Reference no: EM133324777

Case: It has been over three weeks and Mr. Charles continue to decline slowly. He no longer walks and sleeps on a hospital bed in the living room. His daughter two weeks ago, changed her mind on hospice. Mr. Charles developed a high fever and was unable to swallow, Susan convinced her father to be hospitalized. Mr. Charles shown no improvement after multiple hospitalizations for sepsis/osteomyelitis, the family had an extensive discussion with the medical team, and they opted to pursue hospice care. The hospice team kept the family updated on the client's position and educated the client and family on a POLST. Mr. Charles signed the advance directives for DNH, DNR & DNI and proceed to kiss his wife.

During a routine home visit, from the Hospice Case Manager, his family shares that he has experienced a rapid decline. Mr. Charles is unable to use the bedpan and now wears adult briefs. He refused fluids and soft foods for the past 48 hours with minimal urine output. His wife feels "overwhelmed" and feels that additional support is needed, to feed him, since he has now developed a stage 3 decubitus ulcer. Mrs. Charles reported him gasping for air during incontinent care by the hospice aid. She was very annoyed and blame the hospice aid for being rough.

During the Case manager's assessment Mr. Charles appeared to be actively dying and was placed on 2l of continuous oxygen via nasal cannula. He was nonverbal, open, and close his eyes while mouth breathing periodically and intermittently grimacing during wound care. Mr. Charles medication regiment included 1 mg of liquid hydromorphone prior to dressing changes and PRN. His Case Manager Mary noted that his stage III decubitus ulcer on his coccyx has increased significantly from 11 cm x 7 cm x 2 cm to 14 cm x 9 x 3 cm over the past week with increased drainage requiring dressing changes at least 4 times daily. Since he no longer ate, the family was educated by the Hospice Case Manager on mouth care and signs of end of life.

Mrs. Charles called and convinced her daughter to visit her father. Susan appeared devasted during the visit, later that evening. She was disturbed by his pattern of breathing and left the house in tears. Mrs. Charles called the local parish priest for Mr. Charles last rites (commendation of dying). At 2am Mr. Charles took his last breath and his wife called hospice services where he was assessed, and the time of death recorded by Mary the hospice case manager. Mary then called the doctor who official set up the dead certificate and arrangements were made to take the body to the funeral home.

At the funeral, Mrs. Charles appeared happy and reported she have accepted her husband passing, she refused any further assistances offer by her husband's family. Her daughter never attended the funeral and visited the grave two days later with flowers. Susan appeared sad, withdrawn, hypersomnia and bulimic. She took extended time from work. On the advice of a friend, she started to attend grieve counseling at her local church. Three months later, Susan returned to work, appear friendly, listen to her father's favorite music in her car and keeps a picture of father at her bedside.

After the dead of her husband Mrs. Charles felt guilty and ashamed. She blames herself for not supporting her husband. Mrs. Charles has a history of Depression and been sobered for over 40 years. Three months later, Mrs. Charles now suffers with insomnia and poor appetite. She comforts herself with several glasses of wine every evening before bed and stop attending to her ADLS.

Questions:

1 Based on the scenario, what would be the goal of hospice caring for Mr. Charles and his family before the patient's passing?

2 If you were a visiting nurse assigned to Mrs. Charles. What would you assess for and why. Please provided citations on your answer that are evidences based with rationales.

3 Provided two psychosocial and one concept Diagnoses based on Mrs. Charles presentation?

4 Based on the Depression Assessment Continuum. Mrs. Charles will be assessed on what level of depression? Provide EBP on your answer

5 What would have been your response as a nurse to Mrs. Charles when her husband was actively dying and she felt overwhelm and wanted him fed?

6 What would be your recommendations for Mrs. Charles and her daughter after the dead of Mr. Charles. What resources is needed.

7 What was the faith of Mr. Charles? Do you think Mr. Charles spiritual needs were met at the time of his death? Give examples of the general role of spirituality in clients who are near the end of life.

8 Based on your understanding of the subject matter, what factors would of influences Mr. Charles perception of death?

9 Is it normal for the Hospice Case Manager to feel grief after a client dies? Is self-care important? If so, give examples how a nurse can practice self-care.

10 If Mr. Charles was Muslim, would the Hospice Case Manager after pronouncing be able to cleanse the body in preparation for removal? If Mr. Charles was Jewish how soon based on their faith would the funeral take place?

11 List the stages of Kubler- Ross stages of grief in detail

12 What stage of dying according to Kubler-Ross was Mr. Charles in at the time of his death?

13 From the scenario what kind of grief Susan was experiencing visiting her father? Do you agree or disagree after Susan returned to work; she was still experiencing grief? If so which one.