SlideShare ist ein Scribd-Unternehmen logo
1 von 51
Instructions for Completing Case Study,[object Object],Review all slides in detail.,[object Object],Complete all required reading, including links to external material.,[object Object],Review questions and answers included throughout the case study.,[object Object],Once finished, click on the ‘CE Form’ link located at the end of the study.  Answer the 3 questions included on the form, provide payment information for processing your $10.00 CE fee and return the form to the NACNS office.  A valid email address is required for CE certificate delivery.,[object Object],* Continuing Education is optional.  If you are not interested inCEs, please disregard the $10.00 fee.,[object Object],CONFIDENTIAL - Do not forward or share,[object Object]
CNS Advanced Practice Curriculum: A Case for Geriatric Nursing Evidence-based PracticeEnd of Life Care Case Study # 2,[object Object],Alyce Ashcraft, PhD, RN, CNS, CCRN, CNE,[object Object],Texas Tech University Health Sciences Center ,[object Object],Anita Thigpen Perry School of Nursing,[object Object],Wanda J. Borges, PhD, ACNS-BC,[object Object],New Mexico State University School of Nursing,[object Object]
Learner Outcomes,[object Object],At the completion of this case study, the,[object Object],student should be able to:,[object Object],Develop a patient management plan for palliative end-of-life care in a nursing home setting (patient sphere),[object Object],[object Object],Describe communication strategies that will support successful palliative end-of-life care in a nursing home setting (system sphere),[object Object]
Required Reading,[object Object],Coleman, E. Parry, C. Chalmers, S. & Sung-joon, M.  (2006).  The care transitions intervention.  Archives of Internal Medicine, 166:  1822-1828.  Available online at: http://www.caretransitions.org/documents/RCT.pdf,[object Object],Gillick, M.  (2003). Promising practice.  Innovations in End-of-Life Care.  Available online at:  http://www2.edc.org/lastacts/promprac.asp,[object Object],Institute for Clinical Systems Improvement.  (2009, Jan).  Diagnosis and Management of Chronic Obstructive Pulmonary Disease, 7th Ed.  Available online at: (http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic_obstructive_pulmonary_disease_2286.html) ,[object Object],Qaseem, A., Snow, V., Shhekelle, P., Casey, D., Cross, J., & Owens, D.  Evidece-based interventions to improve the palliative care of pain, dyspnea and depression at the end of life:  a clinical practice guideline from the American College of Physicians.  Annals of Internal Medicine, 148:  141-146.  Available online at: http://www.annals.org/content/148/2/141.full,[object Object]
Required Readings (cont’d),[object Object],Registered Nurses Association of Ontario (RNAO). (2005, Mar). Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD). Toronto (ON): Registered Nurses Association of Ontario (RNAO).  Available online at:  http://www.guideline.gov/content.aspx?id=7008&search=copd#Section420Solvari, A., Kocheril, A., Yunis, N.& Crausman, R. (2006). Corpulmonale.  Available online at: http://www.emedicine.com/med/topic449.htm,[object Object],Stapleton, R., Nielsen, E., Engelberg, R, Patrick, D & Curtis, J.  (2005).  Association of depression and life-sustaining treatment preferences in patients with COPD.  Chest, 127(1):  328-334.  Available online at:  http://www.medscape.com/viewarticle/498650,[object Object]
CNS Spheres of Influence: Patient/Client Sphere,[object Object],Within this sphere of influence the CNS is a provider of direct patient/family care.  The following activities may be included in this sphere:,[object Object],Advanced holistic assessment of patient/family needs,[object Object],Nursing and medical diagnosis,[object Object],Disease management including pharmacologic and non-pharmacologic interventions,[object Object],Holistic approach to patient management incorporating health promotion and risk reduction,[object Object],Facilitation of interdisciplinary patient management across the health care continuum,[object Object]
About the Patient,[object Object],As the CNS working in a 40 bed nursing home a part of your routine includes assessment of newly admitted residents. Upon being hired, you conducted a needs assessment and found a high rate of transfers to the emergency department for patients with Do Not Hospitalize orders.  To assist in decreasing the rate, you are working with a palliative care team.,[object Object],Mrs. J. is a 76 year old woman who was admitted yesterday. ,[object Object],She has been living at home alone after her husband died 7 months ago.  She has 3 children, all living in other cities.  Her youngest daughter is the closest, 220 miles away. ,[object Object],Because of her shortness of breath she has been unable to maintain her nutritional needs at home alone, even with a local “Meals on Wheels” program.  The decision was made to admit her to the nursing home.  ,[object Object]
