Case Study, Chapter 16, End-of-Life Care
1. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort.
- What nursing measures should the nurse use to manage the patient’s dyspnea?
- The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?
2. Ms. Williams underwent a lobectomy for lung cancer 6 months ago, followed by treatment with radiation therapy and chemotherapy. On her most recent visit to the oncologist, she is told that despite the treatments, there is evidence of metastatic disease in her spine. The physician explains that there are no further treatment options, and refers Ms. Rogers to Hospice for continuing care.
- What are the underlying principles of hospice?
- To be eligible for Medicare and Medicaid Hospice benefits, what information needs to be provided by Ms. Williams’ physician?
- Ms. Williams has severe back pain and is concerned whether the hospice will assist with her pain management.
Expert Solution Preview
As a medical professor responsible for creating college assignments and evaluating student performance in the field of medicine, these are my answers to the questions provided in the content:
1. What nursing measures should the nurse use to manage the patient’s dyspnea?
To manage Joe Clark’s dyspnea, the nurse should implement the following nursing measures:
– Position the patient in an upright or semi-Fowler’s position to optimize lung expansion and reduce respiratory effort.
– Administer low dose morphine as prescribed to relieve dyspnea and discomfort.
– Encourage slow, deep breathing techniques to promote relaxation and decrease anxiety.
– Provide supplemental oxygen as ordered to improve oxygenation and alleviate dyspnea.
– Assess and address any underlying causes of dyspnea, such as infection or anxiety.
– Collaborate with the healthcare team to evaluate and adjust the effectiveness of the current medication regimen, including Proventil and Flovent inhalers.
2. What nursing measures should the nurse implement to manage the physiologic response to the terminal illnesses, specifically the lack of appetite and struggling to eat and breathe?
To manage the physiologic response of lack of appetite and struggling to eat and breathe in Joe Clark, the nurse should implement the following nursing measures:
– Assess the patient’s nutritional status and consult with a dietitian to develop a customized plan that addresses his nutritional needs and preferences.
– Offer small, frequent meals that are easy to chew and digest, considering the patient’s dyspnea and reduced appetite.
– Provide oral hygiene before and after meals to improve taste sensation and prevent oral discomfort.
– Consider nutritional supplements, such as high-calorie drinks or liquid meals, to ensure adequate caloric intake.
– Collaborate with the healthcare team, including a respiratory therapist, to optimize respiratory function and alleviate dyspnea during meal times.
– Offer emotional support and encouragement to help the patient cope with the challenges of eating and breathing.
3. What are the underlying principles of hospice?
The underlying principles of hospice care include:
– Providing compassionate, holistic care that focuses on the physical, emotional, and spiritual needs of patients facing a terminal illness.
– Emphasizing quality of life and dignity for patients and their families during the end-of-life journey.
– Offering interdisciplinary care, involving healthcare professionals from various disciplines, such as physicians, nurses, social workers, and chaplains, to address the diverse needs of individuals in hospice care.
– Supporting patients’ choices and preferences, promoting autonomy and shared decision-making.
– Acknowledging and respecting cultural, religious, and personal beliefs throughout the care process.
– Providing bereavement support to families and loved ones after the patient’s death.
4. To be eligible for Medicare and Medicaid Hospice benefits, what information needs to be provided by Ms. Williams’ physician?
For Ms. Williams to be eligible for Medicare and Medicaid Hospice benefits, her physician needs to provide the following information:
– A certification of terminal illness, stating that the patient’s life expectancy is six months or less.
– Confirmation that the patient has voluntarily elected to receive hospice care and has agreed to forgo curative treatments for the terminal illness.
– Documentation of the patient’s eligibility for Medicare or Medicaid coverage.
– Assessment and documentation of the patient’s physical and psychological symptoms related to the terminal illness.
5. Ms. Williams has severe back pain and is concerned whether the hospice will assist with her pain management.
Hospice care places a strong emphasis on pain management and symptom control. Therefore, Ms. Williams can expect the hospice team to assist with her pain management. Hospice healthcare professionals, including nurses and physicians, are experienced in addressing and managing pain associated with terminal illnesses. They will work collaboratively with Ms. Williams to develop an individualized pain management plan that may involve pharmacological interventions, such as analgesic medications, as well as non-pharmacological approaches, such as physical therapy or complementary therapies. The hospice team will strive to alleviate her pain and improve her overall quality of life during this challenging time.