Alma is a 75 year old muslim lady with end stage lung cancer being taken care of in a long-term facility. She was transferred to a medical ward last night. The admitting doctor recommended comfort care, DNR status and hospice care, but nothing is in place yet. Alma requested hospice service at the long-term facility, but her son still requests “everything possible to be done”. During the night Alma received a few doses of oral morphine which helped to relieve her pain. She did consent for blood works to be done. This morning Alma is in sever pain at the time of the handover. Multiple PRN medications are available: Fentanyl patch 25mcg 12 hrly, Oxycodone 80mgs tab dly, Compazine 10mg tab 6 hrly, Dexamthasone 4mg tab 4 hrly PRN, Morphine IV 2mgs tds, Morphine solution (100mg/5ml) 100mg 4 hrly, Dulcolax 10mg suppository 10mg daily.
Alma has the following vital obs: O2 Sat 89%, HR:118, RR:10, Temp: 36C, BP: 110/60
Alma looks very withdrawn and looks anxious and uncomfortable. Starts to discuss DNR with the nurse and her son. Requests spiritual care.
• Remind the goals (student doing the exercise.
• Ask about the feeling during the exercise.
• What happened – describe what happened step by step (student)?
• What went well?
• Why specific decisions were made?
• How it should be done (ideas are generated by students, the tutor leads to the right conclusions)?
• What to do to make it better?
• Students’ questions.
• What do you remember from the exercise (each student says 1 item – preferably everyone should say something different?
• Point out step by step what the students’ behavior should look like – exemplary.
• Motivate students to think reflectively while deceiving strengths and correct paths.
I can communicate effectively and compassionatley with the patient, family and health care team members about end of life issues.
I can demonstrate respect for the patient’s views and wishes during end of life care.
I can assess symptoms (e.g, pain, constipation, duspnea, anxitey, nausea/vomiting, fatigue, altered cognition and skin breakdown) commonly experienced by patients at the end of life and be able to intervene appropriately accoding to evidence based palliatve care practices.
I can apply legal and ethical prinicples in end of life care, recongnizing the influence of personal values , professional code of ethics and parient’ preferences.
I can address spritiual health during end of life care.
I can recongnize one’s own attitudes, feelings, values and expectations about death and the individual, cultural and spiritual diversity exsiting in these beliefs and customs.
Assessment and management of eldelry patients in end of life care
REFERENCES, MATERIALS FOR CLASSES
The scenario was prepared based on the content contained in the literature:
- Nayar, P., Qiu, F., Watanabe-Galloway, S., Boilesen, E., Wang, H., Lander, L. and Islam, M. (2014). Disparities in End of Life Care for Elderly Lung Cancer Patients. Journal of Community Health, 39(5), pp.1012–1019.
- Fine, P.G. (2012). Ask The Experts: Pain management and end-of-life care. Pain Management, 2(4), pp.325–328.
- Kazaure, H.S., Roman, S.A. and Ann A Sosa, J. (2014). Not all do-not-resuscitate (DNR) orders are the same: outcomes of 4738 elderly surgical patients who instituted a DNR order at hospital admission. Journal of the American College of Surgeons, 219(4), p.e104.
- The student has knowledge regarding end-of-life care in an elderly patient with Cancer.
- The student will be aware of assessments and management done in end-of-life care.
Alma is a 75 year old muslim lady with end stage lung cancer being taken care of in a long-term facility. She was transferred to a medical-surgical ward last night. The admitting doctor recommended comfort care, DNR status and hospice care, but nothing is in place yet. Alma requested hospice service at the long-term facility, but her son still requests “everything possible to be done”.
CURRENT CLINICAL CONDITION
Patient is in pain and anxious about her condition.
The student should engage in therapeutic communication with the patient and manage her symptoms