Reference no: EM133323572

Case: 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.

Mrs. Paul's family is distraught and wants aggressive interventions to improve her appetite, curb her weight loss (she has lost 18 pounds in the last 4 weeks), and prevent nausea/vomiting. Her physician believes that one of the contributing factors to her fatigue is that her hemoglobin and hematocrit are very low. So she has received 4 units of packed red blood cells over the past 2 weeks. The patient states that the fatigue continues, despite the blood transfusions. She has intractable nausea/vomiting, and, as a result, she is frequently admitted to the hospital.

As the advanced practice nurse (APN) on the medicine unit, you are consulted to address these frequent hospitalizations. As you assess these admissions, you learn that the staff is distraught when caring for this family. The patient's attending family physician nor oncologist have taken an active role in discussing palliative care with the patient or the family. One of the staff nurses confided in you that "this family and patient deserve better-someone needs to be truthful with them, so they know that their loved one is dying."

Question 1: Discuss your evaluation process in this case (fatigue, weight loss, nausea, vomiting).

Question 2: Based on your assessments, identify what management strategies you would use. What issues would you want to discuss with the interdisciplinary team?

Question 3: Considering Mrs. Paul's and her family's needs and concerns, what strategies and interventions might you consider in her care plan?

Question 4: How would you approach the physician about entertaining the possibility of palliative care for this patient and her family?