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Journal 7 Leadership
Journal 7 Leadership
Journal 7
Date: 8/4/2020
I started the scenario in I-Human with A. J, 72-year-old male who was admitted for
restlessness and uncontrolled pain. I achieved a score of 75%. The patient was diagnosed with
metastatic bladder cancer stage IV 8 months ago. After trying chemotherapy and not seeing
results, he began receiving hospice care at home. However, since las week, he had been restless,
uncomfortable, and stopped taking anything by mouth. The Pt had a medical history of COPD,
hypertension, pace maker placed 10 years ago, hernia 15 years ago, appendectomy 25 years ago,
heart failure last EF 35%, permanent O2 for 2 years. Wife died recently. He had two sons and a
daughter. He lived with the daughter and husband. Vitals signs in assessment were as follows:
BP: 90/60, HR:120, RR: 22 labored Cheyney-stokes, SpO2: 90%, temp: 100.1. His code status
was DNR and he signed physician orders for life-sustaining treatment (POLST) six months ago.
Patient was still restless, in pain, slightly arousable, with coarse crackles in lungs, tachycardia,
tachypnea, mottling, capillary refill of 4 in fingers and toes, tenting of the skin, chapped lips, and
dry mouth mucosa. Patient was moaning and grimacing during assessment. Pt’s Daughter was
concerned about a loud rattling sound in her father’s throat. He had a PCA. Dose of morphine
was increase twice for unrelieved pain per doctor’s orders, however the pain was still unrelieved.
I recommended that the HCP reevaluate the treatment plan for the patient since there were
changes in respiratory secretions and pattern, plus pain is still unrelieved. Also, pastoral should
come again to talk to the patient and family. Education about terminal secretions and use of
therapeutic communication to talk to family was very important at this moment, taking into
account that they were still grieving the death of their wife/mother and their dad was about to
die. This case scenario reminded me of my grandmothers’ death. She stopped eating and her
respiration were more and more depressed before her death. Also moaning and grimacing were
present just like with this patient. My strength in this scenario was recognizing the need for
better measures to manage pain and the report of new s/s symptoms found in the assessment. I
consider my communication skills are good for this kind of situations when the patient’s
imminent dead was close. I could have deepened more in the interview I had with the daughter.