Scenario Mr. Kuan is a 51 old Interior Designer: Chronic Disease Management for Healthcare Professionals Assignment, NUS, Singapore

Scenario
Mr. Kuan is a 51 old interior designer. He and his wife have two children, a son (23) and a daughter (25). Mr. Kuan has been feeling unwell with a loss of weight and increasing fatigue over the last month. It is a Monday morning and he was about to go to work but over the last 24 hours has developed severe abdominal pain and abdominal distension and his wife decides they need to go to the Emergency department.

He has previously been fit and well and there is no family history of Gastric Intestinal disease. He currently takes no medication On admission Mr. Kuan’s observations are respirations are 18/min, Heart rate 80/min, strong and regular, Blood pressure 114/70mmhg, and Temperature 36.0. Blood sugar 4.2. He is alert and orientated.

On the unit, Mr. Kuan has to have his pain assessed and stays currently Nil by Mouth in order to maintain safety if requiring an operation. Mr. Kuan is complaining of nausea and has vomited since arriving in the hospital. It also appears that Mr. Kuan has been having very loose bowel movements for the last 5 days.

Mr. Kuan is reporting increasing abdominal pain, which is spasmodic in nature. The pain is so severe it is preventing him from being able to walk and requires him to be given analgesic on STEP three of the WHO pain ladder. He is commenced on a pain pump to maintain patient-centered control. After being diagnosed by a CT scan and exploratory operation.

Mr. Kuan is diagnosed with Dukes B stage of colorectal cancer requiring further pain control; antiemetics and a course of chemotherapy will be prescribed. Mr. Kuan after being discharged and home for 2 weeks continue to suffer from pain at the operation site associated with surgical removal of the tumor and poor healing of tissue. Mr. Kuan is beginning to experience difficulty

Mr. Kuan after being discharged and home for 2 weeks continue to suffer from pain at the operation site associated with surgical removal of the tumor and poor healing of tissue. Mr. Kuan is beginning to experience difficulty in controlling his bowel movements; along with the pain, resulting in Mr. Kuan, having increasing anxiety about leaving the house.

Mr. Kuan’s wife is getting worried that the current pain is not under control and is asking the General Practitioner to prescribe a stronger analgesic. She is finding it difficult to know how best to support her husband. The general practitioner prescribes a weak opioid, but this has a constipating effect on Mr. Kuan. Mr. Kuan finds that returning to normal bowel habits is going to require advice on management.

Mr. Kuan is unable to work at present. He finds it difficult to be reliant on his family and is worried about how he will pay the bills.

advice on management

Mr. Kuan is unable to work at present. He finds it difficult to be reliant on his family and is worried about how he will pay the bills. Four weeks later Mr. Kuan’s pain has decreased but now he finds himself very fatigued and anxious whilst receiving his first chemotherapy treatment and not able to return to work.

After being in bed for a number of weeks Mr. Kuan has lost a lot of muscle mass in his legs and arms and it is taking him a lot of effort to do simple things. Mr. Kuan’s mental health is also being affected. The family is happy that he has recovered from the operation and is expecting him to be back to his normal self. However, Mr. Kuan is taking to his bed more and being very non-communicative when out of bed, and becoming increasingly isolated.