| Course | NURS 6912 Symptom Management for the Hospice and Palliative Care Clinician |
|---|---|
| Week | Week 5 |
| Paper type | Gastrointestinal symptom plan |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6912 Week 5
One Chain, Three Links: A Gastrointestinal Symptom Plan for Constipation, Nausea and Lost Appetite in a Woman With Advanced Ovarian Cancer
Student Name
College of Nursing, Walden University
NURS 6912: Symptom Management for the Hospice and Palliative Care Clinician
Instructor Name
Month Day, Year
One Chain, Three Links: A Gastrointestinal Symptom Plan for Constipation, Nausea and Lost Appetite in a Woman With Advanced Ovarian Cancer
The Patient
A former high school chemistry teacher, 63, lives with ovarian cancer that has spread through her abdomen after three lines of chemotherapy. For the past month she has taken a long-acting opioid with a short-acting dose as needed for abdominal pain, which is now well controlled. Over the last two weeks she has had fewer and harder bowel movements, feels queasy for an hour or two after every meal and has lost interest in food. She lives with her younger sister, who has moved in to help and who shows her care by cooking: full plates of the dishes their mother made, three times a day. The patient eats a few bites and feels guilty. She said, "I feel sick, I can't go, and I can't eat what she makes."
Considered separately, each symptom could be treated with its own medicine. This plan first asks how the three are connected.
Assessment
Each symptom was measured. On the Edmonton Symptom Assessment System, she rated nausea 5 of 10 and lack of appetite 8 of 10, with pain at 2 of 10 (Hui & Bruera, 2017). Her bowel diary over one week recorded two bowel movements, both Type 1 on the Bristol Stool Form Scale, separate hard lumps, a pattern associated with slow transit through the bowel (Lewis & Heaton, 1997). She reports straining and a feeling of incomplete emptying. Her abdomen is soft and mildly distended, with bowel sounds present. She is passing gas. She has not vomited.
Her intake has fallen to a few bites at meals and some fluids. She sips water during the day, well below what she drank before. She walks less than she did, spending most of the day in a recliner, which adds a further brake on bowel movement. Her other medicines were reviewed for contributions to the chain; none, apart from the opioid, is a likely cause of constipation or nausea.
Causal Map
The three symptoms form a chain, summarized in Table 1.
Table 1
Causal Map of Her Gastrointestinal Symptoms
| Link | Leads to | Reasoning |
|---|---|---|
| Opioids and reduced food and fluid intake | Constipation | Opioids slow gut movement and dry the stool; less food and fluid means less bulk and water in the bowel |
| Constipation and slowed gastric emptying | Nausea after meals | A full, slow bowel and a stomach slow to empty make eating uncomfortable; nausea follows meals |
| Nausea | Loss of appetite | Food becomes associated with feeling sick, so appetite falls further |
| Loss of appetite | Less intake | Less food and fluid worsens constipation, closing the loop |
The map suggests that constipation sits near the start of the chain. Treating nausea or appetite alone, without addressing constipation, would leave the loop intact.
Screen for Malignant Bowel Obstruction
Before treating constipation in a woman with abdominal spread of ovarian cancer, the team must consider malignant bowel obstruction, which is common in advanced ovarian and colorectal cancer and changes management entirely (Tuca et al., 2012). The screen looked for colicky abdominal pain, vomiting, especially of large volumes or feculent material, marked distension, absent bowel sounds and no passage of stool or gas.
None of these is present: her pain is controlled and not colicky, she has not vomited, distension is mild, bowel sounds are present and she is passing gas. The screen is negative today. The plan records these findings, and the patient and her sister are taught that new vomiting, colicky pain or no gas should prompt a call the same day, since stimulant laxatives are avoided if obstruction is suspected.
