Question

Ms. J. is 73 years old with severe end stage renal disease. She lives alone. Ms. J. never married but had several long term relationships. She has one brother who lives across the country. She retired from her teaching assistant job four years ago because she just became too sick and the dialysis treatments were difficult to schedule around work. Ms. J. has always had "kidney" issues. She was born with one kidney which functioned moderately well most of her life. At one point she considered a transplant but because she is a "woman of faith" she felt that she should live with what she was given. When her kidney started to badly malfunction she did not consider a transplant because she did not think she had the finances to pursue it. So she went with what was available to her, dialysis. She now has limited income and must handle her medical care with care. She has wonderful neighbors who try to help her as much as they can. Ms. J. has become more severely ill over the last two weeks and she is not able to do much for herself now. When they can her neighbors come in and bring her food and one helps her shower. Ms. J. knows that she is soon to pass but would rather stay in her home with her beloved dog until that happens. You are a hospice nurse who was asked by Ms. J.'s doctor to visit her at home and assess her situation. In this Laboratory assignment you will be focusing on the following:

Case management - Develop a plan of action. What issues will need to be considered to manage this case? Focus on what resources she might need now? Consider what other health care personnel will be important resources. How will her medical expenses be paid?

1. End of Life Care - How will you handle her desire to stay at home given her current resources? What legal and ethical issues must be considered? What support systems and care does she need now at end of her life? How will her spiritual needs be met? How can you assist Ms. J. in achieving "quality of life"?

2. Demonstrates case management and end of life care.

Answer 1

Ms.J as she is in her terminal ill stage,the following actions can be planned accordingly to avoid any issues

• Her daily living activities to be planned
• Her nutritional status to be assessed, monitored and met
• Her fluid intake to be carefully monitored
• Her personal hygiene to be taken care
• Blood investigation (serum creatinine ,electrolytes, CBC) has to be carefully monitored
• Erythropoitein injections has to be administered periodically
• Daily weight checking
• Professionals home health aide, hospice physician, trained volunteers,counsellor or clergy
• Her medical expenses can be covered if she is under medicaid or medicare services, now it can be met by fund raising from public through media ,organization

1)She can be taken care being in home with a help of nursing aides,or hospice nurse who can support her physically, emotionally, spiritually. Her spiritual needs can be met by a clergy. She needs support system for her disease which can be met by peritoneal dialysis which is affordable, easy and can be done in home set up with minimal side effects.All the above things has to be done to improve her quality of life

2) Therefore this case has to be handled sensitively has she believes the faith.End of life care should definitely include spiritual care ,psychological support.