Question

Part C. Answer the questions from the following case study

The nurse is performing an admission assessment for Mr. Parrott, a 78-year-old man with a history of cardiovascular disease and hypertension. He takes 20 mg of furosemide and 5 mg of Zestril daily. He was seen in the physician’s office today reporting swelling in his feet, shortness of breath while playing golf, awakening at night unable to catch his breath, and “feeling” his heart beating in his chest.

Mr. Parrott’s blood pressure is elevated, and there is no auscultatory gap. A third heart sound is present. His chest x-ray shows cardiac hypertrophy. There are adventitious sounds in both lower bases. He has gained 10 pounds in the past 2 weeks. A urinalysis is normal. His ECG is normal with evidence of slight cardiomyopathy.

1. Which assessment finding would the nurse determine to be of the highest priority for intervention?

Glenn is admitted to the hospital, where his condition continues to decline and progresses to pulmonary edema. The patient asks the nurse, “Am I going to die?”

2.How should the nurse respond? What approaches should the nurse utilize when discussing end of life?

  

The conversation between Mr. Glenn and the nurse continues; Mr. Glenn states, “My doctor said that I only have about 2 months to live.” Should the nurse discuss advance directives with the patient? If so, what approaches should the nurse utilize when discussing his wishes?

3. What members of the interprofessional team could be consulted for transition management?

Answer 1

1) Mr.Parrott's case the highest priority problem for intervention is awakening at night unable to catch his breath,and feeling his heart beating in his chest or palpitation,this can be sudden due to sudden increase in his blood pressure adn fluid collection in his lungs,so interventions to reduce the blood pressure and reduce fluid over load should be focused,interventions like semi fowlers or semi sitting position helps to reduce breathing problam.

2)While discussing about end of life with Mr.Glenn the nurse should use clear and compassionate communication which helps him to accept the situation and prioritise and express the type of care he wish to receive,it also helps the nurse to give psychological support to him which makes him feel more comfortable and feel he is cared.The nurse should establish a therapeutic relationship and talk openly which will give an opportunity for the patient toexpress his fear and anxiety. Discuss honestly about the disease progression and prognosis.

* Nurse should discuss about the advance directives with the patient because this will help him to take a decision about his future care and comfort.While discussing nurse should explain what are the advance directives available and what is most appropriate for his care like oxygen administration,fluid restrictions etc and see that family members are actively involved in the discussion.the nurse should focus on explaining about palliative care.

* The interprofessional team members needs to be consulted for transitional care are physician,nurse,respiratory therapist,social worker,dietitian and counsellor.