Integrated Nursing Practice

Table of Contents


Identification of issues of Stephen Robertson.

Rationale and categorization of issues.

Nurse’s role in addressing the health issues.



Introduction to Stephen Robertson Case Study

Stephen Robertson is a 68 years old male patient who is suffering from colorectal cancer from the last four years. He had a colostomy in-situ followed by bowel resection surgery about four years ago. For the last three months, he has been suffering from the last stage of cancer as this becomes metastasized to the lungs and brain. The current study will deal with the identification of the various issues faced by Stephen alongside its rationale and the role of the nurses in curing those issues.

1. Identification of Issues of Stephen Robertson

Stephen Robertson, at present is admitted to the oncology ward as he is facing severe pain for this last phase of cancer. His health condition was continuously detonated and it was risky to take care of him in his home that is why his family shifted him to the hospital. His family members have accompanied him in the hospital. The main three health issues, which he is facing at this right moment, are as follows. 

Issue 1: For the last three months, he has lung and brain cancer as it has metastasized from colorectal cancer. At the last stage of colorectal cancer, it can spread to other distant organs like the lungs and brain. Now he is in the last stage of the cancer and this issue is really crucial and has to be minimized as soon as possible. He is facing severe pain and could not sleep well for the past week (Kjellstadli et al. 2019).

Issue 2: Along with the first issue the patient named Stephen Robertson is staying mostly in an unconscious state and is verbally inactive due to a high dose of medicines. Those medicines are Morphine, which was administered to him by the subcutaneous route and hyoscine by the abdominal subcutaneous route (Bushy, 2019). 

Issue 3: The patient has been kept in NBM (Nil by Mouth), this affects badly on nutrient uptake, and due to lack of food and water intake, several injuries can occur within the patient's body (Kanno et al. 2019).

2. Rationale and Categorization of Issues

All the issues mentioned above are vulnerable to Mr. Stephen Robertson as he is in the terminal stage of cancer. Therefore, according to priority, they are enlisted below to justify their negative impact on the physical and mental health quality of him.

Priority 1: Metastasis in brain and lungs

At the later stage of colorectal cancer, it has a high frequency of metastasis to other distant organs, especially the extra-abdominal sites, like the liver, lungs, and brain in a rare case. The lung is a very common site of metastasis for the fourth and the last stage of colorectal cancer. Though the brain metastasis is a rare event of colorectal cancer spreading, still the impact is very high for severe neurological symptoms and cranial and extracranial dysfunction (Lee, 2020). The survival rate and prognosis rate are poor for this case and at the terminal stage; this is harmful and cannot be cured.

Priority 2: Unconsciousness

The most frequent symptoms of unconsciousness are fatigue, nausea, vomiting, loss of appetite, severe breathing trouble, and chest pain, problems with swallowing. The combined effect of both of these two cancers along with the terminal stage of colorectal cancer has a severe effect on the patient’s health condition as well the mental health like anxiety and depression. Consciousness is self-awareness about the surroundings and able to respond to the external stimuli. In another word, impeded consciousness can be defined as impaired alertness towards the surroundings, loss of verbal communication (De CuntoTaets, 2016).

Priority 3: NBM

Vulnerable effect of NBM is significantly low for patient as this can be cured through proper nutritional uptake and ointments are effective for this problem reduction. Therefore, according to priority list, it can be categorised under third sections for defying vulnerability for terminal stage cancer patients.


The above-mentioned prioritization is completely based on current evidence of oncological practice for an old aged patient. As per the view of Bushy (2019), end of life, nursing care is required for patients to provide them recovery from a vulnerable situation. Metastasis is considered as the most critical issue for Roberston as transportation of germ from one tumour cell to another is fatal and all the body parts are affected because of this. From the case study, it is clear that Stephen Robertson has faced negative impact of metastasis and the additional injuries such as NBM, unconsciousness are negative results of this. It is reported that in Australia, cancer is termed as deadly offspring and rate of unwanted cell proliferation is high for elderly people (De CuntoTaets, 2016). One of the two Australian men and women are affected by cancer and the probability of death is high for this country.

Unconsciousness is another major issue for cancer patients as this reduces physical health capacity and mental health issues are major for this case. As per the opinion of Kanno et al. (2019), deadly causes of cancer are vulnerable and morphine is harmful for patients to sustain in life. It is reported that patients with high unconsciousness died 50% earlier than with a conscious patient. On the other hand, weakness and exhaustion are two inadequacies for terminal stage cancer patients for affecting negatively on both their physical and mental health.

In addition, Khrais (2018) pointed out that the issue for NBM is directly related with minimal intake of food and minerals for individual patients. As a result, ability to talk or concentrate on a particular thing can be reduced and no appetite for nutritional motion is responsible for weight loss. Along with this, it can also be analysed that severity of additional symptoms such as anaemia also happens due to NBM (Kjellstadli et al. 2019). Therefore, probability of death is also increased for individuals but this can be treated under suitable medical norms and rules. Therefore, it is considered under third category where vulnerability of the disease can be cured by using various medical equipment.

3. Nurse’s Role in Addressing the Health Issues

Stephen Robertson has been suffering from colorectal cancer for four years. He also had a Colostomy in-situ and bowel resection surgery. The three critical issues that Mr. Robertson has been suffering from as studied by the nurse in-charge are-

  1. Less consciousness with a lack of verbalization and opening eyes only when feeling pain.
  2. He is an NBM and so needs oral care and less output through colostomy.
  3. He has developed terminal metastases of the brain and lungs for the past three months.

Nursing assessments for solving all three problems are given below with proper justification.

