AJ28

She is hungry actually. Today she ate some chips and cheese and seemed to tolerate them pretty well. No n/v at all. She knows it not a permanent fix but thinks it may improve what time she has left if it will give her some energy. She says the main reason she even feels bad at this point is that she is so weak. The ascites haven't returned yet... its been a week. She is one of those patients that continues to amaze us. Always so upbeat and positive and she always seems to beat the odds. (Been given 3 months to live at least twice in the past 4 years).

Tell me if this makes sense: Pt diagnosed with stage 3 ovarian 4 years ago. Cancer has metastized to line the GI tract and causing ascites. Basically has a non functioning GI tract. Can't eat or really drink anything. If she does it absorption will be impaired to say the least. Dr says that if she can't absorb anything she may last a month, if she can tolerate some then it may be 3+ months. So basically she is going to starve or dehydrate. She requested TPN. Have any of you heard of TPN being used in a case like this? I was under the impression TPN was not done in a hospice or home care setting. Is it justified and could it help (theoretically)?

I have to come up with 4 care plans for my patient tomorrow. I don't usually have any trouble with this so I'm getting very frustrated. The pt has an abdominal wall abscess from a surgical scar. Pt has no abnormal vitals nor labwork. We have to come up with these the day before so we don't have a chance to do any kind of assesment to try and glean more information. Pt. is simply in the hospital waiting on nursing home placement from what the nurse told me. At least on of my NDs need to fit into a certain category (cardiac, PV, neuro, cancer, hematology, discharge planning or psychosocial) so I can do a concept map/care plan on it. Please help!!! I'm so lost! Thanks!