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NURS412 NURSING CARE AT END-OF-LIFE

Week 7 Discussion

Group Case Studies on Various Diseases (Group I)

Stanley is a 42-year-old man with amyothrophic lateral sclerosis. He was diagnosed 1 year ago. His condition is declining. He is married with two school-age children.

Initial Post Requirements

What is the treatment for ALS?

How will you address the subject of enteral feedings, ventilation, and advanced directives?

How will you assist in promoting sleep in this patient?

How will you assist the family in preparing for the worsening of Stanley’s ALS and ultimate death?

Identify the care you will provide to Stanley at the end of life.

Each member of the group will discuss this case, respond to the questions, and participate in the initial post.

Group Case Studies on Various Diseases (Group II)

Review

Jenny Ellison is a 28-year-old woman. She has completed genetic testing, which revealed she would develop Huntington’s Disease.

Initial Post Requirements

What is the epidemiology of Huntington’s Disease?

You need to explain to Jenny the trajectory of the disease process. What are the clinical features of Huntington’s Disease?

Identify the pathophysiology of Huntington’s Disease.

What are the recommended treatments for the management of Huntington’s symptoms?

Determine a plan of the care of the patient dying of Huntington’s Disease.

Each member of the group will discuss this case, respond to the questions, and participate in the initial post.

Group Case Studies on Various Diseases (Group III)

Review

Anthony Peronetti is a 78-year-old patient with Parkinson’s Disease. His symptoms began 8 years ago. His medications have been increased steadily over the last 8 years as his symptoms worsened.

Initial Post Requirements

Identify the medications used for the treatment of Parkinson’s Disease. Describe their actions and adverse effects and the aspects of patient education you should provide to the patient and his family.

Anthony is having difficulty swallowing. His family would like him to begin enteral feedings. What patient education will you provide?

What is the pathophysiology of Parkinson’s Disease?

What nursing interventions are important to implement with Anthony at the end of life?

Each member of the group will discuss this case, respond to the questions, and participate in the initial post.

Group Case Studies on Various Diseases (Group IV)

Review

Mr. J. is an active 71-year-old Hispanic gentleman whose home health nurse calls you to tell you about his symptoms, which include an increase in lethargy, constipation, and questionable altered mental status. The patient is known to have widely metastatic prostate cancer, including bone metastasis. A recent MRI of his brain was positive for metastatic disease. He is a very proud and private man, she tells you, and he doesn’t always listen to what the doctor tells him.

As the nurse in the medical oncology clinic, you have cared for this patient and family for several months. He has been on long-acting morphine at 200-mg q 12 hours po with morphine sulfate immediate-release tablets 10mg to be taken q 2-3 hours po prn for pain. His pain has been well managed on this regimen for the last month. He has been on an effective bowel regimen until the last week. The oncology nurse instructs the home care nurse to have the patient come to the clinic.

Initial Post Requirements

Discuss the physical assessment that would be conducted on Mr. J.

What laboratory or radiographic studies might be ordered? Why?

Discuss the differential diagnosis for these complaints and how might these be managed?

What education would you provide to the patient/family?

Describe the strategies you would review with the home care nurse in promoting a comprehensive plan of care for this patient.

Each member of the group will discuss this case, respond to the questions, and participate in the initial post.

Group Case Studies on Various Diseases (Group V)

Review           Mrs. Paul is a 48-year-old woman dying of end-stage liver disease and chronic renal failure. She is fatigued and has experienced significant weight loss, despite significant edema. She was diagnosed with colon cancer three years ago.

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