NR305 Week 7 iHuman Case: Anthony James

NR305 Week 7 iHuman Case: Anthony James

CLASS: NR305 Health Assessment for the Practicing RN

Situation: Anthony James is a 72-year-old male in room 2. He is a patient of Dr. Johnson who was admitted to the palliative care unit from home this morning.

Background: He was admitted for unmanaged pain and restlessness. He was diagnosed with stage IV bladder cancer eight months ago. After a course of chemotherapy failed to improve his prognosis, he and his family decided to shift the focus of his care to preserving his quality of life. He has been receiving home hospice care for the last several months.

Over the last week, he has gradually stopped taking food and drink by mouth and has been increasingly restless and uncomfortable. He has been admitted to the palliative care unit to manage his symptoms. He has a history of COPD and has been oxygen-dependent for two years. He also has a history of heart failure, pacemaker, appendectomy, and hernia repair.

Assessment: His code status is DNR and he is receiving comfort care. His admission vital signs at 1012 were 98/64, 102 beats per minute, 24 breaths per minute with 94% oxygen saturation, and a temperature of 99.8°F axillary. He has a right chest wall implanted port that has been accessed with a 22-gauge non-coring implanted port (Huber) needle and a sterile dressing was applied.

The extension tubing is a double-lumen and both ports flush briskly and have blood return. PCA is running through the proximal port. He has required four bolus doses of morphine and has had two rate increases of his PCA because of grimacing, restlessness, and moaning. He was also given one dose of PRN lorazepam for worsening restlessness. His daughter is at the bedside. He has had 100 mL of red urine from his catheter.

Recommendation: The plan of care is to manage his symptoms and then discharge to home if possible, however, death may be imminent at this point. Case management and pastoral care have visited the patient. At this time continue to monitor discomfort and notify HCP if the pain is uncontrolled.

Solution:

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