Samuel Green is a 75-year-old Jewish male diagnosed 15 months ago with inoperable pulmonary adenocarcinoma. He became acutely ill after his last...
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Samuel Green is a 75-year-old Jewish male diagnosed 15 months ago

with inoperable pulmonary adenocarcinoma. He became acutely ill after his last round of chemotherapy and was admitted to the inpatient hospice unit for palliative care. His code status is documented as do not resuscitate (DNR). Mr. Green's wife and son are at his bedside and are aware that he is actively dying. The scenario takes place on his first hospice day at 1300.
 Location: Inpatient Hospice Unit
Patient name: Samuel Green
Medical record #: 7773918
 Date of birth: June 2 Age: 75 Sex: Male
Admitting provider: MD
 Scenario start day: Day 1, Wednesday Scenario start time: 1300
Chief complaint upon admission: Uncontrolled pain.
Primary diagnosis: Adenocarcinoma bilateral lungs
Secondary diagnosis: Bone and lymph metastasis


SBAR Hand-Off Current day and time: Wednesday 1300
Admission day and time: Wednesday 0900
Situation Name: Samuel Green Age: 75 Sex: Male Ethnicity: Caucasian Religion: Judaism
Provider: Saul Rubenstein, MD
Admission diagnosis: Adenocarcinoma bilateral lungs, bone and lymph metastasis
Background Pertinent medical history: Right total hip replacement 3 years ago

Pertinent social history: Lives with wife, has one son
Allergies: No known allergies
Code status: Do not resuscitate
Vital signs (most recent): Time: 1230 T: 97.0 F (36.1 C) BP: 74/48 P: 70 RR: 20 O2 Sat: 84%
Oxygen therapy: Mode: Room air LPM: Not applicable
Pain: Rating: Unable to assess Most recent pain medication: Morphine 5 mg/hr continuous IV drip Time: 1230
Other recent medication: None
IVs: Site: Right subclavian Type: Groshong Assessment: Intact, patent Fluid: No maintenance IV; morphine infusion only
Drains and tubes: Site: None Type: Not applicable Assessment: Not applicable
Wounds: Site: None Type: Not applicable Assessment: Not applicable
ADLs: Diet: Kosher, as tolerated Activity: As tolerated
Restrictions: Isolation: Standard precautions Fall risk: High
Assessments:
Neurologic: Difficult to arouse
Cardiac: S1, S2
Respiratory: Lung sounds diminished throughout with scattered rhonchi
GI/GU: Has not voided since admission
Integumentary: Extremities cool, mottled
Ortho/Mobility: Weak, high fall risk
Psychosocial: Knows he is dying, wants his pain to be controlled
Other: Pain control with the morphine drip appears adequate
Labs and diagnostics: None ordered Assessment
Nurse's assessment: Admitted this morning for pain control. On continuous IV morphine drip. Wife and son are present and aware that patient is actively dying. Recommendation
Plan of care: Supportive, palliative care for dying patient
Tests/results pending: None
Orders pending completion: None
Other: None.




1)
What would you provide in the nursing Care plan? 
Select a nursing diagnosis, 3 interventions with rationales, 1 short term and 1 long term goal (Specific, Measurable & Timed) , provide comment regarding: Why OR why not reached.

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