Question

Case Study, Chapter 16, End-of-Life Care

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. (Learning Objective 9)

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?

Answer 1

1. Nursing measures that nurse shoud use to manage the patient’s dyspnea are s follow-
-?Management of his anxiety.
- Besides anxiolytics that may be prescribed by doctor, the nurse can offer some relaxation techniques, visual imagery strategies and meditation practices. ?
- The nurse should also provide a safe space for the patient to talk and express his feelings and concerns. ?
- The nurse should practice active listening and be empathetic.?
- The nurse should assist patient to a Fowler’s position because in this position, gravity pulls the diaphragm downward allowing greater chest and lung expansion. ?
- Educate patient about not using too much energy and the nurse should ensure that the objects that patient may need are within reach of patient’s bed.
- Provide oxygen therapy.

2. Nursing measures to manage given physiologic response to the terminal illnesses:-
- Providing small portions of favorite foods and snacks thorough out the day.
- Encourage patient to drink liquids and offer ice chips to prevent dehydration.
- Provide good oral care.