HESI Case Study: Loss, Grief and Death

Because the pt has been losing weight and she has a decreased metabolic rate due to the dying process, the HCP prescribes 0.2 mg/kg oxycodone HCL of the pt's weight. She weighs 88 lbs. the med is available as 20 mg/mL in a 30 mL bottle with a measured dropper. How many milliliters of med will the RN administer?

0.4 mL

The pt's spouse tells the RN their faith in God has seen them through life's problems and they rely on that faith everyday. What is the best response to support the pt and her spouse spiritually? a. "Do you have any wishes I should convey to the staff?" b. "I wish my faith were as strong as yours" c. "Does your family share your faith?" d. "Would you like to visit the chapel on the 1st floor?"

"Do you have any wishes I should convey to the staff?"

The pt's spouse has a copy of the pt's Living Will and durable power of attorney for healthcare. The spouse states, "I do not want her to suffer". The RN assures the spouse that the physicians and staff will make every effort to keep the pt comfortable. After making sure the pt and her spouse are settled and don't require anything further at this time, what action should the RN take? a. Document that the pt is aware of the Pt Self-Determination Act b. Place a copy of the Living Will in the med record and document its presence c. Notify the HCP that the spouse desires euthanasia for the pt. d. Report to the charge RN the spouse seems to be in denial about the seriousness of the pt's condition

Place a copy of the Living Will in the med record and document its presence

The pt rests more comfortably after the med is initiated, and more alert. She is able to speak with her family when she's awake. She awakens while her faith leader is visiting and asks to pray. The RN enters to room to obtain VS while the faith leader is praying. The pt's spouse asks the RN to remain with them for prayer and then obtain VS. Which action should the RN choose to implement? a. Take the VS as prescribed b. Stand quietly until the prayer is over c. Express discomfort by leaving the room d. Ask the faith leader to come back later to pray

Stand quietly until the prayer is over

What intervention should the RN implement? a. Suction tracheal secretions b. Suction oral secretions from mouth and throat c. Encourage deep breathing every hour while awake d. Teach the pt how to use an IS

Suction oral secretions from mouth and throat

The pt's adult child arrives to visit. Their last interaction was 3 mo ago, and is alarmed mother has lost weight, is weaker, and isn't eating, and not as responsive. They comment to the RN mother talked about the Living Will but says angrily, "Don't you think you should do something? This is a hospital, isn't it?" What is the best response by the RN? a. "Yes, this is the hospice unit of the hospital" b. "It must be difficult to see the changes in your mom" c. "Why are you angry at the RNs and other HCPs?" d. "You are in the stage of denial in the grief process"

"It must be difficult to see the changes in your mom"

The pt is diagnosed with pneumonia and is prescribed IV antibiotics for tx. The pt's swallow study determined that she should be on honey thick liquids and pureed foods. The spouse comes to visit the pt and notices the "Swallow Precautions- thickened liquids" sign and asks the RN what it means. The RN explains since the pt doesn't have adequate swallowing ability thin liquid may go into the trachea and then the lungs instead of the stomach and cause pneumonia. Suddenly, the spouse gets a shocked look on his face and says, "Oh, no! I did that. I gave her pneumonia?" What is the RN's best response? a. "How was she positioned when you fed her?" b. "Saliva entering the lungs can also cause pneumonia. And you didn't have a way of knowing she was aspirating" c. "You know you did the best you could" d. "We know it wasn't intentional on your part.

"Saliva entering the lungs can also cause pneumonia. And you didn't have a way of knowing she was aspirating"

The pt becomes difficult to arouse and doesn't follow commands. The daughter ask the RN what they should tell their preschool child if she dies. Which phrase should the RN recommend? a. "She went to sleep and didn't wake up" b. "She died and that makes us feel very sad" c. "God wanted her because she was so good" d. "We've lost her and will miss her very much"

"She died and that makes us feel very sad"

4 days later, the pt becomes more disoriented and she is unable to swallow thickened liquids or pureed foods without choking. Her weakness has progressed to the point at which she cannot bear her own weight or sit in a chair. The HCP suggests inserting a NG tube to provide nutrition; however, the pt's Living Will excludes tube feedings and IV nutrition. The pt's spouse states they support the pt's decision and this info was shared with their adult child. Which response demonstrates that the RN understands the underlying premise of a Living Will? a. "We will honor the directives in her Living Will" b. "Are you sure that this is what you really want for the pt?" c. "Your HCP's want to do all they can to preserve life" d. "Have you spoken to your faith leader about the pt's wishes?"

