Lynn Nunez, a 45- year - old woman with advanced breast cancer that has spread to her lungs and bones, is admitted to your unit for terminal cancer and palliation. She has draining sores on her left breast. She is experiencing a great deal of pain when she moves, but she does not want sedation. Her wish is to spend her last days with her family, which includes her husband, mother and father, and two teenage daughters. The family is close and supportive, but is having a hard time seeing Lynn suffer. She is Roman Catholic, and the parish priest has visited daily. She has indicated she does not wish to have extraordinary measures, including feeding tubes, IVs, or antibiotics. She has a DNR order.
1. What do you think are Lynn's prioritized needs for care? (Explain your answer).
2. If Lynn were assigned to you for care, what might you suggest for: (Explain your answer)
a. Frequency of vital sign measurement
b. Personal care: bathing, mouth care, and skin care
c. Feeding: what, when, and how much
d. Activity level
3. What might your response be if Lynn were to ask you, "Why do I have to suffer like this?" (Explain your
(1)
1.Providing physical comfort.
Providing physical comfort is an essential part of nursing care
as the patient approaches the end of their life. The patient may
feel uncomfortable due to certain factors such as pain, skin
irritation etc.Here the patient suffers from chronic pain caused by
the movement of the sore on her left breast,so activity and
movements must be minimal ensuring physical comfort.Fomentation on
the inflammation and keeping the sore open and avoiding contact
with clothes while respecting her privacy can be helpful.opioid
analgesics or any other painkillers other than sedation can be
discussed with the physician.adequate oxygenation.ample
lighting,providing calm and quiet environment,music therapy can
also be used.prevention of pressure ulcers is also important
here.
2.Emotional suppourt.
Complete end-of-life care also includes helping the dying person manage mental and emotional distress. Someone who is alert near the end of life might understandably feel depressed or anxious. The simple act of physical contact such as holding hands, a touch, or a gentle massage can make a person feel connected to those she loves (Perkins, 2016). It can be very soothing. Meanwhile, some healthcare providers suggest that a low volume music and soft lighting are comforting for a dying patient. It has been proven that music therapy is able to improve a patient’s mood by increasing relaxation and reducing their pain. Or else, just being present with the patient is often enough. Sometimes, your quiet presence can be a meaningful gift for a dying family member or friend.
Spiritual needs
While an unconscious patient is still able to hear, nurses may suggest that family members invite religious person/s to come and perform certain prayers as it will help the patient with their spiritual needs. Nurses can also encourage families to share their memories of good times with the patient since it is never too late to say how they feel. It is also a good idea for them to make an audiotape or videotape for the family, writing letters, or keeping a journal as it assures the patient that something of their essence will survive past their death (Buckley & Herth, 2004).
Supporting the family member
Family members require a nurse’s support, guidance, and education as they care for their loved one in their final journey. It is common for patients in their last days of life to have decreased appetite or feel nauseated by food. So, as a nurse, you should educate the family about the symptoms the client will likely experience and the implications for care. Whenever possible, communicate news of a patient’s declining condition or impending death when family members are together so they can provide support to one another (Holmberg, 2006). Give the news in private, and stay with the family as long as needed or desired.
(2)Frequency of vital signs measurement
vital signs monitoring is the key to identifying the patients current condition whether she is in pain or an infection is spreading or to find out whether the respiration or cardiac functions has been compromised or not.so it should be carried our it a timely manner and in a way that does not make the patient more uncomfortable.
Personal care
Personal care is the foremost important thing for promoting hygiene, preventng infections and maintaining skin integrity.It boosts the self esteem and improve self image.sponge bath,mouth care and hair care should be provided to the patient as she has decreased mobilty.skin care should done along with or after sponge bath by percussions,vibrations,tapotments and gentle massages.
Feeding
Feeding should be provided according to the current condtion of the patient.consult with the dietician for a balanced meal plan which contains a soft diet considering the likes of the patient.family members should take active part while feeding the patient.
Activity
Activity level must be optimum and as minimal as possible considering the discomfort of the patient on movements.active assistance should be given with participation of family in all routine activities..exhaustion must be prevented and position changes are as important as it plays pivotal role in preventing bed sores.
(3)My response will have the following considerations,
The mental status of the patient
the physical and emotional pain she is going through
the support her family is providing
the spirituality of the patient.
My answer will be "I dont actually have answer for that question and i dont think eny one has.you have lived a happy life,have a loving family that care for you and you god loves you too..bad things happen to everyone but how we deal with it is is the key to being full and contempt.you ahve your family around you,look at them and be happy for them,love them when you can,they are sharing the same grief as you.your smile can make their hearts warm..thats what is to be a woman..a mother,a wife and a daughter..you could face anything in our life with a family like that with you..let the rest of it to god and medicine.."
Lynn Nunez, a 45- year - old woman with advanced breast cancer that has spread to...
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