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NURS412 NURSING CARE AT END-OF-LIFE

Week 2 Discussion

Grief Group Case Studies (Group I)

You have received a hospice referral for Mr. Jones, age 54, who has ALS (amyotrophic lateral sclerosis). He and his family (wife and 3 children—ages 9,16, 19), who are confused and anxious, listen to you as you describe what they should expect from the hospice experience. The family does not seem to understand why you are discussing end-of-life issues with them. You call Mr. Jones’ family physician, who tells you that the patient assured him that he talked to his family about his prognosis. You determine that Mr. Jones has, in fact, not told his family. You talk with Mr. Jones, who admits that he has told his family he is very stable and expected to have many years of life remaining. He asks you to help him break the reality of his poor prognosis to his family.

Initial Post Requirements

What is your role now?

What communication gaps do you recognize?

What strategies would promote continuity of care and improve team communication?

How might a family meeting be helpful in this case?

What special needs would you perceive the children having at this time? How would you meet these needs?

Grief Group Case Studies (Group 2)

Cindy is a 36-year old female with pancreatic cancer, has been hospitalized for two weeks. She has been in the intensive care unit for the past 5 days. Her physical deterioration and suffering had created anguish in her husband and the health care team. The attending physician discussed with the husband the likelihood of his wife having a cardiac and/or respiratory arrest, described the actions the team would take for a full resuscitation as well as the varying levels of resuscitation approved by the treatment setting, which included a do-not-resuscitate option, and asked the husband to express his preferences regarding resuscitation. The husband initially chose the do-not-resuscitate status for his wife and completed all of the official paperwork to implement that decision. During the next 12 hours, the husband actively solicited their definitions of do-not-resuscitate from nursing and medical staff. He then contacted the attending physician to rescind his decision, choosing instead to have a full resuscitation order in place. He explained his decision change as, “When I saw that the nurses and doctors did not all define resuscitation in the same way, I decided that I would not leave that in their hands. I am my wife’s husband, and I will be her husband to the end.” This new decision was enacted, and over the next four days, the patient showed clear signs of dying. Her husband stayed with her in the intensive care unit and witnessed the changes in his wife’s physical appearance. He began commenting on those changes and his wife’s obvious suffering. Within two hours of her death, the husband told the nurse that he did not want his wife to be resuscitated. This information was immediately conveyed to the health care team, and a brief discussion with the physician, husband, and nurse was convened to affirm this decision.

Initial Post Requirements

What were the barriers to effective communication in this case?

How might these barriers have been eliminated?             

Grief Group Case Studies (Group 3)

Max Klein is an 84-year-old retired plumber who has brought his 83-year-old wife, Mary, to the E.R. complaining of chest pain. Mary’s condition declines, she experiences cardiac arrest, and full resuscitation is attempted. During this time, Max communicates to the social worker and chaplain that “This can’t be. Mary is healthy as an ox.” He doesn’t want to notify his children who live out of town “until she’s stable because I know they’ll get her straightened out – they’re really good here at Methodist Hospital.” Max seems anxious but distracted and talks incessantly about how Mary’s been sick before but “always gets better before you know it.” After 2 hours of numerous procedures and attempts, Mary dies.

Initial Post Requirements

What are useful communication strategies while Mary is still receiving aggressive care to communicate her status?

How should Max be told of Mary’s death?

What is the role of the interdisciplinary team in communication in this case?

Grief Group Case Studies (Group 4)

Valenzio Quartera is a 56-year-old man with widely metastatic prostate cancer. He is currently undergoing radiation therapy for bone metastasis. His wife died one year ago from breast cancer. He now lives at home with his twin daughters, age 15 years. As you, the radiation oncology nurse, enter the treatment room, Mr. Quartera asks you, “Susie, you don’t think I’m going to die do you?” “What would happen to my daughters if I die?”

Initial Post Requirements

How would you respond?

How would you address his concern about his daughters?

What would you recommend that he discuss with his daughters at this time?

What would other healthcare team members be appropriate to contact to help Mr. Quartera with his daughters?

Grief Group Case Studies (Group 5)

Mr. Ahmed is a 49-year-old with a recurrent brain tumor currently hospitalized after experiencing seizures. Mr. Ahmed was diagnosed at age 44 and has had extensive surgery, chemotherapy, and radiation therapy. Three months ago, his oncology team advised him and his family that there were no further treatment options and recommended palliative care. The family was not interested in palliative care, and they requested that “everything is done.” He has experienced weight loss, increasing severe headaches, nausea, and now seizures. Following a severe seizure last week, his wife brought him back to the cancer center seeking possible new treatments and wonders if he can receive palliative care, too. As Mr. Ahmed waits in radiology for a scan, you, the oncology nurse, come to see him as you heard he was in radiology. He tells you he is so tired of treatment and being taken far away and wishes his family would “give up and just let me be at home so I can play with my dog and be with my friends.”

Initial Post Requirements

How would you respond to Mr. Ahmed?

Is it possible for Mr. Ahmed to receive treatment and palliative care at the same time? If so, how would you describe this to Mr. and Mrs. Ahmed?

How could you use attentive listening and presence with this patient and his wife?

How would you describe palliative care to this family?

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