"We will honor the directives in her Living Will"

The pt's family has been observing the RN perform oral suction for the pt and says, "I know she's dying. I can do the suctioning. Would you watch me once?" How should the RN respond? a. "Do you think you're strong enough?" b. "Yes. I would be happy to watch you." c. "I am not sure that's a good idea" d. "I think there is a policy against it"

"Yes, I would be happy to watch you"

The pt's spouse states they have been married for 52 years. The spouse sighs and wipes their eyes, softly remarking they won't know what to do when she's gone. What feedback from the RN will encourage the spouse to elaborate more about feelings? a. Praise the couple for being able to stay married so long b. Ask the spouse to share memories of the couple's time together c. Remark they are role models for the faith community d. Share the memories of own family

Ask the spouse to share memories of the couple's time together

A pt who is elderly suffered a stroke a year ago remains weak, has R-sided paralysis and dysphagia. Her spouse has been caring for her at home. A home health RN visits every other day and the community has been providing one meal a day. The pt's adult child lives several states away. The pt was sitting upright while her spouse fed her broth from chicken noodle soup. She started coughing and spitting out the broth, then becomes SOB. The spouse stopped feeding her and patted her back forcefully. The pt was able to catch her breath. 2 days later during a scheduled visit, the spouse informs the home health RN about the incident. The RN assessment reveals the pt's LOC has declined, she has an oral temp 102 F (38.9 C) and diminished breath sounds with crackles in the R lung. The home health RN reports the assessment findings to the HCP. The HCP admits the pt to an acute care facility with the diagnosis of aspiration pneumonia. Which assessment should the RN complete immediately after hearing the pt choked while eating? a. The caregiver's knowledge about feeding a person who is dysphagic b. Auscultate the pt's lungs for adventitious breath sounds c. Assess the pt's LOC with the mini-mental status exam d. Determine the pt's ability to swallow liquids

Auscultate the pt's lungs for adventitious breath sounds

The pt has frequent episodes of coughing and choking with decrease oxygen sat and is transferred to the hospice unit. The RN identified the pt's nursing diagnosis of "Ineffective airway clearance". Which nursing intervention should be implemented to care for the pt's mouth? a. Give her sips of water through a straw b. Offer her an oz of ice chips every hour c. Provide mouth care daily with her bath d. Clean her mouth frequently with oral swabs

Clean her mouth frequently with oral swabs

The pt's adolescent family member enters the room, kisses the pt, and remarks, "I think she can get better if we just give her more time. Just because she was moved to this hospice doesn't mean she will die." The RN recognizes the adolescent has already begun to grieve the loss of a family member. According to the Kubler-Ross Model, how should the RN categorize this stage of grief being exemplified by the adolescent's statements? a. Acceptance b. Depression c. Bargaining d. Denial

Denial

The HCP orders the pt be admitted to the hospital. They also order a CMP, CBC, swallow eval, and saline lock. During the admission procedure, what is the RN's responsibility regarding advance directives? a. Determine if the pt has completed a Living Will and a durable power of attorney for healthcare (DPAHC) b. Explain that the Pt Self-Determination Act (PSDA) requires a living will. c. Instruct the pt's spouse to have the pt sign a Living Will when she's no longer disoriented d. Ask the pt's spouse if they would like to make any changes

Determine if the pt has completed a Living Will and a durable power of attorney for healthcare (DPAHC)

