Question

CASE STUDY – End-of-Life Palliative Care

S.J., 42-yr-old woman, had unsuccessful treatment for breast cancer 1 yr ago and now has metastasis to the lung and vertebrae. She lives at home with her husband, 15-yr-old daughter, and 12-yr-old son. She has been referred to hospice because of her deteriorating condition and increasing pain. Her husband is an accountant and tries to do as much of his work at home as possible so that he can help care for his wife. Their children have become withdrawn, choosing to spend as much time as possible at their friends’ homes and in outside activities.

Subjective Data

• S.J. reports that she stays in bed most of the time because it is too painful to stand and sit.
• She reports her pain as an 8 on a scale of 0 to 10 while taking oral MS Contin every 12 hours.
• She reports shortness of breath with almost any activity, such as getting up to go to the bathroom.
• S.J. says she knows she is dying, but her greatest suffering results from her children not caring about her.
• She and her husband have not talked with the children about her dying.
• Her husband reports that he does not know how to help his wife anymore and that he feels guilty sometimes when he just wishes it was all over.

Objective Data

• Height 5 ft 2 in (157 cm)
• Weight 97 lb (144 kg)
• Skin intact
• Vital signs: Temp 99F (37.2C), HR 92 bpm, RR 30, BP 102/60

Discussion questions

1. What additional assessment data should the nurse obtain from S.J. and her husband before making any decisions about the care of the family?
2. What types of grieving appear to be occurring in the family?
3. Priority Decision: What physical care should the nurse include in a plan S.J. at this time?
4. Patient-Centered Care: What is the best way to facilitate healthy grieving in this family?
5. Teamwork and Collaboration: What resources of a hospice team are available to assist this patient and her family?
6. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses?

Answer 1

Some of the additional assessment which the nurse could obtain are

• Food habits and life styles gives an idea and treatment options to look into her overweight though unnecessary as there is always weight loss in cancer
• Habit of alcohol ,smoking family history for cancer,exposure to treat her
• Assess her coping strategy
• Assess vital signs especially oxygen saturation for breathing difficulty

The family is experiencing anticipatory grieving as they both are aware of what is going to happen

The physical care which the nurse should meet are

• Personal hygiene of the patient
• Positioning of the patients
• Propped up position to ease breathing difficulty
• Provide warm bath to soothe and comfort The patient from pain

The best way to facilitate healthy grieving in this family is giving them time to accept the reality, a family counselling with the children.Involving the children in the care will comfort her and relieve her psychological tension.

The palliative care resource series, Regulatory resources can help them to meet financially

The priority nursing diagnosis are

• Chronic pain related to metastasis as evidenced by pain score
• Ineffective breathing pattern/Deficient tissue perfusion related to metastasis as evidenced by dyspnea,tachypnea
• Altered body temperature /Impaired thermoregulation related to disease condition as evidence vital signs
• Ineffective coping mechanism related to children's withdrawal as evidenced by verbalization