Subjective data,[object Object],Problems,[object Object],1.	Mrs. J. is sitting on the edge of her bed leaning over her bedside table.  She is dyspneic, respiratory rate is 50 per minute. O2 is at 4 liters per nasal cannula and Mrs. J. has an inhaler in her right hand. The CNA who is helping Mrs. J. with hygiene needs states, “Someone needs to do something, she can’t keep this up.”  Mrs. J. states through gasps, “I’m okay, just winded.”,[object Object],2.	Medical diagnoses include COPD and corpulmonale. Patient has been hospitalized 3 times in the past year for COPD exacerbation and has been intubated each time. ,[object Object],3.	Patient is extremely thin in appearance.,[object Object]
Question #1,[object Object],What other subjective information specific to problem #1 do you need to know?,[object Object]
Answer to Question #1,[object Object],Current medications, including those used by the patient to treat dyspnea,[object Object],http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic_obstructive_pulmonary_disease_2286.html,[object Object],Presence of anxiety or pain,[object Object],Patient’s assessment of the current dyspneaepisode ,[object Object],Dyspnea is a subjective experience and should be believed,[object Object],A quantitative measuring scale such as a visual analog scale or a numeric rating scale, i.e. 1-10,[object Object],http://www.guideline.gov/content.aspx?id=7008&search=copd,[object Object]
Answer to Question #1 (cont'd),[object Object],History chills/fever/cough,[object Object]
Answer to Question 1 (cont'd),[object Object],Patient’s desires for treatment at this time,[object Object],http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic_obstructive_pulmonary_disease_2286.html,[object Object]
More Subjective Data,[object Object],Patient states, “I get like this whenever I move around.  I just used my inhaler – it will get better.”  Denies pain but states she is always anxious when she can’t breathe.  Denies chills, fever, or cough.  Rating of dyspnea is 10 on a 1-1- 10 scale,[object Object],CNA states that the patient was not dyspneic until she sat up in bed to brush her teeth.,[object Object],Patient has a living will which states that she does not want life saving measures.,[object Object]
More Subjective Data,[object Object],Continues to agree with her Living Will and Do Not Hospitalize orders – expresses fear of being intubated again,[object Object],Expresses the desire to be kept as comfortable as possible because she is aware of her prognosis,[object Object],States Ativan helps but she gets anxious mostly when she is short of breath,[object Object],States she believes her children understand her wishes,[object Object]
More Subjective Data,[object Object],Current Medications:,[object Object],Hydralazine 50 mg PO tid,[object Object],Digoxin 0.125 mg PO qd,[object Object],Theo 24 – 400 mg PO qd,[object Object],Lasix 40 mg PO qd,[object Object],Potassium supplement,[object Object],AdvairDiskus – 250/50 mcg, 1 puff bid,[object Object],SpirivaHandihaler – 18 mcg inhaled qd,[object Object],Albuterol Inhaler, 2 puffs q 4-6 hrs PRN,[object Object],Lorazepam 0.5 mg PO tidprn,[object Object]
Question #2,[object Object],Based on the subjective data, what does your initial differential diagnosis for problem #1 include?  For each medical or nursing diagnosis, provide a rationale for its inclusion.,[object Object]
Answer to Question #2,[object Object]
Question #3,[object Object],Based on the subjective data, what does your initial nursing diagnosis for problem #1 include?  For each diagnosis, provide a rationale for its inclusion.,[object Object],List nursing diagnoses and provide brief rationale for inclusion (use as many slides as you need) ,[object Object]
Answer to Question #3,[object Object]
Question #4,[object Object],What other data do you or the nurses you lead need to collect at this point?  Provide rationale for your answer.,[object Object]
Answer to Question #4,[object Object],Physical exam – rule out differential diagnoses and assess need for hospital transfer,[object Object],Pulse oximetry – assess current oxygenation status,[object Object],Recent labs and spirometry tests – assess status of COPD/Corpulmonale,[object Object],Spiritual assessment (Timmins & Kelly, 2008),[object Object],Patient’s prognosis – assess need for hospital transfer,[object Object],http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic_obstructive_pulmonary_disease_2286.html,[object Object]
Answer to Question #4 (cont'd),[object Object],Assessment of functional status enables adequate plans to be made for providing palliative care ,[object Object],Use of the Palliative Performance Scale provides a method for determining care needs for the palliative care patienthttp://www.healthcare.uiowa.edu/igec/tools/function/palliativePerformance.pdf,[object Object],Assess for depression as this could affect the patient’s decision for life-sustaining treatmenthttp://www.medscape.com/viewarticle/498650,[object Object],Use of the Geriatric Depression Scale which is a standardized tool is recommended http://www.stanford.edu/~yesavage/GDS.html,[object Object]
