SituationKaren is an 87-year old female with advanced breast cancer with extensive metastasis. She was brought to the hospital via ambulance and was treated for dehydration and uncontrollable pain. She was on a medical/oncology unit for 3 days and then transferred to inpatient hospice. Karen’s provider has written orders for admission. She is currently complaining of pain and shortness of breath. She is currently on 2 LPM via nasal cannula. Her IV was placed and she was just given morphine 2.5mg IV about 2 hours ago. Karen was turned, repositioned and oral care was provided about 30 minutes ago.Karen’s children do not get along. The son wants all measures to be taken in order to save his mother. Her daughter wants her to be comfortable and realizes she is at end of life. Karen’s husband is stuck in between it all.Karen’s children fight in front of her and the son continues to fight for all cares to save her. He wants aggressive treatment.AssessmentVital Signs: HR: 98, BP 95/65, RR 28, SpO2 92% on 2 LPM per nasal cannula, T 37??CGeneral Appearance: Frail, very thin and pale with mild dyspnea. Appears comfortable overall.Integumentary: Skin breakdown in peri area and coccyx.Cardiovascular: Sinus rhythm is S1 and S2 audible. No murmurs.Respiratory: Crackles in both lung fields. Mild dyspnea noted secondary to ascites.GI: Bowel sounds hypoactive, abdomen firm and distended with positive fluid wave.GU: Voiding dark concentrated urine. Incontinent, some skin breakdown noted.Extremities: Decreased movement and strength in all extremities.Neurological: Pupils equal, round, and minimally reactive to light. Responds to her name only.IVs: 20-gauge peripheral catheter intact in right arm with D5 ? NS infusing at 30mL/hour and morphine infusing at 1mg/hr.Fall Risk: High-riskPain: No grimacing, moaning, clenched mouth, restlessness, sighing or crying noted at this time.OrdersInitial Healthcare Provider OrdersAdmit to inpatient hospice bedDiagnosis: Advanced breast cancer with extensive metastases to bones, brain and liverDo Not ResuscitateNothing by mouthVital signs every 4 hoursComplete bedrestOxygen at 2 LPM via nasal cannula; titrate as needed for dyspneaDextrose 5% in 1??2 NS at 30 mL/hourMorphine sulfate per continuous IV infusion at 1 mg/hourMorphine sulfate 5 mg IV every 2 hours prn for breakthrough pain, call healthcare provider if pain not relievedLorazepam 1 mg IV every 4 hours prn for anxietyHaloperidol 5 mg IM two times every dayGlycopyrrolate 0.2 mg IV every 4 hoursEnd-of-life comfort measuresApply barrier cream to skin after each bowel and bladder incontinence .What family nursing problem approach seems appropriate (name two)? List four nursing interventions, can be nursing and dependent interventions?
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