What is your initial plan for Mr. Williams and his family?
Read the case below and discuss a plan for assessing the patient’s pain based on what we read in the text.
Mr. Williams is a 53-year-old heavy smoker. Seven months ago he had surgery to remove a segment of his lung as part of his treatment for adenocarcinoma of the lung. You’re close to Mr. Williams. And as his hospital nurse, his family grew close to you, especially his wife, Mary. Weak and thin, Mr. Williams returned home with the surgeon’s confident assurances to the family that he would make a complete recovery. That never happened. Today he was readmitted with distressing symptoms including shortness of breath, severe pain, weakness and anorexia. His body has deteriorated rapidly, showing cachexia. He’s even more quiet and frail than you remember. You encounter his family while on rounds. They’re visibly upset, but relieved to see a familiar face. Mary says to you, “He’s really bad and in a lot of pain. None of the doctors are telling us anything.”
After a few days of discussion with the doctors and nurses, Mr. and Mrs. Williams agree to accept referral to hospice services. They feel strongly that the curative treatment options available to them at this point offer too few benefits and too many burdens to be acceptable. Their hope now is directed to having more time in their own home, time with their children and friends around, and time where Mr. William’s quality of life is maximized. They are referred to you, the admitting hospice nurse, to formulate a plan for palliative care. In talking about the services available through hospice, financial issues, and policies, you explain that all clients enrolled in this particular hospice group are required to sign a “do-not-attempt-resuscitation” agreement and instructed to call the hospice rather than 911 in the event of an emergency. Mrs. Williams is stunned to hear that her husband would not receive CPR if/when he experiences an arrest. She tells you that she was not aware that hospice would just let Mr. Williams die without trying to help him at all and expresses fear about being alone with her husband and facing a situation where he is in extreme pain and discomfort from dyspnea without professional assistance.
What is your initial plan for Mr. Williams and his family? Priorities?
How will you respond to Mrs. Williams” questions and concerns?
