1. What are some open-ended questions that can be asked to explore the need for palliative care?

How do you feel about your terminal prognosis?

How has the terminal diagnosis affected you and your family?

How are you and your family coping with your prognosis?

What concerns, worries, or fears do you have about you and your families’ future?

What are some areas of care do you feel you and your family need? Spiritual, psychological, pain management.

1. The decision is made to proceed with palliative care, and a plan to manage pain is being developed in partnership with Mr. Brown and his family. What does total pain management entail, and why is managing total pain important to the well-being of Mr. Brown and his family?

The concept of total pain management recognizes that patient’s suffering from a life limiting condition should be treated for multiple sources of pain. These sources of pain can include physical, emotional, social, and spiritual (Hospice, 2020). Therefore, pain is a multidimensional experience and must be treated as such in order to provide adequate relief.

1. How should Mr. Brown’s spiritual well-being be evaluated, and why is it part of total pain management?

A spiritual evaluation could be conducted to assess Mr. Brown and his family’s spiritual or religious beliefs. Asking questions to better understand if the patient and family turn to a higher power for support and guidance. This spiritual evaluation can evaluate if Mr. Brown and his family use spirituality to help provide comfort and a piece of mind about the future.Spiritual care should be included in total pain management because spiritual beliefs can ease suffering from individuals that may be struggling for answers or explanations (Dunphy et al., 2019).

1. As you learn that Mr. Brown’s level of pain has increased since his treatments ended, you suggest the use of opioids for pain management. Mr. Brown’s daughter expresses concern about the use of opioids to manage pain, stating, “Aren’t opioids bad? I hear about people dying from opioid abuse on the news all the time.” What information should you prov foide to assuage the daughter’s concern?

Opioids are considered the gold standard in managing the level of pain that your dad is experiencing. There is a risk of respiratory depression with the use of opioids. Your father will be monitored closely for mentation and signs of respiratory depression (Sinha et al., 2022). It is important for you and other family members to be aware of signs of symptoms of respiratory depression to recognize a possible accidental overdose. Sedation will precede respiratory depression (Sinha et al., 2022). Therefore, if your father loses consciousness, you should call 911. Other signs include pale, cold skin, limp body, gurgling or choking, and small restricted pinpoint pupils (CDC, 2022). Naloxone is a reversal agent that can be administered in the event of an accidental opioid overdose (Sinha et al., 2022).

1. As the disease process progresses, the patient begins to demonstrate signs of dyspnea, including confusion and anxiety. What treatment should be initiated, and what are important considerations when initiating this treatment?

According to Dunphy et al. (2019) a combination therapy approach using oxygen, opioids, and benzodiazepines medications are considered to be the most effective at relieving dyspnea with accompanying confusion and anxiety. Decreased oxygen levels can cause patients to feel panicked as well as confused. Therefore, oxygen is usually first-line treatment for patients nearing the end of life. Opioids and benzodiazepines can help to ease feelings of breathlessness that can lead to anxiety (Dunphy et al., 2019).

References

Centers for Disease Control and Prevention. (2022). Preventing an opioid overdose.https://www.cdc.gov/drugoverdose/pdf/patients/prev…

Dunphy, L. M, Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing- an interprofessional approach. Philadelphia. 5^th edition.

Hospice of the Western Reserve. (2020). The total pain model. 9 key points.https://www.hospicewr.org/Western-Reserve-CareLink/September-2020/The-Total-Pain-Model-9-Key-Points

Sinha A, Deshwal H, Vashisht R. (2022). End Of Life Evaluation And Management Of Pain. https://www.ncbi.nlm.nih.gov/books/NBK568753/