When would the nurse or other members

Ms. D is a 47-year-old woman who was diagnosed with vulvar cancer at the beginning of 2017. She is also HIV-positive. By the time Ms. D engaged in care, the cancer had proliferated quite quickly in the setting of a compromised immune system. Upon discovery of the Stage 4 cancer, doctors recommended a dose of radiation and chemotherapy. However, during the course of this episode Ms. D was struggling with substance use. During her hospitalization, she tested positive for a number of substances, including heroin and cocaine.

1. What are the best pain management approaches for cases in which extreme pain is combined with active addiction?

2. What are some ways to mitigate the risk of further addiction and or potential overdose in this patient?

3. When would the nurse or other members of the care team suggest hospice for Ms. D, and what could hospice offer in the care of this patient?

4. If Ms. D decides to stop treatment such as chemotherapy and radiation despite her oncologist stating treatment will give her more time. Should the nurse support this decision, why or why not? How should the nurse advocate in the patients best interest in this ethical dilemma?

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