Palliative Care: Addressing Hildy Kohler's Needs in a Case Study

This case study provides an analysis of palliative care interventions for Hildy Kohler, a 74-year-old woman with metastatic cancer. It addresses her physical, emotional, spiritual, and psychosocial needs. The analysis includes nursing interventions for pain management, breathlessness, and skin integrity, while respecting her autonomy in refusing pain medication. It also covers strategies for managing dehydration, sleep disturbances, and addressing family concerns about nutrition and end-of-life care. The importance of empathy, clear communication, and family involvement in providing comprehensive support during the palliative care process are highlighted.

Running head: PALLIATIVE CARE.
Palliative Care
Name of Student
Institutional Affiliation

PALLIATIVE CARE.
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Palliative nursing practice is the approach of taking care of patients by relieving undesirable
symptoms and reducing the progression of a disease (Kelley & Morrison, 2015). It majorly
applied in patients with chronic illnesses. In the unit where am situated, there has been a
number of slow painful deaths and this has been a strain for me and my colleagues socially
and emotionally. To boost emotional well-being, we could start by giving the patients the best
of care during the time of struggle so that they can be comfortable and die peacefully. We can
also change the perspective of death and view it as a relief from suffering. We can engage in
educating patients on early symptoms of chronic diseases so as they can be managed early
and preserve quality of life. We can carry out research on the causes of increased rate of
chronic illnesses so as to provide recommendations to be implemented hence improve the
quality of life.
Question 51
In palliative care, the aim is to ensure patient comfort by and maintaining quality of life. The
benefit vs burden principle is applied when deciding whether a particular procedure or
treatment regime should be given to the patient. It compares the benefits and the burden to
the patient. It the burden outweighs the benefits, then the procedure would rather not be
performed (Robinson, Gott, Frey, Gardiner & Ingleton, 2018). Hildy has a metastatic cancer
and the chemotherapy she was to receive could cause a lot of burden on her systems than
benefit her. Hence conclusion arrived at was not to give the treatment.
Question 52
The major issues affecting Hildys comfort are pain and inability to tolerate activities.
She has pain on her back and left shoulder. The pain on her back is due to the tumour that
has metastasized and is pressing on the spinal cord irritating the nerve endings.
 Nursing intervention is to perform detailed assessment in a scale of 1-10, noting down
the aggravating and relieving factors (Fleming, 2017).
 Administer analgesics as prescribed and evaluate pain level to re-plan or change
dosage.
 Demonstrate and educate patient on techniques and position to relieve pain.
She is unable to tolerate activities since she has shortness of breath secondary to the tumour
metastasized to her lungs.

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 Nursing interventions include, educating patients on coping mechanisms including
techniques of performing daily activities e.g. use of aiding devices.
 Administer supplemental oxygen to the patient when need arises to promote
oxygenation and relieve breathlessness.
 Assist patient to perform simple daily activities allowing breaks and reducing
intensity in accordance with patient abilities.
Question 53
Hildy has expressed the need for her spiritual needs and psychosocial needs to be addressed.
She needs her priest to be called in in case she becomes unconscious. She has also asked her
children to be next to her when she dies. In planning my care, I would ensure the priest is
contacted and ensure he comes to promote the patient’s rites. I will explain the condition of
the mother to the children and support them through the grieving process so that they can
accept the loss. This will give them the strength to support their mother at the time of her
death.
Question 54
Hildy has a risk for impaired skin integrity due to the pathophysiology of her condition. She
is fatigued and cannot stay upright for long. This means she is asleep most of the time. Lying
down for longer hours on one side minimizes the blood flow to the area and can lead to
muscle ischaemia. She has lost 15kgs within the month hence the skin size si bigger
increasing the risk of forming folds, she cannot lie flat hence is lying on the side. The nursing
interventions include;
 Turning patient often after every two hours to allow circulation to all areas and assess
the patients skin, majorly on the bony prominences, around the skin folds and sacrum.
 Give nutritional advice to the patient insisting on a balanced diet consumption to
prevent weight loss (Coyer, Gardner, Doubrovsky, Cole, Ryan, Allen & McNamara,
2015).
Question 55
Hildy has explained her diet preferences and she has pointed out symptoms of dehydration.
This information is critical in knowing the food to give to her and administer fluids to prevent
mouth drying and increase urine output. Following the principle of autonomy, I will respect

