Question

END-OF-LIFE ISSUES You are the home health nurse who has been seeing Phyllis Court, who has a diagnosis of Tung cancer for approximately one year. Her provider recently told her that her cancer was no longer treatable: the focus of treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term "palliative Care" when discussing her situation with the provider but does not know what this means will change der. She vaguely does not know Ms. Court confides that she always felt she might survive her illness but has never formally written down her wishes concerning what types of treatment she would or would not want to have. You advise her to complete an advance directive or living will Ms. Court states she is confused and has mixed feelings about her health care wishes right now. She asks. "If I fill out this form, can I change my mind down the road? Revised 1/20

End of life issues, this is a concept map and all the information given

Answer 1

Type of ill ness - Terminal illness /palliative care

Nursing diagnosis

1. Acute confusion related to decision making secondary to palliative care as evidenced by mixed feeling.

Interventions

· Explain the underlying problem

· Present the reality concisely and clearly

· Explain the importance of living will

· Provide a calm environment; eliminate extraneous noise and stimuli.

· Allow sufficient time for patient to respond, to communicate, to make decisions

· Avoid challenging illogical thinking

Positive outcome

Patient can maintain positive feelings about advance directives.

Negative outcome

Patient may refuse the care and become violent.

Evaluation

Assess the mental status and plan further care.

2. Hopelessness related to terminal illness as evidenced by feeling of better survival.

Interventions

· Assess the patient’s understanding of the situation, belief in self, and his or her own abilities.

· Evaluate the patient’s ability to establish goals, make decisions, and solve problems

· Determine the patient’s social support system and possible source of hope.

· Encourage a positive mental perspective, discourage negative thoughts, and brace patient for negative results.

· Work with the patient to set small, attainable goals.

Positive outcome

· Patient can maintain good mental status.

Negative outcome

· Patient may go to chronic stress.

Evaluation

· Evaluate facial expression and response to care.