was very persistent to get this man out of bed, and didn’t stop until he in fact had. I didn’t feel that nagging him to get up was appropriate after the doctors had told him about the spread of his cancer.

Discussing this case with my supervisor we decided to spent more time educating the importance of maintaining active and functional independence and to give him more of a choice to what treatment he wanted to participate in.

The aims of treatment were chosen to maintaining maximal functional independence, and discourage lying around in bed (which he was quite accustomed to) By the end of the prac we were only able to continue bed exercises as he was unwilling to sit out of bed or ambulate. I feel I didn’t help this man as much as I could have, and exhausted so many options to motivate him.

By the end, I treating him day by day, some days he wanted to participate more that others and some days he just wanted to lie in bed. I found it difficult to treat this man but learnt you can only do so much when the patient is willing.