Mrs. Paul is a 48-year old woman dying of end-stage liver disease and chronic renal failure. She is fatigued and has experienced significant weight loss

Mrs. Paul is a 48-year old woman dying of end-stage liver disease and chronic renal failure. She is fatigued and has experienced significant weight loss

Mrs. Paul is a 48-year old woman dying of end-stage liver disease and chronic renal failure. She is fatigued and has experienced significant weight loss, despite significant edema. She was diagnosed with colon cancer three years ago.

Mrs. Paul�s family is very upset and wants aggressive interventions done to help improve her appetite, curb her weight loss (she has lost 18 pounds in the last 4 weeks) and prevent nausea/vomiting. Her physician believes that one of the contributing factors to her fatigue is that her hemoglobin and hematocrit are low. She has receive 4 units of packed red blood cells over the past 2 weeks.

The patient stats that the fatigue continues, despite the blood transfusions. She has intractable nausea and vomiting and, as a result, she is frequently admitted to the hospital. As the nurse on the medicine unit you are admitting and assessing Mrs. Paul during her most recent admission.

The medical unit staff is very upset with Mrs. Paul�s family. The patient�s primary doctor and oncologist have not taken an active role in discussing palliative care with the patient or the family. One of your peers that has been caring for Mrs. Paul during frequent her frequent admissions states: �this family and patient deserve better-someone needs to be truthful with them so they know that their loved one is dying.�
Questions to answer:

Discuss your evaluation process in this case regarding: fatigue, weight loss, nausea, and vomiting.
Based on you assessments identify what management strategies you would use. What issues would you want to discuss with the interdisciplinary team?
Considering Mrs. Paul�s and her family�s needs and concerns, what strategies and interventions might you consider in her nursing plan of care?
How would you approach the physician about entertaining the possibility of palliative care for the patient and her family?

Case Continued
Ms. Paul has four children (ages 15, 17, 21, 25). You happen to have a conversation with the two youngest children, as they have come to the hospital after school to visit their mother. Their mother has gone to radiology for a CT-scan and you (the bedside nurse) decide that this would be a good time to talk with her children. The youngest confides in you that she knows her mother is dying. �I saw her vomit blood before we brought her to the hospital.� �We used to put puzzles together, but she is too tired anymore.� �Is my mother going to die?�
Questions to answer:

How would you respond to the 15-year old daughter?
What other members of the interdisciplinary team would you want to contact to assist with the family?

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