Management in Order
First link: constipation. Guidelines for constipation in advanced cancer recommend regular laxatives for patients taking opioids, usually starting with an osmotic or stimulant laxative and adjusting to response, and assessing for impaction when the rectum is loaded (Larkin et al., 2018). The prescriber will start a scheduled regimen combining the two classes, and the nurse will check for rectal loading, which would need treatment first. Fluids are encouraged in small, frequent amounts she can manage. The goal is a soft, formed stool at least every two to three days without straining. If standard laxatives fail after a fair trial, the prescriber may consider a peripherally acting opioid antagonist, a class designed for opioid-induced constipation.
Second link: nausea. Because her nausea follows meals and fits a pattern of slowed emptying, a prokinetic class is the logical choice if nausea persists once her bowels move, and the prescriber will consider it after obstruction has been reasonably excluded. Small, cool, low-fat meals and sitting upright after eating may help.
Third link: appetite. Appetite is expected to improve partly as constipation and nausea ease. Beyond that, the plan focuses on eating for comfort and pleasure rather than on quantity. Appetite-stimulating medicines are not the first step here, because her lost appetite has a treatable cause.
Her Sister's Cooking
Her sister's cooking is an act of love, and the plan treats it that way. The nurse will meet with both sisters to explain the chain in plain words, so that the sister understands that the plates are not being refused. Together they will agree on small portions on a small plate, favorite foods offered without pressure, cold or room-temperature foods with less smell and a snack basket she can reach between meals. The sister will be given another way to help that matters to the patient, such as walking with her or sitting with her in the evenings, so that her care has somewhere to go when the plates stay half full.
Evaluation
The plan will be reviewed at three days and at one week, using the bowel diary with Bristol types, her nausea and appetite ratings and her own report of how meals feel. Success would mean a soft bowel movement at least every three days, nausea at 2 of 10 or less after meals and appetite returning to the point that she can enjoy part of a meal. New vomiting, colicky pain or absent gas at any point would stop the laxative plan and prompt reassessment for obstruction.
References
Hui, D., & Bruera, E. (2017). The Edmonton Symptom Assessment System 25 years later: Past, present, and future developments. Journal of Pain and Symptom Management, 53(3), 630-643. https://doi.org/10.1016/j.jpainsymman.2016.10.370
Larkin, P. J., Cherny, N. I., La Carpia, D., Guglielmo, M., Ostgathe, C., Scotté, F., & Ripamonti, C. I. (2018). Diagnosis, assessment and management of constipation in advanced cancer: ESMO clinical practice guidelines. Annals of Oncology, 29(Suppl. 4), iv111-iv125. https://doi.org/10.1093/annonc/mdy148
Lewis, S. J., & Heaton, K. W. (1997). Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology, 32(9), 920-924. https://doi.org/10.3109/00365529709011203
Tuca, A., Guell, E., Martinez-Losada, E., & Codorniu, N. (2012). Malignant bowel obstruction in advanced cancer patients: Epidemiology, management, and factors influencing spontaneous resolution. Cancer Management and Research, 4, 159-169. https://doi.org/10.2147/CMAR.S29297
The Walden NURS 6912 Week 5 instructions
Week 5 in this course typically asks you to assess and manage one or more gastrointestinal symptoms, such as nausea, constipation or anorexia, in a patient with advanced illness. A plan of three to five pages is typical. Measure each symptom with an appropriate tool or diary. Look for connections among symptoms before choosing treatments, since one cause may drive several complaints. Screen for serious causes that would change management, such as bowel obstruction in abdominal cancer, and record what you found. Order treatment by the causal chain. Name drug classes with reasons, leaving doses to the prescriber. Include food and family, since meals are social events, and set dates to reassess.
How this NURS 6912 Week 5 example is built
The plan opens with the patient's own summary of her three problems. An assessment section cites Hui and Bruera on the Edmonton system and Lewis and Heaton on the Bristol scale, and records her examination and intake. Table 1 maps four links in the chain. A screen for obstruction cites Tuca and colleagues and lists findings that would overturn the plan, all absent. Management in order cites Larkin and colleagues' ESMO constipation guideline for a scheduled regimen and a peripheral opioid antagonist if needed, then covers a prokinetic class and comfort eating. A section on her sister's cooking follows. Evaluation sets three-day and one-week targets and a stop rule. No doses appear anywhere in the plan.