The pt now lies quietly with her eyes closed. She no longer responds verbally, but she smiles when her family speaks to her. To assist the pt and family in life review, what is the best intervention by the RN? a. Encourage visitors to talk quietly so the pt isn't disturbed b. Suggest to the family that they bring photo albums to show the pt c. Encourage the pt and family to talk about their experiences d. Encourage visitors to use touch when communicating with the pt

Encourage the pt and family to talk about their experiences

The family tells the RN they feel hopeless and don't know what to do to make the pt more comfortable. Family asks the RN if it would be all right to have a massage therapist come in and gently massage her mother's back and limbs. How should the RN respond to the family's request? a. Ask the family what purpose she thinks massage will serve b. Inform family must produce the therapist's credentials first c. Inform the family massage therapists are welcome in the hospice unit d. Share with the family the RNs use alternative therapies themselves

Inform the family massage therapists are welcome in the hospice unit

Based on the assessment findings, what action should the RN implement? a. Inform the family member that her mom's condition is worsening b. Suggest that the daughter tell her father to rush back to the hospital immediately c. Hold the family member's hand, but don't disclose the pt's VS d. Notify the family that the pt will probably die today

Inform the family member that her mom's condition is worsening

The pt's spouse decides to go home to sleep in their own bed. Another of the pt's family spends the night at the bedside. Early the next morning, the pt's VS are pulse 50 beats/min and thready, respirations 10 breaths/min and shallow, BP 70/30 mmHg, Glasgow Coma Scale 3. Which other physical symptom should the RN anticipate? a. Hyperreflexia in legs and arms b. Increased urinary output c. Mottling of hands and feet d. Head turned away from light

Mottling of hands and feet

The RN explains the stages of grief and ways the family can support other family members as the pt moves back and forth among the stages. The pt's family began reading age-appropriate books and talking to the younger children about death as soon as they received the news a family member was hospitalized. They are concerned because their school-aged child repeatedly asks questions about what happens to the physical body after death and wants specific info about what the funeral home will do to the body. Family asks the RN what they should tell their school-aged child. What is the best response by the RN? a. Tell the family to take the child to a grief counselor immediately b. Call the family's faith leader to get info that is culturally appropriate c. Recommend their child's questions be answered honestly in simple terms d. Ask to speak to the child to assess what is really bothering him

Recommend their child's questions be answered honestly in simple terms

The family members are at the bedside very early the next day when the pt stops breathing. The HCP arrives and pronounces the death. As the faith leader is being consulted regarding the prep of the body, a group of individuals from the pt's faith community arrive to assist with the postmortem care. How should the RN respond? a. Instruct the family and the religious leader to leave the room b. Remain available to assist the women of the religious community as needed c. Tell the religious leader that postmortem care must be done by the hospice staff regardless of religion d. Remind the family that an autopsy must be performed before the burial

Remain available to assist the women of the religious community as needed

The RN assessment reveals the pt's diminished breath sounds with crackles in the R lung, her LOC has declined, and she has an oral temp 102 F (38.9 C). After the pt assessment is complete, what does the RN determine is the BEST course of action? a. Report the assessment findings to the HCP b. Elevate the head of the pt's bed to 45 degrees and instruct the spouse to leave it elevated c. Inform the spouse to give the pt acetaminophen d. Provide directions on how to properly feed a person with dysphagia to the spouse

Report the assessment findings to the HCP

The pt begins to sleep more, and she has less alert time. Over the last few days, she has become more restless, has increased grimacing, and periodically clenches her fists. The RN notes an increase in HR, respiration, and BP during these episodes. The HCP is contacted and oxycodone HCL immediate-release concentrate solution is prescribed to be administered via the oral transmucosal route every 4 hours as need for pain. The pt's spouse is informed of the order and asks the RN why oxycodone was prescribed in this manner. What info regarding the med order should the RN provide to the pt's spouse? (Select all that apply) a. This route is least likely to produce drug addiction b. There is no other route by which to give this med c. The med is rapidly absorbed and acts quickly d. This route decreases the chance of aspiration e. Risk for respiratory depression is lessened using this route

The med is rapidly absorbed and acts quickly This route decreases the chance of aspiration