Question

Mr. Lightning Strike Nara is a 35-year-old half Asian and Half Lakota Native male. He is in a Med-Surg unit receiving comfort care. He is dying of pancreatic cancer. Though his father was Japanese Mr. Nara identifies more with his Lakota Native American mother. His father died in an airplane crash when Mr. Nara was 5 years old. He was brought up in a reservation in North Dakota by his mother. Mr. Nara is married to a Lakota Native American woman whose name is Sparkling River. They are expecting their second child in two months (she is 7 months pregnant). They have a 4 year old daughter named Cooing Dove.

The patient’s extremities look mottled and he has a gurgling sound in his throat. He has a foley catheter in for his comfort but scant urine is draining. He is refusing to eat or drink and seems agitated. He talks of seeing his father standing at the foot of the bed. He is on a morphine drip at 1mg/15 min. and IV of D₅W. His wife is on her way in and is bringing the tribe’s Shaman.

Below you will find pictures that show what mottled extremities look like.

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1. What is the significance of mottled extremities in the dying patient?
2. Is pancreatic cancer painful? Are you concerned about the morphine dose and frequency? Why or why not?
3. How will you respond to the wife if she asks why the patient is not being pushed to eat or drink?
4. What can you do to relieve the patient’s accumulation of secretions and restlessness?
5. What cultural issues do you anticipate?
6. What will you say to the wife when she asks why her husband is “hallucinating”

Answer 1

Answer :

1) mottling is blochy ,red purplish marbling of skin and it is caused by the heart no longer being able to pump blood effectively because of this , blood pressure drops causing extremities to feel cool to the touch .

The skin then start to become discoured.

Mottling is typically seen in the last week of life ,although there is no exact time line .it can occur in the final week or not until the final hours .while mottling can be one sign of approaching death.

Care givers should also look For other Whs of life symptoms including changes in breathing and diminished food and water intake .

2) answer : pancreatic cancer is typically diagnosed at the late stage because it doesn't cause symptoms until it's too late .

Mid bdominal pain is one of the first symptoms of pancreatic cancer .there is no fixed pattern but often ,over time ,the pain of pancreatic cancer may move or radiate to back.

Pain is dull ache ,it will come and go .

Normally 1 mg / hr We will Use the morphine sulfate .

In above case also , it is normal dose of morphine with cancer pain .

3) normally at the time of end of life ,most of the people are not interested to ear and drink .

In above care ,he is having pancreatic cancer and he may have symptoms of nausea and vomiting sensation and additionally he is having gurgling sound and agitation that he knows that he will be dying soon .

He may thinking about his wife and daughter ,so he is refused to ear and drink .

Hallucinations because of morphine drip .

Nurse should respond to patient's wife very quite manner and if the patient 'wife able to cope with situation ,tell about the patient condition very clearly and provide psychological support and spiritual support to the patient 's wife.

4) suctioning very much help ful ,should be done second hourly

Administration of anticholinergic drug such as glycopyrolate to reduce the secretions .

Administration of 02 to decrease his restlessness.

5) it is very much important For nurse practitioner to understand their patients cultural backgrounds to provide competent care at the Whs of life .

Make the patient comfortable at end of life as much as possible .

Nurse should know about beliefs or traditions of patient

Nurse should educate his wife about role of wife in his and of life

Educate the wife to how to cope with situation and other plans after the death of patient .

Care on dying very much imlortant .

6) hallucinations because of morphine drug .