Assessment 1: Treatment for unconsciousness of patient

Nurses should not feed unconscious patients like Mr. Robertson orally as he has undergone a colostomy. To avoid aspirations, nurses to remove excess oral secretions must carry out suction. National Safety and Quality Health Services (NSQHS) have laid propositions to use oral and nasopharyngeal airway to sustain potency of the airway and help in easy removal of secretions (Lee, 2020). Mr. Robertson needs proper monitoring and recording of his respiratory function which includes oxygen saturation, blood pressure, respiratory rate, and breathing regularity. Naloxone injections and resuscitative equipment are advised to the nurses to be kept available to avoid life-threatening and unsupportable side effects (Ndiok&Ncama, 2020).

Assessment 2: Recovery from NBM

Mr. Robertson must have been suffering from dehydration since he is an NBM that has led him to face a decreased level of consciousness. According to RN guidelines, proper management of fluid balance and fasting times prevents dehydration (Sancar, Yalcin &Acikgoz,2018). Mr. Robertson is given a clear, carbohydrate-rich drink by nurses before midnight and a second drink 2-3 hours before chemotherapy to reduce their discomfort from fasting. Evidence suggests that carbohydrate drinks help reduce the loss of body mass and decreases nauseatic tendency. This promotes gut motility and reduces the risk of developing ileus. Mr. Robertson also requires proper oral care by nurses for being an NBM. Chlorhexidine mouthwashes or 0.9% saline can also be used to maintain the pH. Lip balm or water-soluble gels can be used for lip dehydration preventionwith the help of nurse professional (Saadoon et al. 2019).

Assessment 3: Reduction of metastasis

The nurses are involved in taking care has to be a skilled practitioner and both emotional and physical strength can be provided by Mr. Robertson. Before each chemotherapy cycle, the nurse has to identify any toxicity experienced by assessing the health condition and execute any change in the treatment pathway (Thasaneesuwan & Nilmanat,2019). The nurse should communicate properly with Mr. Robertson because at times his unwillingness to describe the side effects and fear of ceasing chemotherapy can lead to serious side-effects. According to the NSW Health Policy guidelines, the nurse should also assess the psychological impacts of cancer diagnosis, improvements, and the uncertainties of the outcomes. A distress thermometer is to be used which measures the physiological well-being of the patient (Seifart et al. 2020). Performance status after each chemotherapy, toxicity tools, and holistic needs assessment tools are used to record the general well-being of Mr. Robertson. Following the NSW Policies, nurses from nurse-led chemotherapy clinics are treating Mr. Robertson.

Conclusion on Stephen Robertson Case Study

From the above study it can be concluded that the issues that are being faced by Stephen includes lung and brain cancer as it has metastasized from colorectal cancer. Besides, the patient is also staying in an unconscious state. In addition to this, he has been kept in NBM (Nil by Mouth), this affects badly on nutrient uptake, and due to lack of food and water intake, several injuries can occur within the patient's body. Henceforth, the role of nurses such as removing excess oral secretions based on the standards of National Safety and Quality Health Services (NSQHS), giving a clear, carbohydrate-rich drink by nurses and others can help the patient to overcome the state of current illness.

References for Stephen Robertson Case Study


De CuntoTaets, G. G. (2016). The nursing care in front of the dying process in oncology. J Nurs Care, 5(337), 2167-1168.

Kanno, Y., Sato, K., Shimizu, M., Funamizu, Y., Andoh, H., Kishino, M., ... & Miyashita, M. (2019). Development and Validity of the Nursing Care Scale and Nurse’s Difficulty Scale in Caring for Dying Patients With Cancer and Their Families in General Hospitals in Japan. Journal of Hospice and Palliative Nursing, 21(2), 174.

Khrais, H. I. (2018). Quality of life determinants among lung cancer patients near the end of life. International Journal of Caring Sciences, 11(3), 1580-1587.

Kjellstadli, C., Han, L., Allore, H., Flo, E., Husebo, B. S., &Hunskaar, S. (2019). Associations between home deaths and end-of-life nursing care trajectories for community-dwelling people: a population-based registry study. BMC health services research, 19(1), 698.

Lee, G. E. (2020). Analysis of Spiritual Care Experiences of Acute-Care Hospital Nurses. The Korean Journal of Hospice and Palliative Care, 23(2), 44-54.

Ndiok, A., &Ncama, B. (2020). Barriers and benefits of model development for integration of palliative care for cancer patients in a developing country: A qualitative study. International Journal of Nursing Practice, e12884.

Pesut, B., & Greig, M. (2018). Resources for educating, training, and mentoring nurses and unregulated nursing care providers in palliative care: a review and expert consultation. Journal of palliative medicine, 21(S1), S-50.

Saadoon, M. M., Abouzeid, M. I., Salama, E. S. S., & Wahba, N. M. (2019). Self-Rated Anxiety and Attitude Responses of Pediatric Nurses Surveyed about Providing End of Life Care. American Journal of Nursing Research, 7(3), 316-321.

Sancar, B., Yalcin, A. S., &Acikgoz, I. (2018). An examination of anxiety levels of nursing students caring for patients in terminal period. Pakistan journal of medical sciences, 34(1), 94.

Seifart, C., Knorrenschild, J. R., Hofmann, M., Nestoriuc, Y., Rief, W., & von Blanckenburg, P. (2020). Let us talk about death: gender effects in cancer patients’ preferences for end-of-life discussions. Supportive Care in Cancer, 1-9.

Thasaneesuwan, S., &Nilmanat, K. (2019). Psychological Distress in Patient with Cancer Undergoing Chemotherapy and Nursing Care. Songklanagarind Journal of Nursing, 39(4), 110-119.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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