Additional Data Collection,[object Object],Physical Exam: ,[object Object],VS:  HR-110, BP-132/90, RR – 40, Temp – 98.6, Pulse Ox – 88%,[object Object],General:  Thin, cachetic appearance, alert and oriented.,[object Object],HEENT:  PERRLA ,[object Object],Neuro:  CN II – XII intact,[object Object],Respiratory:  Dyspnea on exertion, tachypneic at rest, using accessory muscles to breath, lungs with course rales from mid lobes to bases bilaterally. Percussion – hyperresonance to all lobes.  Rib cage easily seen through chest wall.,[object Object],Cardiovascular:  Heart sounds S1, S2with S3 gallop and systolic murmur, regular, no JVD, Pulses 3+ to all extremities, no peripheral edema, hepatojugular reflux present.  ,[object Object],Abdomen:  Soft, non-tender on palpation, bowel sounds in all quadrants,[object Object],Musculoskeletal:  Weak movement of extremities, sensation present in all extremities, muscle wasting noted,[object Object],Skin:  Emaciated appearance with poor skin turgor, Stage 1 pressure ulcer to coccyx,[object Object]
Additional Data Collection,[object Object],Chart Review:,[object Object],PMH of COPD x 10 years with diagnosis ofCorpulmonale 2 years ago.,[object Object],Most recent hospitalization was 2 months ago with ventilator management x 1 week – patient extubated herself,[object Object],Primary care provider documents poor prognosis ,[object Object],Living Will/Do Not Hospitalize order,[object Object],BMI = 16,[object Object],Immunizations up to date,[object Object],Nutritional assessment - PO Intake has decreased – documentation of patient’s refusal of food for last week,[object Object]
Additional Data Collection,[object Object],Diagnostictest results prior to nursing home admission:,[object Object],Theophylline level:  18 mcg/ml,[object Object],Digoxin level: 2.0 mg/ml,[object Object],Potassium:  4.0 mEq/L,[object Object],Bun/Creatinine: 18 mg/dl/1.2 mg/dl,[object Object],Albumin:  1.5 mg/dl,[object Object],Spirometry 2 months before admission:  FEV1 <30% predicted,[object Object]
Additional Data Collection,[object Object],Patient’s prognosis is poor at this time based on the severity of her dyspnea and disease process,[object Object],Based on her current living will, advanced directive, transfer to hospital is not indicated,[object Object],http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic_obstructive_pulmonary_disease_2286.html,[object Object],Geriatric Depression Scale Score – 8.0 – indicating no depression,[object Object],Palliative Performance Scale is 6 – indicates a need for total care, mouth care should be done as needed because intake is minimal,[object Object]
Question #5,[object Object],What is your assessment of each of Mrs. J’s presenting problems?  Provide rationale for your assessment.,[object Object]
Answer to Question #5,[object Object],#1:  Grade 5 dyspnea,[object Object],Per Medical Research Council (MRC) scale in COPD Guidelines, grade 5 is too breathless to leave the house or breathless when dressing or undressing (National Guideline Clearinghouse, COPD Guidelines).  This is a common symptom at the end-of-life requiring palliative care (Hansen, et al., 2008).,[object Object]
Answer to Question #5,[object Object],#2:  Very severe COPD with Corpulmonale,[object Object],Spirometrytesting is the gold standard for evaluating status of COPD (Tierney, McPhee & Papadakis, 2005).  FEV1 <30% expected is diagnostic of very severe COPD.,[object Object]
Answer to Question #5 (cont'd),[object Object],Corpulmonale is a complication that can be seen in patients with COPD due to pulmonary hypertension that results in right ventricular failure (Sovari et al., 2006).  More than 50% of cases of corpulmonale are caused by COPD.,[object Object],There is a 30% chance of 5 year survival in patients with COPD who are diagnosed with corpulmonale with a high 2 year mortality rate. ,[object Object],http://emedicine.medscape.com/article/154062-overview,[object Object]
Question #6,[object Object],What is your plan for this patient. Include all components and provide rationale for your choices.,[object Object]
Answer to Question #6,[object Object],Palliative Care Plan,[object Object],Diagnostic:  At this time, no diagnostic studies will be ordered.  The patient has a Living Will with a Do Not Hospitalize order.  She is at the end-of-life and requires palliative care.  No further tests are needed at this time (Qaseem et al., 2008). http://www.annals.org/content/148/2/141.full,[object Object],Therapeutic:  Review options for care plan with patient.  Discuss nutritional needs, skin care, dyspnea management with morphine and oxygen with possible non-invasive ventilatory assistance (Sovari et al, 2006). http://www.emedicine.com/med/topic449.htm,[object Object]
