Question

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 clientwas 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..Since the patient is diagnosed with metastatic disease, the treatment plan will be always palliative. The importance should be given to improve the quality of the remaining life. The nursing intervention are :provide pain killers like morphine to alleviate the excruciating pain. Second is to give laxative to have better bowel movement, since morphine can cause constipation. Next intervention is providing good nutrition. Since the body is very weak and immunocompromised, a good nutrition will always help.

2.Death rattle is a particular sound produced by a person before dying due to the inability to carry out clearance of saliva and other oropharyngeal secretions. The nurse should try to protect the airway by placing a goodles airway in the mouth. Other active intervention like endotracheal intubation and ventilation can be done after getting consent from the family members.

3.Healthcare surrogate always maintain the ethical principles and law. The interventions that are done at the end of life should be with the consent of the the family members. If healthcare workers do something that family members doesn't like, and eventually the patient dies, it will produce legal liabilities on the healthcare surrogate. So decision making while managing a dying patient is important. Dying declaration can be recorded.

4.The nurse should always give support to the client family members while dealing with a dying patient. The emotional support is very important. If any family members are facing depression or other mental disturbance, they can get a psychology counselling. The nurse should prepare the family members to accept the truth and come out from this difficult situation.