Madeline S. is a 66-year-old German woman admitted to a home care agency for care related to end-stage cardiac disease and renal failure. She has complained of chronic generalized chest pain, frequent cramps in her legs, and worsening arthritis pain related to her immobility. The home care nurse has been in contact with Madeline’s physician almost daily for the past week and her analgesics have been steadily increased with little pain relief but an increase in nausea, constipation and sedation. The nurse feels frustrated as she observes Madeline declining rapidly with worsening depression, withdrawal and weeping. Madeline’s neighbor has noticed that her lights are left on 24 hours a day and the nurse has noticed that Madeline has several rosaries and prayer books now at her bedside. Madeline has refused referral to hospice but the home care nurse has requested a team conference with assistance from the local hospice affiliated with the home care agency.
Discussion Questions:
1. What disciplines should be included in the case conference? 2. What additional assessment might the nurse obtain? 3. How can this patient’s pain and suffering best be treated?
