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Providing Quality End-of-Life Care to Critically Ill Clients
Critical care nurses provide care to seriously ill clients who often have multiple concurring illnesses. Some of the clients they care for lose their battle with their illnesses and pass away. It is important that nurses continue to provide quality end-of-life (EOL) care to their clients despite their terminal state. This paper will discuss research related to providing quality EOL care, the nursing interventions proposed, strengths and limitations of these interventions and a plan of quality, end-of-life care for the client.
T.L. is a 69 year old, Caucasian male hospitalized for respiratory hemorrhage, sepsis, decreased blood pressure and an intracranial hemorrhage. During his admission assessment, TL indicated that he is a minister and husband. He and his wife own and operate a radio station for Hispanics in his community. His wife stated "he is a good, Christian man". A health history taken revealed he is allergic to Penicillin and it's derivatives.
T.L. has been hospitalized since April 5, 2002. He has a "No Harvey Team" order per his physician. He had a chest CT on 6/12 to check the status of his empyema. He has a chest tube that is draining bloody drainage. He receives continuous feeds through his Percutaneous Endoscopic Gastrostomy (PEG) tube and hyperailmetation. He has a foley catheter. T.L. is seen by a Respiratory Therapist. He is on continuous mandatory ventilation (CMV) with a rate of 8.0, tidal volume of 700, positive end expiratory pressure (PEEP) of 5.0, fraction of inspired oxygen (FiO2) of 40%. His sputum is positive for Methicillin-resistant Staphylococcus Aureus (MRSA). He is trached and suctioned as needed producing a moderate to large amount of thick, yellow secretions. He has elastic compression stockings on both legs to the knee. He is on a continuous Dopamine 3mcg/5cc infusion and a titrated Cardizem to keep his heart rate below 100, last at 10cc/hour. The interdisciplinary goal for T.L. is to manage his symptoms and keep him as comfortable as possible.
T.L.'s primary psychosocial nursing diagnosis is Fear related to loss of control and unpredictable outcome secondary to disabling illnesses as evidenced by client being hospitalized since April 5, 2002, his wife expressing concern that client does not suffer, and the No Harvey Team order in his chart. This is T.L.'s primary nursing diagnosis because he was a relatively healthy 69-year-old minister and husband until his intracranial bleed in April. Since then his life has been completely disarrayed and he is now in the Critical Care Unit on the ventilator, completely bed-ridden. This has been a stressful, frightening time for him and his wife. In a brief conversation with her, she expressed that it is their faith in God that has allowed them to endure the last few months.
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nurses, health care workers, loved ones, interventions, nursing diagnosis, pain management, policy reform, Critical care nursing, symptom, the client, managed care, illnesses, positive end expiratory pressure, consumer demand, Methicillin resistant Staphylococcus Aureus, Percutaneous Endoscopic Gastrostomy, communication, this family, intracranial hemorrhage, primary nursing, symptom relief, foley catheter, chest tube, terminally ill, compression stockings, Respiratory Therapist, blood pressure, prolongation, Advance Directives, heart rate, decision making, radio station, chart, older people, Team, disabling, adequate, psychosocial, calm, exact, educational, realm, anxiety, the interventions, Cardizem, hypothesize, Uman, outlive, secretions, sepsis,