Mesothelioma pt.

[ajitamamasita]

Hello,

I have a new hospice pt. with a dx of mesothelioma of the pleura. Pt. has a pleural drain that is drained 3 x week. I've tried researching this illness and I'm getting conflicting information. Can anyone who has had a terminal pt. like this tell me what to expect with the course of this disease. My pt. is already sob at rest, fatigues very easily, and is on 2L O2 contin. We've discussed using roxanol for sob, but so far pt. refuses. The thing that most recently came up is this new increase in his abdom girth...which I'm assuming the cancer has spread to the peritoneum??? Any info anyone can provide would be greatly appreciated.

[SurrealMoment]

I would study his H&P, his scans, to locate the plaques and their sizes..meso is a type of cancer, with plaques invading tissues and spaces. I have one such pt now. It could be a fairly slow decline with a sharp drop at the end, unless your fellow is already near the drop off, as you say he is SOB at rest? Tell him morphine (or a derivative) is his best friend for his SOB, and you have many choices of effective preventatives and remedies for constipation! But that morphine will make his breathing more efficient, and reduce his effort to breathe. Do a lot of teaching how morphine relieves respiratory distress! And don't forget Lorazepam to pump up the dyspnea relief! Try to tell him help is available and he can feel better,and try to find out about his primary fears so you can address them. Good luck.

[ErinS, BSN, RN]

Great recommendations from surrealmoment. Also, i have found for pt's who absolutely refuse morphine, that something like a saline neb makes them feel like they have the power to manage the symptoms, and that can relieve anxiety as much as ativan.

[eternalsunshine]

I think education is a big thing here, there is so much negative portrayal of opioid type drugs etc in TV programmes etc. that people seem to assume that they will become an addict if they take it. I wonder if he has some underlying fears like this

I would start by asking him about if he has any questions about taking an opioid type drug and how incredibly effective it is when used at a very low dose to improve the symptoms of Dyspnea. Ask him if he has any worries or thoughts about this group of drugs, rather than asking him why he doesn't want to take it, as this can come accross sometimes a bit threatening to a patient. I was taught on a course about always trying to use an alternative questioning line to 'why' which can come accross a bit accusing to some patients. You could suggest him trying a dose and maybe someone could sit with him for a while afterwards, in case he is scared but does not want to say anything for fear of sounding silly.

Also .5 lorazepam works fantastic for a lot of patients to just 'take the edge off' if there is increased anxiety and calm down the shortness of breath. Also fatigue is extremely common with this disease. Making sure that the patient has everything to hand, such as his phone, drink, call bell etc, so he does not have to get up unnecessarily and can conserve his energy for more enjoyable things such as family visits.

The increasing Abdo girth could be due to Ascites from metastatic disease. A abdominal exam could confirm if there is fluid accumilating.

You may find this information of help:

http://www.medicinenet.com/ascites/article.htm

Hope this is of help :)