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Week 9 discussion

Treating Patients in Specialized Areas of Care

When treating frail elder patients in specialized areas of
care, there are various dynamics that might impact patient care plans. From
questions about potential outcomes, benefits of treatment, and quality of life
to factors such as personal values, families, culture, and religion, decision
making can be difficult for patients and their families. As the advanced
practice nurse, you must support them through this process. For this
Discussion, you examine the following case studies and consider how you might
address the needs of the patients and their families.

Case Study 1:

Mr. Wiggins is a 78-year-old African American male with
chronic kidney disease, which requires dialysis. The etiology of his renal
disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy.
He has been on hemodialysis for the past 10 years and has done relatively well.
Four weeks ago, he had a major CVA and is minimally responsive. His condition
is not expected to change, and the family is having a difficult time with his
recent health changes. Advanced directives were discussed with them, and his
wife is a durable power of attorney for his health care. The wife hates to see
her husband this way and understands this is not how he would want to go on,
but their children and many of the family members (his brothers and sisters)
think the patient will return to himself. They want everything done in terms of
life support measures—full code status. His family wanted a feeding tube
placed, and he is now receiving 24-hour tube feedings. You are the NP caring
for Mr. Wiggins. You have known and cared for him and his wife for several
years. The wife pulls you aside, shares her dilemma, and asks you to make the
decision regarding continuing medical care/support for her husband. How will
you respond?

Case Study 2:

Mrs. Adams is a 96-year-old Caucasian female who has
recently been diagnosed with colon cancer. She was admitted to the hospitalist
service through the ED with dehydration and rectal bleeding. The bleeding
resolved, and she received 2 units of PRBs and fluid/electrolyte replacement.
She is stable and ready to be discharged home.

Mrs. Adams is in remarkably good health, and other than
arthritis and mild HTN, she has no significant medical or surgical history. She
is able to carry out all of her essential daily living activities. She pays her
own bills, is competent, and has good functional abilities. She was driving up
until last year. Now, she has neighbor’s assist with weekly shopping and
transportation to church. Her sensory, functional, and cogitative abilities
were evaluated this admission and remain intact. She has been offered
palliative surgical intervention, but deferred all treatment. Her only son is
in agreement with his mother’s decision. Her parents and husband are deceased.
You have been asked to obtain advanced directives. What will your discharge treatment
plan be for Mrs. Adams?

Case Study 3:

Mr. Pierce is an 82-year-old East Indian male, recently
widowed 6 months ago. He fractured his left hip 2 months ago attempting to
climb his backyard fence to get his cat out of a tree. His children live
internationally and have been taking turns caring for him. His eldest son
brought him in through the ED last night because Mr. Pierce started having
shortness of breath and his lips turned blue. In addition, his son noticed his
left leg was very swollen compared to the right. The ED nurse practitioner
ordered a thin cut cat scan (CT) with pulmonary embolism (PE) protocol and deep
vein thrombosis (DVT) scan. Mr. Pierce has a large DVT that is obstructing circulation
and multiple pulmonary emboli. His condition is life threatening and he is only
expected to live a few weeks. He has a living will and advanced directives and
has requested to be able to die in the comfort of his home. “I hate hospitals.”
You have been consulted at the patient and family’s request because you are Mr.
Pierce’s primary care provider. What additional services can be offered to
ensure his care/comfort at home and to give him peace of mind regarding his
estate?

To prepare:

Select one of the three case studies. Reflect on the
provided patient information.

Think about potential outcomes for the patient in the case
study you selected.

Consider how care, treatment, and/or support might be
facilitated for the patient. Reflect on how you might also address the needs of
the family.

Post on or before Day 3 an explanation of potential outcomes
of the patient in the case study you selected. Then, explain how care,
treatment, and/or support may be facilitated for the patient. Include how you
might address the needs of the patient’s family as well.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your
colleagues on two different days in one or more of the ways listed below.
Respond to colleagues who selected a different case study than you did.

Offer alternative outcomes based on the case study and
provided patient information.

Share additional suggestions for the care, treatment, and/or
support for the patients in the case studies your colleagues’ selected.

Validate an idea with your own experience and additional
literature search.

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