Answer to Question #6 (cont'd),[object Object],Palliative care plan,[object Object],Referral/consult: Consult with PCP about patient needs and desires, Palliative Care Plan, Hospice consult, Psychiatric/Mental Health CNS/NP.  ,[object Object],If agreed to by the patient, dietary consult for nutritional status, and spiritual care consult as needed,[object Object],PT/total assist for transfers,[object Object],Mouth care as needed due to decreased PO intake,[object Object]
Answer to Question #6 (cont'd),[object Object],Palliative care plan,[object Object],Patient Education:  Anxiety, pain, and dyspnea management.,[object Object],Plan family/team conference with family members as able – can use available technology for facilitating family involvement of those living in other areas  ,[object Object],Apply Culturally and Linguistically Appropriate Services standards,[object Object],http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15,[object Object],Follow-up:  Follow up daily, more often as needed for dyspnea episodes to adjust care plan for optimal level of comfort.,[object Object],Dyspnea plan was developed for this patient with Morphine sulfate 2-4 mg q 15 minutes prn until dyspnea resolves with use of nebulizer during dyspneic episodes as needed (Buttaro, Trybulski, Bailey & Sandberg-Cook, 2003).,[object Object]
CNS Impact,[object Object],Working in the patient sphere, the CNS brings expertise in pathophysiology, physical assessment and therapeutic interventions for managing chronic disease.,[object Object],Employed by the LTC facility, the CNS is uniquely positioned to respond to acute episodes as illustrated by this case.,[object Object],In addition, the CNS can provide needed assessment of palliative care issues and interface with the primary care provider to ensure the treatment plan is adjusted based on patient needs and desires.,[object Object],Education of the patient and their family in the process is another important direct care role.,[object Object]
CNS Spheres of Influence: Nurse Sphere,[object Object],Within the nurse sphere of influence, the CNS evaluates nursing practice to ensure optimal patient outcomes, as well as develops and implements strategies for changing nursing care to achieve optimal outcomes.,[object Object]
 Nursing Staff Decision-making,[object Object],Mrs. J was transferred to the Emergency Department during the night due to increased dyspnea. Chart review reveals one dose of morphine had been given to the patient prior to transfer.,[object Object],The transfer represents the discomfort staff have caring for patient’s at end-of-life who are dyspneic and have concerns about the “double effect” of medications at end-of-life.,[object Object]
Question #7,[object Object],What support does the nursing staff require?,[object Object]
Answer to Question #7,[object Object],Nursing staff requires understanding of palliation at end-of-life as well as personal assessment of comfort with the treatment plan.  (Field & Cassel, 2003, pg. 207).,[object Object],Impact of family members input on decision to transfer needs to be assessed. http://www.caretransitions.org/documents/RCT.pdf,[object Object],Incorporate case studies in teaching nursing staff about dyspnea plan.http://www.eperc.mcw.edu/FileLibrary/User/jrehm/EPERC/Cases/CaseStudiesDyspnea.pdf,[object Object],For this to be achieved, nursing staff must be included in care planning team meetings with the patient and the family.             http://www2.edc.org/lastacts/promprac.asp,[object Object]
CNS Impact,[object Object],Within the nursing practice sphere, the CNS is able to identify educational needs of staff members related to palliative care, as well as role model the importance of the nurse’s role in palliative care.,[object Object],Providing evidence about the need for palliative care and the guidelines for palliative care treatments can assure the nursing staff of compliance with standards of care.,[object Object]
CNS Spheres of Influence: System Sphere,[object Object],Within the system sphere of influence the CNS evaluates system processes to ensure optimal patient care delivery and outcomes, as well as leads organizational change efforts that are based in theoretical foundations and evidence based practice.  The goal is to facilitate lasting change that will improve patient care delivery and outcomes within a system of care. ,[object Object]
Status of Palliative Care Plan,[object Object],In most instances failure to sustain a palliative care plan can be traced to system-level issues. ,[object Object]
Question #8,[object Object],What system level recommendations would help to maintain palliative care plans?,[object Object]
Answer to Question #8,[object Object],CNS Recommendations:,[object Object],Consider working night shifts to identify barriers to palliative care that may be unique to that shift.,[object Object],Continue to work with the team that was developed to implement palliative care at the end-of-life to identify barriers,[object Object],Use a theoretically driven organizational change plan to achieve the goals  ,[object Object],http://www.rnao.org/bestpractices/PDF/BPG_Toolkit.pdf,[object Object]
