Question

An 85-year-old female diagnosed with ovarian cancer 5 years ago. She was treated with surgery and chemotherapy. Surgical treatment included bilateral salpingo-oophorectomy and total abdominal hysterectomy. At that time, the client was found to be BRCA1 positive. She declined any prophylactic surgery or treatment. She was subsequently diagnosed with breast cancer 18 months ago and underwent a lumpectomy of the right breast, followed by chemotherapy and radiation. Two months ago, she was diagnosed with Stage IV metastatic disease in her bones, brain, and liver. Question 1. What is the priority in caring for Amira Quintona? What are two nursing interventions you can utilize when caring for her, please provide the rationale? Question 2? You hear a nurse talking about “Death Rattle.” What is this, and what is the significance of it in a patient who is in hospice care? 3. Describe the ethical and legal issues of advanced directives including the role and responsibilities of the healthcare surrogate decision-maker. 4. Discuss the nursing management of the client-family unit at end-of-life. 5. Based on what you’ve learned about the nursing process, describe one applicable nursing diagnosis, treatments and nursing considerations for this diagnosis

Answer 1

1.The priority care necessary for this patient are

• Life saving support with oxygen therapy to relive breathing difficulty
• Pain management as this is expected in last stage of cancer
• Doing as per the patient request and needs by prioritising the autonomy in the decision making
• Meeting the nutritional needs of the patient ,as they avoid foods psychologically and physiologically . This is can relieve fatigue
• Oral care, skin care to be planned as the risk for pressure ulcer is possible
• Bowel and bladder pattern has to be assessed once in every four hours or applying a diaper

2.This is an abnormal sound produced from the respiratory system .This happens because of the secretion in thrat blocking the respiration and a rattling sound is heard during inspiration and expiration .

It signifies that there is secretion in the patient throat which has to be auctioned out to improve airway

3.The ethical issues of advance directive is the healthcare providers trying to discuss end of life care with patients to make decisions regarding it. This can help the professional to provide care without any concern of violating the principle of ethics to a patient (autonomy ,beneficence ,non maleficience) This can also trigger anxiety in patient.

The legal issue here is the risk to explain this when a patient is healthy enough or sound enough physically and mentally in advance. Providing DNR, medical futility ,life-sustaining care is withhold or stopped.

The role and responsibilities of a surrogate decision maker is to make health care decision on behalf of a patient what they said to then when the patient was in a sound mind or was able to communicate.

4.The nursing management for the family are

• Helping them through the grieving process
• Providing them psychological support
• Involving them in the patient care to improve their satisfaction of caring for their loved one .