Palliative Care at End-of-Life
B.B., a 79-year-old female, is brought to the emergency department by an ambulance. B.B. is complaining of shortness of breath and feeling hot and sweaty. She was diagnosed with stage IV cervical cancer two months ago and decided not to have any treatment. Her husband died a year ago and she has been living alone since that time. In the two months since her diagnosis, she has been cleaning out her house, donating things to charity, and giving her daughter family photo albums and jewelry. Her daughters have continued trying to get her to have chemotherapy, but B.B. refuses. They would check on B.B. every morning and night, and said that she had been getting weaker in the last week. Today they found B.B. lying in bed, short of breath and diaphoretic, and called an ambulance.
- States she can’t catch her breath
- States she wants to go home and says “I don’t want to die in the hospital”
- Daughters appear upset and angry and tell their mother that she needs to be in the hospital to get better
- No advance directives or living will
- Has a history of hypertension and osteoarthritis
- Blood pressure 100/60, pulse 96, respirations 28, temperature 101.4° F
- 5’4”, 100 lb., BMI 17.1 kg/m2
- Oxygen saturation 88% on room air
- Labored respirations
- Crackles in bilateral bases of lungs
Answer the following case study questions thoroughly and cite resources appropriately in APA format
From the data provided, which stage of grieving is B.B. in?
Patients and families often struggle with many decisions during a terminal illness. What are some decisions that patients can make about their end-of-life wishes?
What legal documents are available to guide B.B.’s daughters in making decisions about B.B.’s care should she become unable to make her own decisions?
How do nurses deal with families and patients when they don’t agree on treatment options?
What are some options available to B.B. so that she can be comfortable and able to die at home?
What are the criteria for admittance to a hospice program?
As the time of death nears for B.B., what physical manifestations should B.B.’s daughters be told to expect as normal signs of approaching death?
Providing care for patients and families at the end of life can be both rewarding and challenging. It is important for you to be aware of how grief affects you personally and to alleviate your stress. What are some interventions that can help you alleviate your stress from caring for patients at the end of life?