Question

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. a. What are the underlying principles of hospice? b. To be eligible for Medicare and Medicaid Hospice benefits, what information needs to be provided by Ms. Williams' physician? C. Ms. Williams has severe back pain and is concerned whether the hospice will assist with her pain management.

Answer 1

1a

Hospice exists to provide support and care for persons in the last phase of incurable diseases so that they might live as fully and as comfortably as possible.Hospice programs provide multidiscipliniary care at the end of life with emphasis on symptom management ,advance care planning,spiritual care and family support,including bereavement.

b .Admission to a hospice program has two criteria.First the patient must desire the services;second a physician must certify that the patient has 6months or less to live.For Medicare and Medicaid patients,two physicians must certify that the patient is terminally ill with less than 6 months to live.After this initial certification ,only one physician ,is needed to recertify the patient.

c Hospice care is generally provided in the home ,with inpatient care reserved for acute pain management or respite care for families or caregivers in need for a break.Hospice nurses are educated in pain control and symptom management.

2

• Determine the psychological status of the patient inorder to reinforce the use of coping strategies during the surgical experience.
• Determine physiologic factors that are directly or indirectly related to the surgical procedure that may contribute to operative risk factors.
• Establish baseline dATa for comparison in the intraoperative and postoperative period.
• Identify and document the surgical site on which the surgical procedure will be performed.
• Identify prescription medications and over-the counter drugs and herbs that have been taken by the patient that may affect the surgical outcome.

b Day-of-surgery preparation will vary a great deal depending on whether the patient is an inpatient or an outpatient.The nursing responsibilities immediately before surgery include final preoperative teaching,assessment and communication of pertinent findings,ensuring that all preoperative preparation orders have been completed and ensuring that records and reports are present and complete  to accompany the patient to the OR.it is essentialy important to verify the presence of a signed operative report ,laboratory data ,a history and physical examination report ,a record of any consultations,baseline vital signs and nurses notes complete to that point.if the patient is an inpatient,the hospital nurse is responsible to ensure that the patient is ready and appropriately prepared for surgery.Hospitals may requirethat a patient wear a hospital gown with no underclothes,whereas surgery cnters may allow the patient to wear underwear,depending on the surgical procedure to be performed.The patient should be encouraged to void before preoperative medications are administered if the medications will interfere with maintaining balance and increase the risk for a fall when ambulating to the bathroom.