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engaging in a reasoning process regarding the risks and benefits of procedures and or treatment options and (4) his ability to chose whether or not he wants to pursue further treatment or testing.Decision-making processes for this patient should be structured around the patient and his familyso they all can review all options, risks and benefits and achievable outcomes (Kane, Ouslander, Abrass & Resnick, 2013). Encouraging C.G. to participate in his advance care planning gears him towards thinking about his priorities, beliefs, values and how they want to be cared for towards the end of their life(Kane, Ouslander, Abrass & Resnick, 2013). Some topics of consideration include CPR, mechanical ventilation, chemical resuscitation, artificial nutrition or intravenous hydration, transfusions, organ tissue donation and use of medical devices such as pacemakers etc. the clinician can also help the patient and his family think towards other EOL services such as funeral and memorial service arrangements. An advance directive is a legal document that allows a patient to convey their decisions about their EOL care in an event that the patient is not able to express their wishes 9 Kane, Ouslander, Abrass & Resnick, 2013). ADs help simplify patient’s wishes and decision-making to be executed by the designated representative. They also help the executor feel confident, despite their beliefs and values, that they executed and honored the wishes of their loved one. C.J. does not have an AD, as a clinician, once should assist the patient in making an AD especially given his terminal disease. It will provide an opportunity for his family members to also feel involved in his care and execute his wishes without compromising their values or beliefs. PLAN.1.Secondary malignant neoplasm of respiratory and digestive systems (ICD 9 197) as evidenced on PET CT.Obtain 5th vital sign assessment – pain and treat accordingly. Pain due to cancer is a complex symptom that affects most aspects of a person's life, including physical functioning, the performance of activities of daily living, psychological and emotional status, and social
interactions. It is beneficial to identify the etiology of the pain as it can potentially alter the prognosis of the disease or affect the plan of care for treatment. Given the high prevalence of cancer pain and its potential for profound adverse consequences, all patients with active malignancy should be routinely screened for pain (Goudas, Bloch, Gialeli-Goudas, Lau & Carr, 2015). Recommend treating pain with Codeine 15mg PO every 4hrs for moderate to severe pain not to exceed 360mg/day (Goudas, Bloch, Gialeli-Goudas, Lau & Carr, 2015). It is available in several dosage forms that are appropriate for moderate pain in cancer patients with limited to no opioid exposure and dose can be escalated to relatively high doses (60mg PO every 4hrs max) for severe pain that worsens over time.