Answer to Question #8,[object Object],Guidelines for end of life care in patients with serious illnesshttp://www.annals.org/content/148/2/141.full,[object Object],Examples of successful programs in planning for palliative care within the nursing home environmenthttp://www2.edc.org/lastacts/promprac.asp,[object Object]
CNS Impact,[object Object],Within the organization/system sphere, the CNS can work closely with staff to identify a team for developing and implementing a plan to provide palliative care to all patients. This process can assure an appropriate level of evidence-based standardization, yet attend to the individual needs of patients.,[object Object],With expertise in needs assessment, as well as development and implementation of nursing interventions, the CNS is able to achieve optimal organizational outcomes for this patient population.,[object Object]
CNS Impact Overall,[object Object],The number of patients dying in long term care (LTC) setting has increased from 18% in 1986 to 23% in 2001 (Hanson et al., 2008). ,[object Object],These patients experience a range of symptoms as end-of-life draws near – pain, dyspnea, poor intake, problems with cleanliness and delirium.,[object Object],As the population ages, more patients will be requiring palliative care at the end of life.,[object Object],Working within the three spheres of influence, the CNS is an essential member of the Palliative Care Team in the Long Term Care facility (NACNS, 2004).,[object Object]
Additional Resources,[object Object],Education in Palliative Care and End-of-Life Care – www.epec.net,[object Object],End-of-Life/Palliative Education Resource Center - http://www.eperc.mcw.edu/,[object Object],Center to Advance Palliative Care – http://www.capc.org/palliative-care-across-the-continuum/long-term/,[object Object],Hartford Center of Geriatric Nursing Excellence – www.nursing.upenn.edu/centers/hcgne/palliativecare.htm,[object Object],National Guideline Clearinghouse - http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=COPD,[object Object]
References,[object Object],Buttaro, T., Trybulski, J., Bailery, P. & Sandberg-Cook, J.  (2003).  Primary Care a Collaborative Practice, 2nded, pp. 52, 391-394.,[object Object],Field, M. and Cassel, C. Editors.  (2003).  Approaching Death:  Improving Care at the End of Life.  Available online at:  http://www.nap.edu/catalog/5801.html ,[object Object],Gillick, M.  (2003). Promising practice.  Innovations in End-of-Life Care.  Available online at:  http://www2.edc.org/lastacts/promprac.asp,[object Object],Hanson, L., Eckert, J., Dobbs, D., Williams, C., Caprio, A., Sloane, P. et al.  (2008).  Symptom experience of dying long term care residents.  Journal of the American Geriatric Society, 56:  91-98.,[object Object],Institute for Clinical Systems Improvement.  (2009, Jan).  Diagnosis and Management of Chronic Obstructive Pulmonary Disease, 7th Ed.  Available online at: (http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic_obstructive_pulmonary_disease_2286.html) ,[object Object],National Association of Clinical Nurse Specialists (NACNS).  (2004).  “Statement on Clinical Nurse Specialist Practice and Education.”  Glenview, IL:  NACNS.,[object Object],Qaseem, A., Snow, V., Shhekelle, P., Casey, D., Cross, J., & Owens, D.  Evidece-based interventions to improve the palliative care of pain, dyspnea and depression at the end of life:  a clinical practice guideline from the American College of Physicians.  Annals of Internal Medicine, 148:  141-146.  Available online at: http://www.annals.org/content/148/2/141.full,[object Object]
References (cont'd),[object Object],Registered Nurses Association of Ontario (2002). Toolkit: Implementation of clinical practice guidelines. Toronto, Canada:Registered Nurses Association of Ontario. Available online at: http://www.rnao.org/bestpractices/PDF/BPG_Toolkit.pdf,[object Object],Solvari, A., Kocheril, A., Yunis, N.& Crausman, R. (2006). Corpulmonale.  Available online at: http://www.emedicine.com/med/topic449.htm,[object Object],Stapleton, R., Nielsen, E., Engelberg, R, Patrick, D & Curtis, J.  (2005).  Association of depression and life-sustaining treatment preferences in patients with COPD.  Chest, 127(1):  328-334.  Available online at:  http://www.medscape.com/viewarticle/498650,[object Object],Tierney, L., McPhee, S. & Papadakis, M.  (2005).  Current Medical Diagnosis and Treatment, 44th Ed, p 235-236.  McGraw Hill.,[object Object],Timmins, F. & Kelly, J.  (2008).  Spiritual assessment in intensive and cardiac care nursing.  Nursing in Critical Care, 13(3):  124-131.,[object Object]
Thank You For Completing This Case Study,[object Object],To retrieve your CE certificate, please click ‘here’ to access our CE form.,[object Object],Please answer all questions and return the form to the NACNS office to earn your CE certificate.,[object Object],*Continuing Education is Optional,[object Object],CONFIDENTIAL - Do not forward or share,[object Object]

