Felicia Lima

Case Study #1
Research Skills
February 10, 2015

Patient/Problem:

Mr. Jones is a seventy-five year old widower who was referred today for hospice care.
Mr. Jones has an admitting diagnosis of Adeno Carcinoma of the left lung with metastasis to the
liver, brain and spleen. Patient has past medical history that includes a-fib, hypertension, COPD,
and a recent cessation of smoking but previous to that was a smoker for fifty-five years. At this
time Mr. Jones does not want to be admitted to a sub-acute center. Mr. Jones is aware of his
terminal diagnosis and would like to die at home. During the home visit I saw very little food in
the refrigerator and cabinets. Also when reviewing current medication I saw that there was an
unfilled prescription for Fentanyl Patches. Mr. Jones does not have much family support, his
children are unaware of his diagnosis. Mr. Jones also has signs of shortness of breath as
evidenced by respirations in the 30s with activity and cyanotic lips and nail beds. Mr. Jones
states his pain is a 6 out of 10 and takes Percocet when the pain gets real bad.
Mr. Jones admitting diagnosis of Adeno Carcinoma of the left lung is a type of cancer
that forms in the mucus-secreting glands throughout the body in his case it was the lung.
Unfortunately for Mr. Jones the cancer has metastized in other words spread to the glands of his
liver, brain and spleen. Hospice is a program of care and support for those who are terminally ill.
Hospice helps those with a terminal illness to live comfortably with care provided generally in

the home. Medicare covers services provided while under hospice care. While on hospice there is
a nurse and doctor available twenty-four hours a day for patient needs.
Interventions:
To ease Mr. Jones respiratory distress is to have oxygen at 2-4 liters per minute via nasal
cannula to maintain oxygen saturations 90% or higher. Hospice will encourage optimal nutrition
for Mr. Jones, during home visits weekly weights will be obtained to ensure adequate nutrition.
Mr. Jones is a candidate for Meals on Wheels which states to be a candidate you must be over 60,
homebound, and unable to cook your own meals at home. Meals on Wheels delivers one hot
meal a day. Due to Mr. Jones not wanting his family involved with care hospice is going to put
together pastoral visits at his home.
Comparison/Alternative:
Hospice will be monitoring Mr. Jones pain, he will be prescribed a Fentanyl Patch for
pain as well as another as needed medication Percocet for every 3 hours as needed for pain. Due
to increase in pain medications Mr. Jones is expected to have constipation as a side effect. Mr.
Jones with be prescribed a stool softener as well as activity as tolerated. Hospice will ensure Mr.
Jones coping mechanisms are adequate he will participate in self-help groups as tolerated.
Hospice will also recommend yoga as a way to relax the body to ease pain and decrease in
respiratory distress.
Outcome:
Mr. Jones will maintain oxygen saturations at or above 90% and an open airway with
little to no respiratory distress. As to nutritional status Mr. Jones will maintain his weight and

adequate caloric intake. Mr. Jones will report a satisfactory pain level of less than 4 out of a scale
of 0-10. Mr. Jones will pass soft, formed stool at a frequency that is normal for patient.
Mr. Jones will participate in Meals on Wheels eating 100% of meals delivered to him to
maintain adequate nutrition. Mr. Jones will express the benefit of pastoral service visits. Mr.
Jones will attend self-help groups as tolerated and describe positive results from attending. Mr.
Jones will exhibit increased comfort and relaxed muscle tone and posture from practicing yoga.

References:

Adenocarcinoma. (1, January 1). Retrieved February 13, 2015, from

http://www.cancercenter.com/terms/adenocarcinoma/

Meals on Wheels and Dining Centers. (n.d.). Retrieved February 13, 2015, from
http://www.massresources.org/meals-on-wheels.html#eligible

Medicare hospice benefits. (n.d.). Retrieved February 13, 2015, from

http://www.medicare.gov/Pubs/pdf/02154.pdf