ELNEC Graduate Student Module 4: Symptom Management in Palliative Care

Mrs. F., a 78-year-old Italian woman, is caring for her husband who has end-stage COPD and is experiencing anorexia and cachexia. She tells you that she is so upset that he won't eat her pasta anymore, which was "always his favorite." She cannot understand why he doesn't like it anymore. Which of the following is your best response? "I don't know why he wouldn't eat it. You have brought some to our unit and it is wonderful." "Don't take it personally Mrs. F., maybe you should stop pushing him to try to eat." "Can you change your recipe and try making it a little blander for him." "Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

"Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

Which of the following patients' statements suggest that the patient is experiencing spiritual distress? "I am so afraid that God has abandoned me in my time of need." "I am mad that my minister has not come by to see me in the hospital." "I believe strongly that God never gives a person more than they can handle." "I find great comfort when I spend time among my flowers in my garden."

"I am so afraid that God has abandoned me in my time of need."

3. You are caring for a 65-year-old male patient with HIV/AIDS who is suffering from anorexia and cachexia. He asks you what he can do to put some weight on as he is upset that he "looks so terrible". Your best response is: "I hear you say you are upset with how you look, can you tell me more about that?." "We can start total parenteral nutrition, which would be in intravenous infusion that would give you more protein." "You have already seen the dietician, there is nothing more we can do." "Since you aren't eating much, it's probably time to think about putting in a feeding tube."

"I hear you say you are upset with how you look, can you tell me more about that?."

1. Mr. Tate tells you that he is very worried about dying. He knows his disease is terminal and he only has a few months to live. He tells you he has done "some bad things" in his younger days and thinks God is going to make him suffer with pain now because of his past. After listening to his story, what is your best response? "Oh don't worry Mr. Tate, that was a long time ago." "Some people have pain at the end of life, but we can help you manage the pain." "Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours." "I know that God doesn't make people suffer and I am sure that you will not suffer at end of life for your past."

"Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours."

Geraldine is an 85-year-old woman with Parkinson's disease. She is still functioning at home and is able to safely care for herself. Ever since her diagnosis she has been extremely anxious about her disease and how debilitated she might get as it progresses. Which of the following interventions is the most appropriate intervention to address her anxiety? Lorazepam 2 mg orally every 4 hours as needed for anxiety. Suggest she attend an exercise class to preserve her balance and strength. A referral to a counselor to talk about her fears and anxiety related to her disease. Recommend she start looking into assisted living facilities to address her debilitation.

A referral to a counselor to talk about her fears and anxiety related to her disease.

2. You have been assigned to care for a woman with advanced ovarian cancer, who was recently admitted to the hospital with nausea and vomiting for three days. She has not had chemotherapy for 4 weeks. She last moved her bowels five days ago. Pertinent medications include Controlled release OxyContin® 40 mg orally twice a day with immediate-release oxycodone 10 mg for breakthrough pain every 2 hrs as needed. She has taken 4 doses of breakthrough pain medication in the past 24 hrs. On physical exam, you find sluggish bowel sounds and discomfort on mild palpation in both lower quadrants. You are concerned that: She has not taken any scheduled laxative with her pain regimen. Her last chemotherapy was four weeks ago and the disease may be progressing. The nausea and vomiting is due to a complete bowel obstruction. Her mild discomfort on abdominal palpation does not warrant opioid therapy.

She has not taken any scheduled laxative with her pain regimen.