Weitere ähnliche Inhalte

Was ist angesagt?

End of life care
End of life careEnd of life care
End of life carepankaj rana
 
Hospice ethics presentation
Hospice ethics presentationHospice ethics presentation
Hospice ethics presentationlp384531
 
Palliative Care Across the Continuum
Palliative Care Across the ContinuumPalliative Care Across the Continuum
Palliative Care Across the ContinuumKindred Healthcare
 
Introduction to palliative care
Introduction to palliative careIntroduction to palliative care
Introduction to palliative careJWilliamKamya
 
florence nightingale theory
florence nightingale theoryflorence nightingale theory
florence nightingale theoryanusha sivakumar
 
Palliative care and end of life care
Palliative care and end of life carePalliative care and end of life care
Palliative care and end of life careYouttam Laudari
 
Nursing informatics presentation
Nursing informatics presentationNursing informatics presentation
Nursing informatics presentationLeeann Sills
 
Introduction to palliative care
Introduction to palliative careIntroduction to palliative care
Introduction to palliative careChai-Eng Tan
 
palliative Care related MCQs.pptx
palliative Care related MCQs.pptxpalliative Care related MCQs.pptx
palliative Care related MCQs.pptxanjalatchi
 
Florence Nightingale's Environment Theory
Florence Nightingale's Environment TheoryFlorence Nightingale's Environment Theory
Florence Nightingale's Environment TheoryJosephine Ann Necor
 
The comprehensive geriatric assessment pcp slides
The comprehensive geriatric assessment  pcp slidesThe comprehensive geriatric assessment  pcp slides
The comprehensive geriatric assessment pcp slidesMarc Evans Abat
 
Insomnia in Hospice and Palliative Care
Insomnia in Hospice and Palliative CareInsomnia in Hospice and Palliative Care
Insomnia in Hospice and Palliative CareAndi Chatburn, DO, MA
 

Was ist angesagt? (20)

End of life care
End of life careEnd of life care
End of life care
 
Hospice ethics presentation
Hospice ethics presentationHospice ethics presentation
Hospice ethics presentation
 
Palliative Care Across the Continuum
Palliative Care Across the ContinuumPalliative Care Across the Continuum
Palliative Care Across the Continuum
 
Introduction to palliative care
Introduction to palliative careIntroduction to palliative care
Introduction to palliative care
 
florence nightingale theory
florence nightingale theoryflorence nightingale theory
florence nightingale theory
 
Palliative care and end of life care
Palliative care and end of life carePalliative care and end of life care
Palliative care and end of life care
 
Nursing informatics presentation
Nursing informatics presentationNursing informatics presentation
Nursing informatics presentation
 
End of Life: Grief and Bereavement
End of Life: Grief and Bereavement End of Life: Grief and Bereavement
End of Life: Grief and Bereavement
 
Exploring Hospice Care
Exploring Hospice CareExploring Hospice Care
Exploring Hospice Care
 
Introduction to palliative care
Introduction to palliative careIntroduction to palliative care
Introduction to palliative care
 
Family centered care
Family centered careFamily centered care
Family centered care
 
1. critical care concepts and role of nurse
1.  critical care  concepts and role of nurse1.  critical care  concepts and role of nurse
1. critical care concepts and role of nurse
 
palliative Care related MCQs.pptx
palliative Care related MCQs.pptxpalliative Care related MCQs.pptx
palliative Care related MCQs.pptx
 
End of life care
End of life careEnd of life care
End of life care
 
Nursing care delivery
Nursing care deliveryNursing care delivery
Nursing care delivery
 
Florence Nightingale's Environment Theory
Florence Nightingale's Environment TheoryFlorence Nightingale's Environment Theory
Florence Nightingale's Environment Theory
 
