Question

4. A 36-year-old patient is dying from acute lymphocytic leukemia. He is a home hospice patient, and 6 hours ago his family brought him to the emergency room for pain and intractable vomiting. He’s now resting comfortably after receiving medications and hydration. His family, however, is concerned because they’ve noticed that his extremities look mottled. He also rouses less easily. His blood pressure is 80/40 and his pulse is 150, with occasional skipped beats. The family reviews his DNR status and informs you that the patient wishes to die at home, surrounded by his extended family. Their house is located in another state, about 3 hours from the hospital. They tell you that the patient can recline in their van for the trip home, and that they wish to take his IVs and morphine pump. As his nurse, how will you handle this situation? Explain in detail.

5. How would the nurse ask a family to donate organs after their 23-year-old son has just been mortally injured? What are the processes for the organ retrieval?

Answer 1

4).

Nurses play a key role in caring for seriously ill patients and those at the end of life. In the case of end-of-life care, providing physical and psychological support, respecting, and fulfilling their desire is important. A health care professional or a nurse must meet certain requirements to provide the maximum comfort to the people receiving end-of-life care. Most of the terminally ill patients generally suffer from the compromised liver, brain, lungs, kidney, and cardiac functioning and dyspnoea and pain may be the common concerns in most of the cases.

For example, providing oxygen supply and pain relieving medications though may not cure the disease, it is considered as palliative care because it offers comfort to the patient or it may sometimes be helpful in the patient recovery from the grief as well, which is better than completely avoiding any medical care to the patient as it increases the comfort measure.

Nurses providing end-of-life care need to be culturally competent to understand the patient’s preferences. Respecting and fulfilling the cultural interests and personal wishes of the patient is most important. Providing emotional and psychological support along with the other palliative care measures as needed must be the top priority in case of terminally ill patients.

Not only the patients, but also their family members need necessary psychological support as they will be losing their loved one. So, in the given case, the patient do require morphine administration as a part of palliative care, removing which put him at an extreme pain, which should be avoided. So, the family members must be explained about the consequences of removing the IV tubes and morphine and the importance of reducing pain to the patient especially at the time of death.