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her decision of not having pain relief medications so she can spend time with her children
(Cheon, Coyle, Wiegand & Welsh, 2015).
Question 56
Hildys condition has deteriorated and the issues causing discomfort are dehydration and
inability to sleep.
She is presenting with dry cracked lips due to reduced intake of fluids. Nurse should;
 Encourage patient to take a lot of fluids and provide the foods that she prefers
 Monitor fluid input and output to assess the function of the kidnes
 Administer intravenous fluids to compensate for the decreased oral intake
She has disturbed sleep due to skin itchiness. Itchiness of the skin is due to skin dryness.
Nurse should;
 Apply oil on the skin to prevent dryness and educate family to apply oil after
showering.
 Administer antipruritic medications that do not cause drowsiness
 Advice the patient to cut nails to prevent breaking of skin
Question 57
Hildy has refused to take pain medications because she does not want to fall asleep. The pain
is increasing in intensity due to the deteriorating condition. This could be a point of conflict
for the daughter since the daughter would want the mother to be given analgesics to relieve
the pain and the mother declined.
Question 58
The non-pharmacological ways of pain management include distracting the patient and
changing positions while offering rest. Hildy can be distracted by involving her in social
groups or using television programmes. Having a bedrest then changing position and doing
body manipulations may provide relief from pain as it could avoid lying on one side for
longer periods (Ambrose & Golightly, 2015).

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Question 59
In addressing the sons concerns about pushing large amounts of food and fluids to the patient,
I would explain to the son that forcing food to the mother will make her more distressed. I
will explain that during the end of life, a person loses the appetite and is less thirsty. The
body has already started conserving energy. Due to the reduced intake of fluids, ones lips and
skin become dry and the urine output reduces. Constipation also is due to dehydration and
reduced gastric motility (Reid, McDonald, Nwosu, Mason, Probert, Ellershaw & Coyle,
2017).
Question 60
Regarding giving support to the family, I will show empathy to the family and demonstrate
understanding. I will listen carefully to their concerns and explain vividly the areas they need
clarification. I will use clear language and accept their behaviour to be normal during
grieving process (Sykes, 2015). I will involve the family in the care and explain plainly the
prognosis. I will respect their requests to stay with the patient and provide privacy for the
family. I would be patient with the questions give honest ideas concerning her prognosis.

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References
Ambrose, K. R., & Golightly, Y. M. (2015). Physical exercise as non-pharmacological
treatment of chronic pain: why and when. Best Practice & Research Clinical
Rheumatology, 29(1), 120-130.
Cheon, J., Coyle, N., Wiegand, D. L., & Welsh, S. (2015). Ethical issues experienced by
hospice and palliative nurses. Journal of Hospice & Palliative Nursing, 17(1), 7-13.
Coyer, F., Gardner, A., Doubrovsky, A., Cole, R., Ryan, F. M., Allen, C., & McNamara, G.
(2015). Reducing pressure injuries in critically ill patients by using a patient skin
integrity care bundle (InSPiRE). American Journal of Critical Care, 24(3), 199-209.
Fleming, G. C. (2017). Development of a cancer pain management learning module for
registered nurses in palliative home care.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England
Journal of Medicine, 373(8), 747-755.
Reid, V., McDonald, R., Nwosu, A. C., Mason, S. R., Probert, C., Ellershaw, J. E., & Coyle,
S. (2017). O-5 A systematically structured review on biomarkers of dying in cancer
patients at the end of life; an exploration of potential mechanisms for the biology of
dying.
Robinson, J., Gott, M., Frey, R., Gardiner, C., & Ingleton, C. (2018). Predictors of patient-
related benefit, burden and feeling safe in relation to hospital admissions in palliative
care: A cross-sectional survey. Palliative medicine, 32(1), 167-171.
Sykes, N. (2015). One Chance to Get it Right: understanding the new guidance for care of the
dying person. British medical bulletin, 115(1), 143-150.