Nursing shortage
Nursing shortageNursing shortage
Nursing shortage
 
The comprehensive geriatric assessment pcp slides
The comprehensive geriatric assessment  pcp slidesThe comprehensive geriatric assessment  pcp slides
The comprehensive geriatric assessment pcp slides
 
Insomnia in Hospice and Palliative Care
Insomnia in Hospice and Palliative CareInsomnia in Hospice and Palliative Care
Insomnia in Hospice and Palliative Care
 
CHN, COPAR & PHC
CHN, COPAR & PHCCHN, COPAR & PHC
CHN, COPAR & PHC
 

Andere mochten auch

Palliative Care Presentation
Palliative Care PresentationPalliative Care Presentation
Palliative Care Presentationguestfed9d3
 
Case presentation geriatric depression
Case presentation geriatric depressionCase presentation geriatric depression
Case presentation geriatric depressionkkapil85
 
Case study-10-depression
Case study-10-depressionCase study-10-depression
Case study-10-depressionAyesha Yaqoob
 
Role of a nurse in palliative care
Role of a nurse in palliative careRole of a nurse in palliative care
Role of a nurse in palliative carenetworknursing
 
Nursing care plans
Nursing care plansNursing care plans
Nursing care plansReynel Dan
 
Powerpoint final case study presentation
Powerpoint final case study presentationPowerpoint final case study presentation
Powerpoint final case study presentationJLUM13
 
A Case Study on Schizophrenia
 A Case Study on Schizophrenia A Case Study on Schizophrenia
A Case Study on SchizophreniaReeba Sara Koshy
 
Future society global or local
Future society global or localFuture society global or local
Future society global or localVaibhav Maurya
 
JS-Portfolio Defensive Backs
JS-Portfolio Defensive BacksJS-Portfolio Defensive Backs
JS-Portfolio Defensive BacksJimmie Sutton III
 
Glucose metabolism in burn patients
Glucose metabolism in burn patientsGlucose metabolism in burn patients
Glucose metabolism in burn patientsanestesiahsb
 
Caregiver stress
Caregiver stressCaregiver stress
Caregiver stressashbrink
 
Anxiety attacks how to support sufferers
Anxiety attacks   how to support sufferersAnxiety attacks   how to support sufferers
Anxiety attacks how to support sufferersCPGilfillan
 

Andere mochten auch (20)

Palliative Care Presentation
Palliative Care PresentationPalliative Care Presentation
Palliative Care Presentation
 
End of-life care
End of-life careEnd of-life care
End of-life care
 
Patient Case Presentation
Patient Case PresentationPatient Case Presentation
Patient Case Presentation
 
Case presentation geriatric depression
Case presentation geriatric depressionCase presentation geriatric depression
Case presentation geriatric depression
 
Dementia Case Study
Dementia Case StudyDementia Case Study
Dementia Case Study
 
Case study-10-depression
Case study-10-depressionCase study-10-depression
Case study-10-depression
 
Role of a nurse in palliative care
Role of a nurse in palliative careRole of a nurse in palliative care
Role of a nurse in palliative care
 
Nursing care plans
Nursing care plansNursing care plans
Nursing care plans
 
Powerpoint final case study presentation
Powerpoint final case study presentationPowerpoint final case study presentation
Powerpoint final case study presentation
 
A Case Study on Schizophrenia
 A Case Study on Schizophrenia A Case Study on Schizophrenia
A Case Study on Schizophrenia
 
Future society global or local
Future society global or localFuture society global or local
Future society global or local
 
JS-Portfolio Defensive Backs
JS-Portfolio Defensive BacksJS-Portfolio Defensive Backs
JS-Portfolio Defensive Backs
 
Depressive disorder.drjma
Depressive disorder.drjmaDepressive disorder.drjma
Depressive disorder.drjma
 
NTRS 415B - Case Study PowerPoint
NTRS 415B - Case Study PowerPointNTRS 415B - Case Study PowerPoint
NTRS 415B - Case Study PowerPoint
 
Glucose metabolism in burn patients
Glucose metabolism in burn patientsGlucose metabolism in burn patients
Glucose metabolism in burn patients
 
CASE STUDY (Q5)
CASE STUDY (Q5)CASE STUDY (Q5)
CASE STUDY (Q5)
 
