Situations: Mrs. M, a 45 y.o. woman with squamous cell cancer of the cervix was introduced in Module 2: Pain Management and Palliative Care. This case scenario revisits Mrs. M. after some time has elapsed.
Though Mrs. M.'s pain was managed effectively at home for a short while, her condition has deteriorated further and continues to change daily. She is at a point where her complex care needs are no longer being effectively met at home. Mrs. M, fearful of dying—and of dying at home, returned to the hospital. Her 5 children are being cared for by a sister who lives in the area.
Two days ago, Mrs. M. began running a low grade fever and her respirations are noisy and congested. Her feet and hands are cold to the touch and blue. She has very low urine output. She seems to be withdrawing from those around her, yet is very anxious about talking with her parish priest.
1. Describe signs and symptoms of the dying process that Mrs. M. is exhibiting. Her current state is most congruent with someone whose life remaining can be described best in terms of hours, days, or months?
2. Identify psychological, social, and spiritual care needs and corresponding interventions for her care. How would you adapt these interventions if the patient was an infant? An elderly (>85 y.o.) person? An individual from a culture whose was both different than your own and unfamiliar to you?
The symptoms of cold and blue extremities, along with congested respirations are due to
decreased cardiac output and hence, low blood volume. Renal activity decreases as a result and
causes low urine output (Endlink, 2013). Mrs. M will soon begin experiencing difficulty with swallowing,
if she hasn't already. As patients prepare to die they want to ensure their loved ones are cared for and
may go back and forth between wanting them around and not wanting them to see their poor state or
condition. This may be one of the reasons Mrs. M. decided she would be more comfortable in the
hospital than at home. Delirium and confusion due to fever and lack of regulation of body temperature
may add to her fears. Mrs. M is nearing her last hours of life, as evidenced by the congestion brought on
by fluid build-up in the lungs and reduced cardiac output.
Psychological concerns of Mrs. M include concern for the well being of her children and wanting
to let go peacefully, to prevent traumatic memories for her children. It is typical for people who are
near death like Mrs. M to withdrawal completely or to want to withdrawal completely from family and
loved ones to spare them pain and to maintain some perceived measure of control over the dying
process. If Mrs. M were to remain at home she may be fearful that family ...
The solution discusses the end of life care.