Madeline S. is a 66-year-old German woman admitted to a home care agency for care related to end-stage cardiac disease and renal failure. She has complained of chronic generalized chest pain, frequent cramps in her legs, and worsening arthritis pain related to her immobility. The home care nurse has been in contact with Madeline's physician almost daily for the past week and her analgesics have been steadily increased with little pain relief but an increase in nausea, constipation and sedation. The nurse feels frustrated as she observes Madeline declining rapidly with worsening depression, withdrawal and weeping. Madeline's neighbor has noticed that her lights are left on 24 hours a day and the nurse has noticed that Madeline has several rosaries and prayer books now at her bedside. Madeline has refused referral to hospice but the home care nurse has requested a team conference with assistance from the local hospice affiliated with the home care agency.
Discussion Questions:
- What disciplines should be included in the case conference?
- What additional assessment might the nurse obtain?
- How can this patient's pain and suffering best be treated?
Full Answer Section
- Social Worker: To provide psychosocial support and assist with end-of-life planning.
- Spiritual Counselor: To address her spiritual needs and provide comfort.
- Home Health Aide: To assist with activities of daily living and provide companionship.
Additional Assessments
In addition to the ongoing assessments by the home care nurse, the following assessments may be helpful:
- Comprehensive Pain Assessment: A detailed assessment of the location, intensity, and quality of pain, as well as any aggravating or alleviating factors.
- Functional Assessment: An evaluation of Madeline's ability to perform activities of daily living, such as bathing, dressing, and eating.
- Psychosocial Assessment: An assessment of her emotional state, coping mechanisms, and support system.
- Spiritual Assessment: An assessment of her spiritual beliefs and practices to identify potential sources of comfort and meaning.
Treatment Interventions
To address Madeline's pain and suffering, a multi-modal approach may be necessary:
- Pharmacological Interventions:
- Pain Medications: Optimize pain medication regimens, including the use of opioids, non-opioid analgesics, and adjunctive therapies.
- Medications for Nausea and Constipation: Address these side effects of pain medication.
- Non-Pharmacological Interventions:
- Relaxation Techniques: Teach relaxation techniques, such as deep breathing and meditation.
- Massage Therapy: Provide gentle massage to relieve muscle tension and promote relaxation.
- Music Therapy: Use music to alleviate pain and anxiety.
- Spiritual Support: Offer spiritual counseling and support to address her emotional and spiritual needs.
- Hospice Care: Refer Madeline to hospice care to receive specialized care and support during the end-of-life process.
By implementing a comprehensive and compassionate approach, the healthcare team can help Madeline manage her symptoms, improve her quality of life, and provide comfort during her final days.