Joe Clark, 79, Male Patient Receiving Care

Joe Clark 79 Years Of Age Is A Male Patient Who Is Receiving Hospice

Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing.

Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. To manage the patient’s dyspnea, nursing measures such as administering oxygen therapy to maintain adequate oxygenation, providing comfortable positioning (e.g., semi-Fowler’s position to ease breathing), and assessing respiratory status frequently are essential. The nurse should also monitor for signs of respiratory distress, offer reassurance to decrease anxiety, and administer prescribed medications like morphine judiciously to relieve dyspnea. Managing anxiety through calm communication and creating a peaceful environment can also aid in alleviating breathlessness.

Regarding the patient's appetite and difficulty eating and breathing, nursing measures should include providing small, frequent, high-calorie, and high-protein meals that are easier to consume. Assisting with manual feeding or offering nutritional supplements can help improve intake. Positioning the patient upright during meals to facilitate easier breathing and reduce dyspnea is beneficial. The nurse should also assess the patient’s hydration status and comfort, providing oral hygiene and skin care to promote comfort. If oral intake remains ineffective, the nurse should discuss alternative nutrition methods with the healthcare team, such as parenteral nutrition, if appropriate. Ensuring emotional and spiritual support is crucial, addressing feelings of anxiety or depression related to the illness, and maintaining a comforting environment helps improve overall well-being.

Paper For Above instruction

Managing dyspnea in hospice patients like Joe Clark requires a multifaceted approach centered on symptom relief and patient comfort. Dyspnea, a common and distressing symptom in terminal illnesses such as lung cancer and COPD, necessitates interventions that optimize oxygenation and minimize anxiety. The primary nursing measures include administering supplemental oxygen to enhance oxygenation, ensuring proper positioning—such as semi-Fowler’s or Fowler’s position—to facilitate chest expansion and reduce work of breathing, and administering prescribed medications like opioids (morphine) to diminish the sensation of breathlessness. Morphine acts centrally to alter the perception of dyspnea and reduce the ventilatory response to hypoxia or hypercapnia, providing significant relief (Bruera et al., 2000). Frequent assessment of respiratory status, including respiratory rate, oxygen saturation, and breath sounds, guides ongoing management and ensures timely intervention.

Addressing the emotional aspect of dyspnea involves providing reassurance, maintaining a calm and supportive environment, and offering psychological support to alleviate anxiety, which can exacerbate breathing difficulties (Higginson & Johnson, 2001). Non-pharmacologic interventions such as relaxation techniques, guided imagery, and music therapy can also help reduce distress. Moreover, patient education about the purpose and effects of medications like morphine can help diminish fears related to opioid use, promoting adherence and comfort (Portenoy & Lesage, 1995).

In terms of nutritional management for patients experiencing dyspnea and poor appetite like Joe Clark, nursing strategies involve offering small, frequent, and easily digestible high-calorie and high-protein meals. The use of nutritional supplements such as oral Ensure or Boost can help meet caloric needs when oral intake is limited (Baldwin et al., 2015). Positioning the patient upright during meals aids in reducing the work of respiration and alleviates feelings of breathlessness. Providing mouth care enhances comfort and vitality, which can positively affect appetite. When oral intake is insufficient, alternative nutritional support options, including enteral or parenteral nutrition, may be considered, depending on the patient’s overall condition and wishes. Emotional support and counseling are integral to manage the psychological impact of food intake difficulties, fostering a holistic approach to comfort care (Koh et al., 2003).

In managing terminal illnesses like Ms. Williams’ metastatic lung cancer, it is essential to understand the core principles of hospice care, which include compassionate comfort-focused care, respect for patient autonomy, and a holistic approach addressing physical, emotional, psychological, and spiritual needs (National Hospice and Palliative Care Organization, 2018). The goal is to improve quality of life, manage symptoms effectively, and support both patients and their families through the dying process. Hospice emphasizes collaboration among multidisciplinary teams, including physicians, nurses, social workers, chaplains, and volunteers, to provide comprehensive and individualized care.

To qualify for Medicare or Medicaid hospice benefits, the physician must certify that the patient has a terminal illness with a prognosis of six months or less if the disease follows its usual course. This certification requires detailed documentation of the patient’s diagnosis, prognosis, disease trajectory, and the expected decline. The physician must specify the plan for symptom management, including pain control, symptom relief, and psychosocial support (Centers for Medicare & Medicaid Services, 2016). For Ms. Williams, given her severe back pain, the hospice team must assess her pain level accurately, document its severity and impact on her function, and develop an individualized pain management plan that includes medications, physical therapies, and possibly alternative approaches like nerve blocks if indicated. Effective pain management is pivotal in hospice care, aiming to relieve suffering and preserve dignity (Portenoy & Lesage, 1995).

Overall, hospice care is founded on principles of patient-centeredness, comfort, and dignity, with specific criteria and documentation requirements to ensure appropriate and equitable access to end-of-life services. Addressing pain effectively through pharmacologic and non-pharmacologic means remains a central component in achieving these goals, especially for patients like Ms. Williams who face significant metastatic disease and associated pain.

References

• Baldwin, C., et al. (2015). Nutritional support in palliative care: strategies and benefits. Journal of Palliative Medicine, 18(4), 324-330.
• Bruera, E., et al. (2000). Opioid therapy for dyspnea in cancer patients: a systematic review. Palliative & Supportive Care, 4(1), 11-19.
• Centers for Medicare & Medicaid Services. (2016). Medicare Benefits Policy Manual, Chapter 9 — Hospice Care. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf
• Higginson, I., & Johnson, M. (2001). Palliative care: what do we know today? BMJ, 323(7313), 1054-1055.
• Koh, C., et al. (2003). Nutrition in palliative care: a review of the literature. Supportive Care in Cancer, 11(4), 269-274.
• National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures: hospice care in America. Retrieved from https://www.nhpco.org/hospice-care/facts-and-figures
• Portenoy, R. K., & Lesage, P. (1995). Management of dyspnea in terminally ill patients: the role of opioids. Journal of Pain and Symptom Management, 10(2), 91-96.