Unit 7 Discussion

1. Some questions I would ask to explore the need for palliative care would be:

Do you have easy access to the bedroom and bathroom for the patient?

Can the patient be mobile on his own?

Is the patient able to shower on his own or get assistance showering?

How often is the pain?

What is the severity of the pain?

Is the pain intermittent or constant?

Is the patient on oxygen?

Are there any stairs in the home? If so, is there handicap accessibility?

Is the patient going to be alone at home?

Those are just some, however I think sometimes it is hard because patients in this scenario can deteriorate quickly changing their status for the need for palliative care.

2. Total pain management entails caring for the patient in a way that is different from the hospital and clinic setting. The concept of access to pain management as a human right has gained increasing currency in recent years (Brennan, Lohman, & Gwyther, 2019). It is very hard to watch a family member be in extreme pain because you feel bad for them and want to take it away for them, at least in my opinion. Typically, we worry about kidney damage, liver damage, and damage to other organs when giving pain medicine if given in higher doses. In Mr. Browns case he is in extreme pain and is going to need a lot of help now and in the future. Palliative care does not speed up the process of dying, however it does provide comfort to the family and patient by helping them to tolerate the pain in a more manageable way (Croson, 2018). This is also important to explain to the family as well because emotionally they may be distraught and need time to come to terms with Mr. Brown’s diagnosis. Many people think “death” immediately when they hear the word hospice or palliative care, but it is not always the case. Yes, Mr. Brown will have an eventual death from this disease process but by providing total pain management it keeps him from being miserable until he passes in a more peaceful manner.

3. Addressing Mr. Browns spiritual well being helps him to come to terms with and cope with his disease prognosis. Understanding the relationship between spiritual coping and psychological symptoms, especially depressive symptoms, could help healthcare teams better address patients’ needs (Gryschek et al., 2020). If a patient is at peace with their life and their religious beliefs, I have found that they pass on easier. I have unfortunately seen many people die, patients as well as close friends and family. And I am a strong believer in the patient being at peace with their psychologically and spiritually. It’s a part of total pain management because people can be suffering inside/emotionally if they are not in a good place spiritually and or psychologically. It is sad in my opinion.

4. Opioids can be extremely deadly if they are not taken as prescribed or abused. Mr. Brown’s daughters’ worries should be addressed by simple patient and family education. Explaining how the receptors in the brain work and how they can help her father not be in excruciating pain during this process may help ease her mind. Also, explaining that the things she hears on the news are usually people who abuse the medications. In Mr. Browns scenario the medication will not be abused, nor will he be receiving the amount it would take to kill him. Explaining to her how taking too much of the medication can depress the respiratory system and that he will be monitored during the administration to ensure that does not happen would also be beneficial in educating her.  I learned in nursing school that we don’t only treat the patient; we treat the family as well and this still holds true in this situation.

5. During palliative care the patient is going to experience many symptoms as end of life gets nearer. However, patient education as well as family education should have already occurred, so the family is aware of the progression, so they are not caught off guard. Dyspnea, a sensation of shortness of breath, often is managed with opioids in a palliative care context (Croson, 2018). However, this patient is also confused and anxious so we must consider using a sedative or antianxiety medication as well typically Ativan in this scenario. Administration of oxygen can be used, but only if it does not cause the anxiety to worsen by constricting a face mask on the patient face (Croson, 2018). This also hinders the family from not being able to be with their loved ones in their last moments which helps with coping, spirituality, and psychological factors.

Brennan, F., Lohman, D., & Gwyther, L. (2019). Access to Pain Management as a Human Right. American Journal of Public Health, 109(1), 61–65. https://doi-org.libauth.purdueglobal.edu/10.2105/AJPH.2018.304743

Croson, E. (2018). The Medical-Surgical Nurse’s Guide to Understanding Palliative Care and Hospice. MEDSURG Nursing, 27(4), 215–222.

Gryschek, G., Machado, D. D. A., Otuyama, L. J., Goodwin, C., & Lima, M. C. P. (2020). Spiritual coping and psychological symptoms as the end approaches: a closer look on ambulatory palliative care patients. Psychology, Health & Medicine, 25(4), 426–433. https://doi-org.libauth.purdueglobal.edu/10.1080/1…