Palliative and End-of-Life Care

Joshi Kamakani is a 70 year old male with metastatic prostate cancer. He is a retired engineer that the Palliative Care home care team and the NP has been looking after him at home for the last two months. Joshi was diagnosed with inoperable prostate cancer three years ago and has been treated with ablative hormone therapy. Six months ago, Joshi started to have pain in his hips. His oncologist ordered a CT scan and found he had metastases in his ribs, pelvis and lumbar spine. Joshi and his wife June had a meeting with the team at the cancer centre and decided not to go ahead with any further cancer treatment. The NP team has been involved since.

June called the NP yesterday and asked for a home visit. Joshi has been having more pain this week and has been spending most of his time on the couch. He cannot get around without assistance and is very fatigued.

Joshi’s past medical history includes hypertension and reflux. He is taking Predisone 5 mg PO BID, Leuprorelin Depot 22.5mg IM every 3 months, hydrochlorothiazide 25 mg daily and pantoprazole 40 mg daily.

For pain, Joshi takes Morphine slow release 100 mg q12h and has not needed additional medication for breakthrough pain so far.


Learning Outcomes

  • Symptom Management.
  • Understanding of opioid rotation.
  • Applying guidelines for pain management.
  • Communicating assessment and treatment plan to client and family.
  • Understanding the role of the Rx monitoring programs.

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