Julia Morales is a 65-Year-Old Woman Who has Stage 4 Lung Cancer - Medical Science Assignment Help

Assignment Task

Reflection Scenario 1

Patient Introduction

Julia Morales is a 65-year-old woman who has stage 4 lung cancer. She has been treated with chemotherapy and radiation but now wishes to forgo further treatment. She is living together with her partner, Lucy Grey, age 73. They have been together for more than 25 years. Julia and Lucy both want Julia to spend her remaining days in their home, and Lucy wishes to care for Julia. The oncologist nurse practitioner has asked the home health agency to do a home visit to assess client needs for comfort, safety, and other support. Julia has questions about hospice care and what that comprises, especially related to pain treatment. Lucy and Julia’s son, Neil, will also be present at the visit. Please make sure to assess Lucy’s preparedness to care for Julia. I think she has some questions related to the caregiver role.

Gerontological Nursing Care

1. Eliopoulos, C. (2018). Gerontological Nursing, 9th Edition.

Julia is a 65-year-old woman who has stage 4 lung cancer. She stopped treatment a few months ago and since then her partner, Lucy Grey, age 73, has been taking care of her in their home. Julia’s pain is controlled with fentanyl patches, and she is being repositioned every two hours. We are no longer checking her blood pressure, because this was painful for her. Her respirations have been around 8/min. We expect her to die very soon, and Lucy and Julia’s son, Neil, are aware. They are both with her constantly. Julia will probably not make it through your shift. Dr. Davis wants to be called in the event of Julia’s death.

The patient is a 73-year old woman, Lucy Grey. She called 911 after having a dizzy spell and a near fall in her home. When we arrived, she was sitting on her couch in her living room. Her blood pressure is 160/88, heart rate is 102, respirations are 20, and her oxygen saturation is 97%. She is on 2 liters of oxygen per nasal cannula.

She was alert, coherent, and apologetic for calling us. Denies taking any medications today, states she had tea and oatmeal for breakfast. No complaints of pain, mobilizes without assistance, a little slow due to ”stiff knees.” There is a scrape on her arm; we just taped a gauze pad on it. We have a saline lock in her right forearm. She told us that her partner, Julia, died from lung cancer three months ago and that she has been scared of being alone after the loss of her partner. Julia’s son, Neil, has been called, and he should be here any minute.

Overview

Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. They are retired and have spent the past several years traveling

together. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy's past medical history includes a knee replacement. Their support system includes Julia's son, Neil, and Lucy's niece, Nora.

Monologue

The introductory monologue takes place in Julia's home prior to an initial home health nurse visit. In the monologue, Julia discusses her life, including raising a son to adulthood, then meeting Lucy. She reviews her history with cancer and relates her understanding of home hospice care and her desire to die at home. She expresses concern about leaving Lucy alone.

Simulation Scenarios 1, 2, and 3

The scenarios begin with the home health nurse evaluating Julia after she has decided to stop treatment for her lung cancer. Her partner Lucy wishes to care for her in their home. In the second scenario the end of Julia's life is near and she is surrounded by her loved ones and the hospice nurses. Julia dies during this scenario. The learners are introduced to supportive measures for both the patient and the family during this process. The final scenario concentrates on Lucy and the difficulties she has adjusting to her new life after Julia is gone. The objectives focus on the students' assessment of Lucy's grieving process, how well she is coping, and the physical changes that she has experienced over the past few months.

Simulation Scenario 1 involves a visit by the home health agency nurse. Learners are expected to complete a physical and functional assessment of Julia and her nursing care needs, as well as an assessment of the home with a focus on safety. Julia inquires about hospice services, but her son, Neil, urges her to try one more round of chemotherapy. Lucy is supportive of Julia's decision and tries to comfort Neil. Learners will assess Lucy's caregiver strain, and articulate what hospice care means for the patient and family. The assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool of Older Adults, the Katz Index in Activities of Daily Living, and Informal Caregivers of Older Adults at Home: Let's PREPARE! Simulation Scenario 2 takes place in the home two months later. Julia is barely responsive and has Fentanyl patches for pain. Nursing care consists primarily of performing an appropriate patient assessment and ensuring patient comfort. Julia dies during this scenario and the learner provides support for the family. During debriefing, discussions may include how nurses manage their own emotions and self-care after the death of a patient. A second monologue occurs three months after Julia's death. Lucy is in the emergency room. She is grieving and wants to talk about Julia and their life together. She feels very lonely, but has had some contact with her neighbor, Adele, and her niece, Nora. There have been other instances where she has become anxious, dizzy, and slightly confused, stating that her heart was pounding and she felt like she "can't walk or do anything." Lucy thinks she has called 911 "about once a month since Julia died" and was transported by ambulance to the emergency department.

Simulation Scenario 3 takes place in the emergency department. Lucy called 911 once again after another fall at home. Her blood pressure is slightly elevated. Otherwise, Lucy is found to be in good health. Objectives relate to assessing her safety, her fears, the grieving process, and her need for assistance at home. The assessment tools recommended for this scenario include SPICES, The Hendrich II Fall Risk Model, the Geriatric Depression Scale, and the Generalized Anxiety Disorder 7 (GAD-7

Reflection Scenario 2

patient Introduction

Millie Larsen is an 84-year-old female who lives alone in a small home. She arrived with her daughter, Dina, three hours ago. Her daughter noticed that Millie wasn’t making sense or acting normally during a visit earlier today. She was seen by Dr. Lund an hour ago. He suspects urinary tract infection and has written preliminary orders. An IV has been started and labs have been drawn. They just came back. I haven’t had a chance to look at them. Her antibiotic also just arrived from the pharmacy and needs to be given. I completed a SPICES assessment, which indicated problems with incontinence and confusion. The result is in the health record. The confusion needs to be further assessed, and her fall risk should also be assessed. Can you please do that?

Gerontological Nursing

1. Eliopoulos, C. (2018). Gerontological Nursing, 9th Edition

Millie Larsen is an 84-year-old female who was admitted yesterday evening with confusion and urinary tract infection. Upon admission, the Confusion Assessment Method (CAM) algorithm showed evidence of delirium. Her blood pressure was very elevated yesterday, but we were able to restart her meds, and her blood pressure this morning is down to 160/92 mmHg. She has had 450 mL of amber urine output, and she had no pain during the night. She had a near fall around 6 AM when she was trying to get to the bathroom. She has no visible injuries, and her primary care provider and her daughter have been notified.

It seems like the confusion has begun to clear, but please do an assessment. She also needs an overall assessment, and her independence in activities of daily living should be assessed, but I didn’t have the time to complete these assessments. Would you please get that done this morning and then notify Dr. Lund? I just completed her fall risk assessment, and it indicates a high risk for falls. I have not yet reported the result of the fall risk assessment, so please also report that. Depending on the assessment results, she may be discharged later today. However, she lives alone and her daughter

Dina, who is with her in the room, is concerned about Millie going home alone, so discharge plans need to be discussed.

Patient Introduction

Millie Larsen is an 84-year-old female who was admitted the day before yesterday and was diagnosed with acute confusion and urinary tract infection. Prior to admission, she had not been taking her medications properly, and as a result her blood pressure was elevated on admission. Yesterday, though, it was down to 162/90, and this morning it was 142/86. She had a near fall yesterday morning, reportedly because she forgot the IV in her arm. The confusion began to clear yesterday, but she will need a reassessment for confusion.

She has discharge orders in her record. She had a physiotherapy consult yesterday, and the physiotherapist recommended she be sent home with a walker. Her independence in activities of daily living and instrumental activities of daily living were assessed yesterday. The results are in the record.

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