What nursing measures should the nurse use to manage the patient’s dyspnea? The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

1. Nursing measures to manage dyspnea: The nurse can use various measures to manage Joe Clark’s dyspnea. One effective measure is to maintain a semi-fowler’s position for the patient to facilitate lung expansion and ease breathing. The nurse can also encourage the patient to perform pursed-lip breathing and deep breathing exercises, which are helpful in relieving dyspnea (Ferrell, Coyle, & Paice, 2019). The nurse should assess the patient’s oxygen saturation levels regularly and adjust the oxygen therapy as needed. Additionally, the nurse can provide emotional support to the patient by being present, using calm and reassuring words, and reducing anxiety-provoking stimuli (Ferrell et al., 2019). The nurse can also provide distraction techniques, such as music or reading, to help ease the patient’s discomfort.

Nursing measures to manage anorexia: The nurse should assess the patient’s nutritional status, including weight, food intake, and hydration. The nurse should encourage small, frequent meals and snacks throughout the day and provide the patient with food and drinks that he enjoys. The nurse should also offer alternative food choices that are nutrient-dense, such as smoothies or high-calorie supplements (Ferrell et al., 2019). Additionally, the nurse can provide mouth care, such as brushing and flossing the patient’s teeth, using mouthwash, and applying lip balm to alleviate dryness and soreness. The nurse should also collaborate with a registered dietitian to develop a customized nutritional plan for the patient.

2. Principles of hospice: The underlying principles of hospice care include providing comfort care, maintaining the patient’s dignity, and enhancing the quality of life for the patient and family during the end-of-life phase (Ferrell et al., 2019). Hospice focuses on relieving symptoms and improving the patient’s overall well-being, including physical, emotional, and spiritual needs. Hospice care is provided in the patient’s home, or in a hospice facility, and a team of healthcare providers, including nurses, physicians, social workers, chaplains, and volunteers, work together to meet the patient’s needs.

Eligibility for Medicare and Medicaid Hospice benefits: To be eligible for Medicare and Medicaid Hospice benefits, Ms. Williams’ physician must provide a written certification of her terminal illness with a life expectancy of six months or less if the illness follows its usual course (Centers for Medicare & Medicaid Services, 2022). Additionally, the physician must certify that the patient has elected to receive hospice care and that the care provided is related to the terminal illness.

Pain management in hospice: Hospice provides comprehensive pain management to relieve the patient’s pain and suffering. The hospice team, including the nurse and the physician, will develop a pain management plan that includes non-pharmacological and pharmacological interventions. Non-pharmacological interventions may include massage, heat or cold therapy, relaxation techniques, and acupuncture. Pharmacological interventions may include non-opioid analgesics, such as acetaminophen, and opioid analgesics, such as morphine or fentanyl (Ferrell et al., 2019). The hospice team will closely monitor the patient’s response to pain management and adjust the treatment plan as needed to ensure optimal pain relief.

References: Centers for Medicare & Medicaid Services. (2022). Medicare hospice benefits. Retrieved from https://www.medicare.gov/coverage/hospice-and-respite-care

Ferrell, B. R., Coyle, N., & Paice, J. A. (2019). Oxford textbook of palliative nursing (5th ed.). Oxford University Press.