Reference no: EM133712219

Problem

Mrs. S. is an 86 year old woman with dementia and cancer of the colon. She has been a resident of the nursing facility for 6 months. When she was admitted, she was able to assist with her personal care. She was very unstable on her feet. She frequently attended activities in a wheelchair. She ate approximately 90% of her meals on the days when her favorite foods were served. On admission, Mrs. S. was pleasant but confused and disoriented. After residing in the nursing facility for three months, she began to recognize nurse's aides who frequently cared for her.

About three months ago, Mrs. S's appetite greatly diminished. She would eat approximately 30% of her meals and often declined her favorite foods. She frequently fell asleep during activities and requested to be put to bed. She began sleeping approximately 16 hours a day. She complained of pain in her right lower quadrant. She was no longer able to perform any of her personal care and became incontinent at night. She continued to smile and chat with facility staff that had cared for her.

About 2 months ago, Mrs. S. became too weak to get out of bed. When placed in a wheelchair or chair, she would slump over and sleep. She began sleeping 18 hours a day. She ate approximately 10% of her meals. She developed a decubitus ulcer on her right hip. With treatment, the decubitus did not get any larger but it would not heal completely. She became more confused and disoriented but remained pleasant when with visitors/staff. She was incontinent day and night. She began to use her call bell continuously and became very anxious when left alone. A volunteer visited her frequently and read to her, which Mrs. S. seemed to enjoy. She also became calmer after visits from her chaplain.

Three days ago Mrs. S. seemed to withdraw from the nurses aides who provided her personal care. She became agitated when staff attempted to feed her or give her medications. She was running a low-grade fever. She repeatedly stated that she saw her mother and father. Her respirations were noisy and congested. Her feet were cold and blue.

One day ago Mrs. S. became comatose. She is incontinent of stool and urine. She has no swallow reflex. Her feet, legs and hands are mottled, respirations are shallow with 5 second periods of apnea. B/P is 60/40.

Source: Lo, K. (2000). Dignified Care of the Actively Dying Resident. Largo, Fl: The Hospice Institute of the Florida Suncoast. Reprinted with permission.

After reading the case study on Mrs. S, please answer the following question

Discuss keys aspects of physical, psychocological, and/or spiritual care that should be provided to Mrs. S. and her family at this time. If you have had experiences recognizing symptoms of impending death of a patient or loved one, feel free to share your insights here.