Caregiver stress
Caregiver stressCaregiver stress
Caregiver stress
 
NAMI PA Main Line Forum Anxiety Talk
NAMI PA Main Line Forum Anxiety TalkNAMI PA Main Line Forum Anxiety Talk
NAMI PA Main Line Forum Anxiety Talk
 
Anxiety attacks how to support sufferers
Anxiety attacks   how to support sufferersAnxiety attacks   how to support sufferers
Anxiety attacks how to support sufferers
 
Ed 300 anxiety
Ed 300 anxietyEd 300 anxiety
Ed 300 anxiety
 

Ähnlich wie End of Life Care Case Study # 2

NRS 410 Great Stories /newtonhelp.com
NRS 410 Great Stories /newtonhelp.comNRS 410 Great Stories /newtonhelp.com
NRS 410 Great Stories /newtonhelp.combellflower214
 
Nrs 410 topic 1 mandatory discussion question
Nrs 410 topic 1 mandatory discussion questionNrs 410 topic 1 mandatory discussion question
Nrs 410 topic 1 mandatory discussion questionagathachristie189
 
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Karin Verspoor
 
Running Head Homework 2 Homework 2 Homework 2.docx
Running Head Homework 2 Homework 2 Homework 2.docxRunning Head Homework 2 Homework 2 Homework 2.docx
Running Head Homework 2 Homework 2 Homework 2.docxwlynn1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete classcoursesexams1
 
Discussion post reply APA Format2 references for each discussi
Discussion post reply APA Format2 references for each discussiDiscussion post reply APA Format2 references for each discussi
Discussion post reply APA Format2 references for each discussiLyndonPelletier761
 
J2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
J2016 - Tecson et al AJC Impact of EECP on Heart Failure RehospitalizationJ2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
J2016 - Tecson et al AJC Impact of EECP on Heart Failure RehospitalizationEmily Hu
 
Free ebooks for all courses
Free ebooks for all coursesFree ebooks for all courses
Free ebooks for all coursesEdhole.com
 

Ähnlich wie End of Life Care Case Study # 2 (20)

NRS 410 Great Stories /newtonhelp.com
NRS 410 Great Stories /newtonhelp.comNRS 410 Great Stories /newtonhelp.com
NRS 410 Great Stories /newtonhelp.com
 
Nrs 410 topic 1 mandatory discussion question
Nrs 410 topic 1 mandatory discussion questionNrs 410 topic 1 mandatory discussion question
Nrs 410 topic 1 mandatory discussion question
 
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)
 
Running Head Homework 2 Homework 2 Homework 2.docx
Running Head Homework 2 Homework 2 Homework 2.docxRunning Head Homework 2 Homework 2 Homework 2.docx
Running Head Homework 2 Homework 2 Homework 2.docx
 
Fall Risk Case Study # 1
Fall Risk Case Study # 1Fall Risk Case Study # 1
Fall Risk Case Study # 1
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
Nur 641 e complete class
Nur 641 e complete classNur 641 e complete class
Nur 641 e complete class
 
CapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative CareCapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative Care
 
Discussion post reply APA Format2 references for each discussi
Discussion post reply APA Format2 references for each discussiDiscussion post reply APA Format2 references for each discussi
Discussion post reply APA Format2 references for each discussi
 
J2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
J2016 - Tecson et al AJC Impact of EECP on Heart Failure RehospitalizationJ2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
J2016 - Tecson et al AJC Impact of EECP on Heart Failure Rehospitalization
 
Free ebooks for all courses
Free ebooks for all coursesFree ebooks for all courses
Free ebooks for all courses
 
Phc part 2
Phc part 2Phc part 2
Phc part 2
 
Aft Task 3
Aft Task 3Aft Task 3
Aft Task 3
 
Thomas bodenheimer
Thomas bodenheimerThomas bodenheimer
Thomas bodenheimer
 
Thomas Bodenheimer
Thomas BodenheimerThomas Bodenheimer
Thomas Bodenheimer
 

Kürzlich hochgeladen

Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxDr. Asif Anas
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17Celine George
 
5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...CaraSkikne1
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationMJDuyan
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxSaurabhParmar42
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxiammrhaywood
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17Celine George
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational PhilosophyShuvankar Madhu
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and stepobaje godwin sunday
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfMohonDas
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 

Kürzlich hochgeladen (20)

Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptx
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17
 
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdfPersonal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
 
5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...5 charts on South Africa as a source country for international student recrui...
5 charts on South Africa as a source country for international student recrui...
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive Education
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptx
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational Philosophy
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and step
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdf
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 

End of Life Care Case Study # 2

  • 1.
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.