Scenario A

You are a nurse providing care for Mrs. Lyn, a 47-year-old client admitted with metastatic lung cancer receiving hospice care. The client’s condition has declined significantly over the past week; she is actively dying. Over the last 24 hours, Mrs. Lyn has declined rapidly and is now unresponsive but appears to be resting comfortably. You enter the client’s room and find Mr. Lyn weeping at the client’s bedside.

1. What actions would you take to comfort Mr. Lyn?
2. Mrs. Lyn develops labored breathing. What medication is helpful to administer to treat dyspnea at end of life?
3. Mrs. Lyn’s breathing becomes less labored with medication, but her respiratory rate becomes irregular. Mr. Lyn tells the nurse, “My daughter lives six hours away and would like to be here when the time comes. How much longer does she have to live?” What is the nurse’s best response?
4. The daughter arrives and seems hesitant to talk to or touch her mother. What tasks can the nurse coach family members to do at the end of a client’s life?
5. Mrs. Lyn dies the following evening. What postmortem care should the nurse provide?

Scenario B

Terry, a 42-year-old male client, was recently diagnosed with advanced colon cancer and underwent a colon resection a few days ago. While changing his colostomy bag, he comments to the nurse, “I still can’t believe this is happening to me.”

1. According to Kubler-Ross’ theory of grief/loss, what stage of grief is Terry currently experiencing?
2. The nurse responds, “This is a difficult time for you.” Terry replies, “Yes, it is. My parents want me to do every kind of experimental treatment possible, but I just want to live my life until the time comes.” The nurse asks, “You have some tough decisions to make. Has anyone talked to you about palliative care yet?” Terry asks, “I’ve never heard of palliative care. What is it?” How would you explain palliative care to him?
3. Terry states, “I don’t want my parents telling my doctor what to do. It is my decision.” The nurse asks, “Do you have any advance directives in place?” Terry responds, “What are advance directives?” How would you explain advance directives to Terry?
4. The nurse identifies “Grieving related to anticipatory loss as evidenced by disbelief and feeling of shock” as a nursing diagnosis for Terry. Identify a SMART outcome.
5. The nurse plans interventions to enhance Terry’s coping. List sample nursing interventions that may help Terry to cope with this new diagnosis.