Where the marks sit in the NURS 6912 Week 5 rubric
Symptom plans for the gut are usually weighed on assessment quality, reasoning about causes, safety screening and holistic management. Assessment credit goes to specific measures, such as stool type and a diary, rather than general descriptions. Reasoning is often the largest share, and a plan that links symptoms and orders treatment accordingly earns it. Safety is scored on screening for obstruction or other serious causes before prescribing laxatives. Holistic management earns credit for addressing food, family and meaning, not only medicines. Evidence should come from current guidelines. Clear evaluation targets and APA references complete the typical grid, with extra credit in some sections for patient-centered goals. Graders often check that the obstruction screen names the findings that would stop the laxative plan.
NURS 6912 Week 5 help: mistakes that cost marks
Gastrointestinal plans lose marks when each symptom gets its own drug with no thought about how the symptoms connect. Another common loss is prescribing stimulant laxatives without first considering bowel obstruction in a patient with abdominal cancer. Some plans treat poor appetite with an appetite stimulant before addressing constipation and nausea. Others ignore the family's role in meals. Measure each symptom, map the chain, screen for obstruction, treat in order, involve the family and set review dates with a clear stop rule. The desk can draft a plan for the symptoms in your scenario. Where your patient has a feeding tube or stoma, adjust the measures and say why.
Get a NURS 6912 Week 5 example written to your instructions
Put the Week 5 case, prompt and rubric in one message, and list the symptoms the scenario gives and any medications it names. Within 24-48 hours you receive a causal map linking them, a red-flag screen, management by mechanism without doses and a family section. A first request is free.
More NURS 6912 papers and MSN samples
- NURS 6912 Week 1: Discussion post
- NURS 6912 Week 2: Pain assessment writeup
- NURS 6912 Week 3: Pain management plan
- NURS 6912 Week 4: Dyspnea management plan
- NURS 6912 Week 6: Delirium case analysis
- NURS 6912 Week 7: Case analysis
- NURS 6912 Week 8: Discussion post
- NURS 6912 Week 9: Family teaching plan
- NURS 6912 Week 10: Symptom management plan
- NURS 6912 Week 11: Reflection
- NURS 6910 Week 5: Goals of care plan
- DNRS 6501 Week 5: Discussion post
- NURS 6730 Week 5: Policy brief
- DNRS 6521 Week 5: Discussion post
NURS 6912 Week 5 questions, answered
Why treat constipation before nausea?
Because in this case the constipation, largely from opioids and low intake, is judged to be driving much of the nausea, so relieving it may settle both. The example argues that link from her bowel diary and the timing of her symptoms. Your case may point the other way, and the causal map is built from your findings rather than assumed.
What is the Bristol Stool Form Scale doing in a palliative plan?
Giving constipation a measure. The scale classifies stool into seven visual types, which lets the plan record a baseline and show change at reassessment instead of relying on whether she feels regular. Paired with a bowel diary, it gives your management section a target. Any validated bowel measure your course prefers can replace it.
How does the plan address her sister's cooking?
With a short section in plain language explaining that loss of appetite in advanced cancer is usually part of the illness, not a failure of care, and that small amounts of favorite foods offered for pleasure are enough. It gives her sister something useful to do. Rubrics in symptom courses often credit family teaching that eases conflict at the table.
Where can I find a free NURS 6912 Week 5 sample paper?
The complete plan, causal map, obstruction screen, ordered management and the sister's section, is available here without a fee. A plan for your scenario's symptoms can be requested.
Why does the NURS 6912 Week 5 plan treat constipation first?
Because the causal map places it near the start of the chain: constipation and slowed emptying drive the nausea, and nausea drives the lost appetite, so treating the later links alone leaves the loop intact.