Approaching Death: Improving Care at the End of Life, Case Study Example

Mr. P is a 76 year old male with cardiomyopathy and congestive heart failure who has been hospitalized several times due to his CHF symptoms. He struggles with maintaining the diet restrictions his nurse and physicians have time and again underscored must follow in order to lead a healthier and happier lifestyle. Moreover, he does not take his medications as prescribed by his physicians so his management of his polypharmacy is subpar. He feels terrible everyday due to the fact that he struggles breathing normally and has moist crackles in his lungs combined with edema. The edema and shortness of breath are attributed to his CHF (Parmley, 1985). His wife laments that his declining health is the reason why can never leave the house, as she is his only family left and she fears his suicidal ideation as his despondency and his articulation of his desire to die suggests. Mr P suffers from a multitude of problems that nurses and physicians alike would label him as a terminal patient and requires medical personnel to tread lightly when interacting with the patient. A nurse should discuss the option of hospice care with both the patient and his wife in order to ascertain how they feel about hospice care for the terminally ill. If the patient declines hospice or expresses overt antagonism towards it, then home healthcare should be discussed in order for home nurses to be able to monitor him on a quotidian basis with regards to his diet and taking the various medications as directed by his primary care physician. Home health nurses would also be able to check his vital signs daily in order to monitor his health status closely.

Because Mr. P. ponders why God has not “taken him” yet, it is clear that he is a religious or spiritual person. As such, palliative care is a third option that can be discussed that might be the most optimal choice in his case. When patients like Mr. P. are terminal, enhancing the quality of end-of-life care is a critical goal within the healthcare system at the micro and macro levels. Palliative care refers to a comprehensive healthcare approach to addressing the spiritual, physical, and psychosocial needs of the patient as well as their families. Such care necessitates the coordination of a multidisciplinary group of nurses, specialists, the family (Mr. P.’s wife), and other qualified caregivers (Field & Cassel, 1997). This approach is optimal so that both Mr. P and his wife’s quality of lives are enhanced as nurses would focus on mitigating any discomfort Mr. P. has as a result of his terminal status. Such care focuses on the acute symptoms such as shortness of breath, depression, loss of appetite, fatigue, and pain. Such care aims at aiding Mr. P. gain strength in order to carry on with his quotidian activities by helping him tolerate medical treatments in addition to becoming more in control of his healthcare through an understanding of the choices he has for his own treatment. Through such care, Mr. P. will have better control over his treatment, thereby empowering him, as well as fully comprehending all of his options and treatment possibilities.

A simple treatment plan should be administered to Mr. P. who needs to alter his lifestyle in order to enhance the quality of his life. If home health nurses is the option he pursues, then the nurses not only need to monitor his medications, they also need to monitor his home oxygen intake since he struggles breathing due to his congestive heart failure. As such, the home health nurses would manage his issues with poly pharmacy while also ensuring he is getting enough oxygen and eating foods that are low-sodium. It is the duty of both nurses and home caregivers to educate Mr P. on his condition and the lifestyle changes that are necessary in order to improve the quality of his life and mitigate depressive tendencies. For treating heart failure, decreasing the amount of salt is crucial in order to treat debilitating symptoms of the condition. Sodium is a mineral that is present in virtually all foods. Ingesting too much salt prompts the body to retain a large volume of water, thereby exacerbating the fluid build-up that correlates with heart failure. Adhering to a low-salt diet would help Mr. P. control his edema and high blood pressure in addition to decreasing his labored breathing. Nurses need to reiterate that Mr. P. should not consume more than two grams of sodium per day, and if possible, less than fifteen hundred milligrams (Parmley, 1985). Moreover, the teaching plan needs to incorporate the vitality of Mr. P. taking his various medications as directed by his team of physician, especially his diuretics. As his only family, his wife needs to be told about the currency of home health nurses who can educate both the patient and herself on the importance of diet, exercise, and appropriately taking the medications as directed in order to enhance the quality of their lives. Caregivers would also take some of the burden off of Mr. P.’s wife, which would enable her to get out of the house when necessary.

References

Field, M.J. & Cassel, C.K. (1997). Approaching death: improving care at the end of life. Washington, DC: National Academy Press.

Lunney J.R., Lynn, J., Foley, D.J., et al. (2003). Patterns of functional decline at the end of life. JAMA, 289, 2387–2392

Parmley, W.W. (1985). Pathophysiology of congestive heart failure. American Journal of Cardiology, 56(2), 7-11.

Penderell, A., & Brazil, K. (2010). The Spirit of Palliative Practice: A Qualitative Inquiry Into

the Spiritual Journey of Palliative Care Physicians. Palliative and Supportive Care, 1, 1- 6

Penderell, A., & Brazil, K. (2010). The Spirit of Palliative Practice: A Qualitative Inquiry Into the Spiritual Journey of Palliative Care Physicians. Palliative and Supportive Care, 1, 1- 6

Penderell, A., & Brazil, K. (2010). The Spirit of Palliative Practice: A Qualitative Inquiry Into the Spiritual Journey of Palliative Care Physicians. Palliative and Supportive Care, 1, 1- 6