Nursing Interventions for Michelle’s Deteriorating Condition in Hospice Care

QUESTION

While in the hospice Michelle’s condition starts to deteriorate. The results of her nursing assessment are detailed below.

CNS:                      The patient is drowsy and confused.  Michelle has been moaning all morning CVS:     Bilateral pitting oedema to both feet.  Cyanosis present in all four extremities. Vital signs not required to be measured.

Respiratory:          Cheyne-Stokes breathing patterns.  Increased oral secretions

Renal:                   No urine output for 12/24.

GIT:                       BNO for three days (3/7).
She has not eaten or drunk anything for two days (2/7) and does not respond to encouragement from family.  NBM.

Musculoskeletal:   Full nursing care required.  Bedridden.

Skin:     Skin is dry.  Poor skin turgor.  Malignant wound on her chest requires re dressing PRN;

Considering Michelle’s deteriorating condition develop two (2) nursing interventions for Michelle. Please provide one (1) rational for each intervention.

ANSWER

Nursing Interventions for Michelle’s Deteriorating Condition in Hospice Care

Introduction

As Michelle’s condition worsens in hospice care, the nursing team must provide appropriate interventions to ensure her comfort and manage her symptoms effectively. This essay will discuss two nursing interventions tailored to Michelle’s specific needs, along with the rationale for each intervention.

Nursing Interventions

Comfort Measures for Respiratory Distress

Intervention: Implement palliative care interventions to alleviate respiratory distress caused by Cheyne-Stokes breathing patterns and increased oral secretions. Elevate Michelle’s head and provide oxygen therapy as prescribed to improve oxygenation. Perform frequent oral care to maintain oral hygiene and reduce oral secretions.

Rationale: Cheyne-Stokes breathing patterns and increased oral secretions are common end-of-life symptoms that can cause discomfort and distress to the patient. Elevating Michelle’s head helps optimize lung expansion and may ease her breathing. Oxygen therapy can improve oxygen levels and provide comfort. Regular oral care prevents dryness, reduces secretions, and helps maintain oral comfort.

Wound Care and Skin Management

Intervention: Provide meticulous wound care and skin management for the malignant wound on Michelle’s chest. Perform gentle cleansing of the wound using a non-irritating solution and re-dress the wound as needed to maintain cleanliness and prevent infection. Implement measures to maintain skin integrity and prevent pressure injuries due to prolonged bedridden status. Use appropriate pressure-relieving devices and reposition Michelle regularly.

Rationale: Malignant wounds can cause pain and discomfort for patients, and proper wound care is essential to prevent infection and promote healing. By cleansing the wound gently and re-dressing it as needed, the nursing team can alleviate Michelle’s pain and reduce the risk of infection. Additionally, as Michelle is bedridden, there is a higher risk of developing pressure injuries. Implementing pressure-relieving measures and regular repositioning help distribute pressure evenly and prevent skin breakdown, ensuring her overall comfort and skin integrity.

Conclusion

As Michelle’s condition deteriorates in hospice care, providing appropriate nursing interventions is crucial to ensure her comfort and manage her symptoms effectively. The implementation of comfort measures for respiratory distress and meticulous wound care and skin management are essential in easing her breathing difficulties, reducing discomfort from the malignant wound, and maintaining her overall well-being. By addressing Michelle’s specific needs with tailored interventions, the nursing team can make her end-of-life journey as comfortable and dignified as possible.