Case Study A 85-year-old woman is in the last stages of metastatic lung cancer. She is receiving oral pain medications to control pain associated…

Question Case Study A 85-year-old woman is in the last stages of metastaticlung cancer. She is receiving oral pain medications to control pain associated with the metastatic involvement of her spine. She is in the hospital after falling at home but has not suffered a fracture; her length of stay is estimated to be no more than 3 to 4 days. She eats very few calories, but she is able take in about 250 kcal in supplemental nutrition. You assess her risk for pressure ulcers, and she is at high risk due to her nutritional status, time spent in bed, and need for assistance to move in the bed. She has no breaks in her skin at this time, and she is on a regular hospital mattress. She has been incontinent of urine. Two key pieces of evidence for her care include: I. Use higher-specification foam mattresses rather than standard hospital foam mattresses for all individuals assessed as being at risk for pressure ulcer development. (Strength of evidence = A) Strength of evidence A: The recommendation is supported by direct scientific evidence from properly designed and implemented controlled trials on pressure ulcers in humans (or humans at risk for pressure ulcers), providing statistical results that consistently support the guideline statement (Level 1 studies required). (NPUA-EPUAP, 2009) II. Avoid use of urinary catheters in patients and nursing home residents for management of incontinence. (Category IB) Category 1B: A strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms or an accepted practice (e.g., aseptic technique) supported by low- to very-low-quality evidence. Inappropriate catheter use includes “a substitute for nursing care of the patient or resident with incontinence” (CDC, 2009). Acceptable use is to improve comfort for end-of-life care if needed (CDC, 2009). 1. Given the two pieces of evidence, what are the key clinical questions to consider when caring for this patient? 2. If you are going to take a patient-centered approach to caring for this patient, what further information do you need? 3. What questions would you ask of the patient and family? Of the physician? 4. If the evidence of meaning existed, what questions related to the meaning of a patient’s experience would you ask? 5. What are the areas of ambiguity related to clinical decisions that need to be made relative to the two areas of evidence? 6. What are the potential conflicts between the decision that the evidence would point to and what the patient may desire? 7. How could you use the principles of patient-centered care to resolve any conflict between the evidence and patient desires? Health Science Science Nursing NUR 427 Share QuestionEmailCopy link Comments (0)