ANSWER TO THIS POST IN A THOUGHFUL WAY AND USE NORLANDER AS ONE OF THE REFERENCES
The most important aspect of Jane’s care is understanding what she and her family know about her prognosis and goals of care. By establishing a baseline of needs with Jane and her family, I would be able to get a better handle on what kinds of interventions I can provide for them both physically, spiritually, psychosocially, and emotionally. I would utilize the Palliative Assessment Screening Tool (PAST) to steer the questions towards Jane and her family to get a better sense of their needs. PAST is used to guide staff nurses in the early identification of the palliative care needs of their patients and helped nurses obtain referrals to a medical palliative care provider to improve patient outcomes, particularly symptoms of pain, nausea, and shortness of breath (Flaherty et al., 2018). By utilizing this tool, I would be able to pinpoint some of the areas of distress for Jane and her family and hopefully alleviate some of the issues.
There are a few physical symptoms that I would take into consideration regarding Jane’s case and would like to address with immediate interventions. First, her dyspnea should be considered. This can be a combination from her previous medical history of low ejection fraction, heart valve replacement, and pulmonary edema. In addition, she is currently being treated for pneumonia which can also be a cause of her shortness of breath. It is important to keep this symptom well-controlled since this can be a highly distressing issue and can be a major source of anxiety. Dyspnea can be one of the most distressing symptoms for both patients and their families (Norlander, 2014). By continuing her course of antibiotics for the pneumonia, and I would also implement other interventions into her care plan including head of bed elevation, opening of a window, and maybe even attaching a fan to her bedside for a feeling of fresh air. In addition, I would aid Jane in breathing techniques including purse-lip breathing to help slow her respiratory rate if she is becoming anxious. I would not immediately jump into anxiolytics for her since her hypotension and delirium could worsen.
The next physical symptoms that I would consider are her hypotension and fluid overload. Jane is at a very delicate balance with CVVHD, fluids, and dopamine infusion. Therefore, it is of the utmost importance to relay to the patient and family that this will continue to be overseen in the ICU since the patient requires close monitoring.
Jane’s spiritual, psychosocial, and emotional symptoms are also important for her and her family’s plan of care. I would first address her confusion that is being attributed to ICU psychosis, and make sure it is not an extension of the infection that she is fighting. Once better understood, I would then take steps to re-orient Jane to her baseline mental status including scheduling her timing of medications and care, including a clock or calendar in her rom providing a calming environment, and even having her family members at the bedside. As previously discussed, I would get a sense from Jane and her family of their understanding of her prognosis and how they have been coping with her frequent hospitalizations. I would assess the family’s needs based off their responses and be as transparent as I can about Jane’s condition. I would offer support for them in any way that I could and ensure them that the palliative care plan is a collaborative effort and will continue to change as Jane’s needs change.
Flaherty, C., Fox, K., McDonah, D., & Murphy, J. (2018). Palliative care screening. Clinical Journal of Oncology Nursing 22(4), E92-E96. doi: 10.1188/18.CJON.E92-E96
Norlander, L. (2014). To comfort always: A nurse’s guide to end-of-life care. (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. ISBN: 9781938835506
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