Ms. Smith: Anorexia, Depression, Anxiety In An 85-Year-Old

Ms Smith Anorexiadepressionanxietyms Smith Is An 85 Year Old Woma

Ms. Smith is an 85-year-old woman diagnosed with end-stage cardiac disease, currently receiving care through a home hospice program. Over the course of her illness, she has maintained comfort and functionality, experiencing no significant symptoms until recent weeks. In the last two weeks, her family has raised concerns regarding her deteriorating appetite, persistent sadness, and anxiety, which they believe are impairing her ability to function effectively. The hospice nurse’s routine visit revealed that Ms. Smith reports minimal appetite, preferring to consume occasional snacks, and states she feels generally comfortable despite her limited intake. Her family, however, insists on the necessity of better nutrition and has requested the insertion of an IV to support her nutritional needs.

Additionally, her family perceives her psychological state as concerning, believing that her sadness and restlessness—described as being “too antsy”—are indicative of depression. Ms. Smith herself admits to a longstanding history of depression, which she has fought by focusing on the positives in her life. She also reports experiencing anxiety, especially during visits from her children, stemming from fears about her impending death and feelings of guilt regarding her parenting. She confesses to poor sleep at night, driven by fears of leaving her family behind. Ms. Smith expresses a desire for peace in her final days, wishing to die in her preferred manner without interference or conflict over her care.

Discussion Questions

How might the hospice nurse incorporate interdisciplinary care for this patient? What additional assessments would be needed? What interventions might be considered?

Paper For Above instruction

The management of complex symptoms such as depression, anxiety, and nutritional decline in end-of-life care requires a comprehensive, interdisciplinary approach that addresses physical, psychological, social, and spiritual aspects of patient well-being. For Ms. Smith, the hospice nurse plays a pivotal role in coordinating this holistic care, collaborating with various health care professionals to provide person-centered support that respects her wishes and dignity during her final days.

Incorporating interdisciplinary care begins with assembling a team that may include physicians, mental health professionals (such as psychologists or counselors), social workers, spiritual care providers, dietitians, and hospice nursing staff. This team works collaboratively to develop a tailored care plan addressing her physical symptoms—such as poor appetite and potential pain management—as well as her psychological distress. For instance, a mental health professional could evaluate her for depression severity and provide psychotherapy or recommend appropriate pharmacological treatments like antidepressants compatible with her terminal condition. Likewise, a spiritual counselor could help Ms. Smith explore her spiritual needs and facilitate peaceful reflection, which can deeply impact her sense of comfort and closure.

Additional assessments necessary for comprehensive care include thorough physical evaluations to rule out reversible causes of her lack of appetite and anxiety, such as medication side effects, metabolic derangements, or worsening cardiac function. It is also essential to assess her psychological state through standardized screening tools for depression and anxiety, such as the Geriatric Depression Scale or the Hospital Anxiety and Depression Scale. Social assessments can help identify family dynamics, communication issues, and support systems that influence her emotional well-being. Evaluating her spiritual concerns and preferences is equally important, as these can significantly influence her end-of-life experience.

Interventions should be multifaceted and individualized. Pharmacological management may include adjusting medications to alleviate depression or anxiety symptoms—while considering safety and potential side effects in an elderly, frail patient. Non-pharmacological approaches like relaxation techniques, guided imagery, or spiritual counseling can promote peace and reduce anxiety. Addressing her nutritional concerns involves respecting her autonomy while providing balanced information about the risks and benefits of interventions such as IV nutrition. Since she prefers minimal intervention at this stage, a focus on comfort measures, including appropriate symptom control (e.g., opioids for dyspnea, anti-anxiety medications), is paramount.

Communication with Ms. Smith and her family must be compassionate, honest, and respectful of her wishes. Facilitating advanced care planning discussions can help clarify her goals of care, ensuring that interventions align with her desires for dignity and comfort. Respecting her wish to die peacefully and on her terms requires sensitive negotiation, balancing medical recommendations with her personal preferences. Family meetings led by an interdisciplinary team can also help resolve conflicts, improve understanding, and foster support for her decisions.

Finally, holistic palliative interventions that incorporate comfort rituals, emotional support, and spiritual care can significantly enhance her quality of life in her remaining days. Ensuring her environment remains peaceful, and that her fears about death are addressed with compassionate presence and spiritual guidance, can provide solace. Overall, interprofessional collaboration, thorough assessment, and individualized, dignified interventions are essential to meet Ms. Smith’s complex needs at the end of life.

References

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