Reference no: EM133248894

Assignment - Anorexia Case Study

There are two case studies that follow. Choose one of them and answer the questions that follow:

Case 1- Symptoms

Ms. Smith: Anorexia/Depression/Anxiety

Ms. Smith is an 85-year-old woman with end-stage cardiac disease in a home hospice program. She has been very comfortable, not experiencing any other symptoms, and has been quite functional until the last two weeks. Her family contacts the home hospice nurse concerning her lack of appetite, "continual sadness," and anxiety which they feel is affecting her ability to function.

During a routine home visit by the hospice nurse, the patient relates she has no appetite and is quite comfortable just having occasional "snacks" when she pleases. However, her family remains adamant that she requires better nutrition, and they request an IV be inserted. In addition, the family believes Ms. Smith is depressed and "too antsy," and these contribute to her lack of appetite. Mrs. Smith states that she has had trouble with depression for many years, but has always tried to find "the brighter side" to fight off the sadness. She also acknowledges that she becomes anxious when her children come to visit, as they "don't want to admit I am dying," she says. She reports that she does not always sleep well at night, because she is afraid to die and leave her family behind. She says, "I wish I had raised my children better. If I had, there might not be all of this fighting going on about my care. I wish they would leave me alone, so I can die the way I want to."

Questions -

1. How might the hospice nurse incorporate interdisciplinary care for this patient?

2. What additional assessments would be needed?

3. What interventions might be considered?

Case 2- Symptoms

Mr. Hayes: Cough/Diarrhea/Agitation

Mr. Hayes is a 53-year-old with widely metastatic colon cancer, which has spread throughout his abdomen. He arrives on your palliative care unit with a chief complaint of intractable nausea and vomiting for 24 hours and diarrhea (1000 cc emesis and 400 cc diarrhea in the past 24 hours). He describes that he is barely capable of managing any activities of daily living. Mr. Hayes has been found to have a non-resectable partial small bowel obstruction. The patient asks, "How much longer do I have?" and "Can we speed this up?" "I don't want my children (ages 11 and 13) to see me like this." The patient admits to feeling down but denies any suicidal ideation. He is clearly anxious about becoming a burden to his family and wonders how his children see him. His 13-year-old daughter confides in you that she is "afraid" her daddy is going to die. He is a devout Catholic and mentions to the night shift nurse that he is certain his symptoms and suffering are a punishment for his having a divorce ten years ago. He says to the nurse that he just wants to be left alone and does not want anyone to bother him tonight.

Questions -

1. What additional assessment should be done?

2. Is additional suicide assessment indicated?

3. How might various disciplines contribute to his care?

4. How would you answer the daughter who says she is afraid her "Daddy is going to die?"

5. What community resources are available to assist Mr. Hayes and his children?

6. What role might his religion play in his illness?