Symptom Management – Ms King Case
Ms. King is a 32-year old single Caucasian woman who is actively dying of AIDS (has Kaposi sarcoma, as well as central nervous system lymphoma) on the medicine unit. She has lived in a nursing home for the past 18 months and has no immediate family. When her symptoms became more pronounced and her pulse oximeter read 76% on room air, the nursing home sent her to the hospital to be admitted two days ago. She is dyspneic and has reduced breath sounds bilaterally. For the past 3 days she has had a productive cough and becomes extremely dyspneic when coughing (chest x-ray revealed pneumonia) and also begins to vomit. She is anxious and becomes agitated easily. Generally, she is confused and becomes delirious, mostly at night. “If I go to sleep, I know I will never wake-up,” she told the nurse last night. She is not oriented to time, place or person. She has not slept for three days/nights. She also has nausea and vomiting (3-4 times/day—total emesis over the past 24 hours = 650 cc). She denies the presence of pain.
The staff on this unit is young, for the most part, and has an average of one year of nursing experience. Most of the nurses have not cared for people with AIDS. Some are fearful, others are judgmental. Some staff members have significant anticipatory grief reactions and have difficulty caring for Ms. King. A do-not-resuscitate order (DNR) is in place and the orders revolve around “comfort care.”
As the nurse on this medical unit, you decide that some additional education is needed for the staff. You will provide general AIDs education and then help them to develop a palliative care plan around the dyspnea, nausea/vomiting, cough, anxiety, agitation, and delirium.
Discussion Questions:
As the nurse developing this education for your staff:
- What drug treatments would you want to share with the staff in regards to the symptoms listed above?
- What non-drug treatments would you want to review?
- Discuss your plan to address the staff’s discomfort in providing care to Ms. King.
- Detail educational opportunities for the staff to improve the care provided to Ms. King.