Medical-Surgical Nursing:Assessment and Managementof Clinical Problems 9th Edition by Sharon Lewis,Shannon Ruff Dirksen,Margaret McLean Heitkemper,Linda Bucher

Exercise 17

CASE STUDY: End-of-Life Palliative Care Patient Profile S.J., a 42-year-old woman, had unsuccessful treatment for breast cancer 1 year ago and now has metastasis to the lung and vertebrae. She lives at home with her husband, a 15-year-old daughter, and a 12-year-old son. She has been referred to hospice because of her deteriorating condition and increasing pain. Her husband is an accountant and tries to do as much of his work at home as possible so that he can help care for his wife. Their children have become withdrawn, choosing to spend as much time as possible at their friends' homes and in outside activities. Subjective Data
• S.J. reports that she stays in bed most of the time because it is too painful to stand and sit.
• She reports her pain as an 8 on a scale of 0 to 10 while taking oral MS Contin q12hr.
• She reports shortness of breath with almost any activity, such as getting up to go to the bathroom.
• S.J. says she knows she is dying but her greatest suffering results from her children not caring about her.
• She and her husband have not talked with the children about her dying.
• Her husband reports that he does not know how to help his wife anymore and that he feels guilty sometimes when he just wishes it were all over. Objective Data
• Height: 5 ft, 2 in (157 cm)
• Weight: 97 lb (44 kg)
• Skin intact
• Vital signs: Temp 99°F (37.2°C), HR 92 bpm, RR 30, BP 102/60
-Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? 11 Substance Abuse