Case Study Chapter 16: End-of-Life Care

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1. Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort.

What nursing measures should the nurse use to manage the patient’s dyspnea?
The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

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.

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