NR 305 Case Study or Share an Experience

NR 305 Case Study or Share an Experience

NR 305 Case Study or Share an Experience

This is my area of nursing. I work in hematology/oncology and hospice. I have had a lung cancer patient tell me, “Kelly, I think tonight’s the night”. I said, “Tonight’s the night for what, patient X?” And she said, “Tonight is the night I would like to pass on and see Jesus. I am ready.” And I said, “OK, patient X. Should we call your daughter and have her here with you?” She said, “Yes. Let’s have her come.” Cue the hand holding and smiles. That was that. She passed later that evening by removing her oxygen and being given morphine for comfort.

I have ordered patient’s last meals before sedating them to a comfortable coma-like state. I feel good about what I do when someone is ready to be at peace and be comfortable.

Option #1; Ann & Michael:

I would ask if Michael would mind stepping out of the room and talking to me. Unfortunately, during the pandemic, my hospital has strict end of life visiting policies and I might have to be asked these questions over the phone.

I would ask Michael if Ann had ever mentioned what she would want in this type of situation? Had she ever said things like if I am unable to do xyz, I would want xyz to happen?

What are your reservations to the surgery, Michael? What worries you? Do you feel like you understand the benefits versus the risks fully?

If Michael wanted Ann to just be comfortable in her remaining time on the earth, I would feel comfortable discussing hospice care. Often, in hospice care, we can provide a patient with oxygen for comfort purposes and medicate to make breathing more comfortable and restful. Sometimes we do remove the oxygen and only medicate. We would discuss options of taking Ann home or keeping her under the hospital’s care.

Let us say that Michael wants to understand more about inpatient hospice care, I would discuss all his and his wife’s “physical, psychological, spiritual, and practical” needs could be addressed by the hospice team (Hill & Hacker, 2010). Michael could determine that psychologically, Ann would not have a good recovery after a lobectomy although he does not want her to suffer with dyspnea. Physically he knows that Ann’s dyspnea is exhausting and giving her also sudden anxiety and restlessness. She has become incontinent. Spiritually he believes in God and does not want his wife to suffer, but also does not feel it is right to choose her life or death – chaplain or priest may be asked to step in here. Practically speaking, he feels he has already said goodbye to the Ann that he knew before, but he questions whether hospice is giving up on his wife.

I would reassure that we could really make Ann rest well and relieve her suffering. We could give medications like Ativan for her anxiety, dyspnea, and restlessness. We could also give medications like morphine or dilaudid for dyspnea. We can give robinul and scopolamine patches to dry up lung secretions. We can suction to clear the lung secretions as needed and as comfortable. All the while, we will keep her skin clean and dry, provide oral care and repositioning as tolerated. We will be happy to play spiritual music or biblical readings. We can involve music therapy and chaplains as often as possible. We are here to ensure you have support to through nursing and social and spiritual services.

All these struggles and concerns can be attended to by the right department and nurses play a big role in rounding up those departments as well as communicating with the medical team to relay the patient’s/family’s wishes (Weber & Kelley, 2018).

References

Hill and Hacker (2010). Helping patient with cancer prepare for hospice. Clinical Journal of Oncology Nursing 14(2): 180-188. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1188/10.CJON.180-188 

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

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Thank you for sharing your experiences in this post.  Your description is so vivid and thorough.  Reading it made me

NR 305 Case Study or Share an Experience
NR 305 Case Study or Share an Experience

very interested in the type of nursing that you provide.  I can tell by how you descriptions that you love what you do and are a very calm , compassionate and genuinely caring nurse.  I liked that you use a very holistic approach when providing care and comfort for your patients by addressing their physical, mental, and spiritual needs.  I have not yet taken care of a patient who was actively dying besides a close family member or friend but not in a nursing role.  The examples you shared, especially about specific medications to relieve Ann’s suffering helped put things into context for me.  I can only hope that when the time comes for me or my loved one’s that I have someone like you taking care of us.

The first patient who passed away on my shift was the one that made the most impact. I was in my second month out of orientation, working on a Vascular Surgery unit. Most of our patients were post surgical, but we were also one of the few Telemetry floors at the time, so we often had a mix of other specialties. It was Father’s Day, and I had buried my own father two months prior. One of my patients was an elderly woman with metastatic cancer. She was scheduled to go to Hospice the next morning. She was alert and oriented times one or two, but that morning she was more confused than normal. She’d been in our care for about a week, and was getting palliative radiation treatments to help with the pain from her tumors. That morning, she refused. The transporter came out to let me know, and I went in to make sure. She was agitated, and told me she absolutely was not going. None of her family was with her at the time. I believe they were still getting things in order for the move the next day.

In hindsight, I probably should have seen some of the signs, and asked more questions. She was more agitated than usual, and  it was in my head that she was Hospice, and end of life, but I had no idea that she was actively dying until one of the palliative doctors came out to find me later that afternoon. He told me that I should call her family and get them to the hospital as soon as possible. I hadn’t noticed in the morning, but her hands were mottling, she hadn’t eaten, and by the afternoon her blood pressure was dropping. (Signs and Symptoms of Approaching Death, n.d.) I called her family, and calmly asked them to come up. They were surprisingly calm, given the circumstances, but I assume it was because the Hospice plan was already in place. The palliative doctor called pastoral care to consult, and I was to call when they arrived. We moved the patient’s roommate out of the room, and I attempted to make her comfortable with pillows. At that point, the patient was no longer speaking. She didn’t appear to be agitated or in pain. When the family came, I called Pastoral care to come to the bedside. He gave her last rites and spoke with the family. Shortly after he left, a family member came out to ask me if she had passed. Her breathing had stopped. When I walked in the room, it had become more of a death rattle type breathing pattern. (Providing Care and Comfort at the End of Life | National Institute on Aging, n.d.) I knew what this was. I stroked her forehead and started to cry. I explained what the breathing pattern meant. They asked me if I’d had a chance to speak with her that day, and I told them how feisty she had been about not going to radiation. This put smiles on their faces, because she was a small woman, with a big personality. A few minutes later, she passed away. I excused myself and gave the family time to themselves.

If the same situation happened today, I don’t know that I would have done anything differently. I might have called the family sooner had I been more aware of what to look for. I might have offered to get a radio, or tune in to a music station for some calming music. (Providing Care and Comfort at the End of Life | National Institute on Aging, n.d.) I felt like the family appreciated what we were able to do to give them time, and comfort. I think that my father’s recent passing helped me to be more empathetic to their situation. They actually told me that they were touched to see me cry, and hugged me as they left.

 

References

Providing care and comfort at the end of life | national institute on aging. (n.d.). National Institute on Aging. Retrieved August 21, 2020, from https://www.nia.nih.gov/health/providing-comfort-end-lifeLinks to an external site.

Signs and Symptoms of Approaching Death. (n.d.). Hospice Patients Alliance. Retrieved August 21, 2020, from https://hospicepatients.org/hospic60.htmlLinks to an external site.