nsg interventions: end of life care with addiction

[supafly]

situation: terminally ill pt with a smoking addiction

confused @ what my interventions should be.

for someone not terminally ill, i would think education, referral to services, etc. so that person could make a lifestyle change for the better.

but for end-of life care, i think getting them to stop would be more hassle for them than benefit. more pain than pleasure.

a palliative approach at end of life strikes me as being more sensible. and to me that means allowing them to smoke. can that be right?

please help.

[moonchild20002000]

Yes,it is the choice of the pt. to smoke... will not change the outcome.

[supafly]

thx. do you even bother w/ pt education about health benefits of stopping? are there any interventions to make r/t the addiction?

[jmgrn65, RN]

thx. do you even bother w/ pt education about health benefits of stopping? are there any interventions to make r/t the addiction?

No it's end of life what is going to do with the information? If it makes him more comfortable, then by all means smoke, drink and be merry. It is too late to change. I think a patient should be able to have whatever it is they need or want (within reason) thier dying.

[Daytonite, BSN, RN]

you don't begin to list interventions until you've identified a problem. is there a problem here? who says this patient has a "smoking addiction"? that sounds like a medical diagnosis to me and we don't base nursing diagnoses and interventions on medical diagnoses, but upon the patient's responses to these conditions. is this a hypothetical patient or a real patient? in problem solving, the very first thing we do is an investigation of the facts (an assessment). the very phrase "smoking addiction" is a decision that has already been made by someone--a doctor? the patient? if the doctor or the case scenario gave you that bit of information then addiction is not a nursing problem that you determined from your assessment, is it? to proceed with this you need, then, to look up the signs and symptoms of addiction because those signs and symptoms are what form part of the basis of your nursing problem and what your interventions have to be aimed at. however, if this is a real patient and the patient said to you "i have a smoking addiction", you also have a subjective statement to add to the signs and symptoms of addiction that you can work with in determining the nursing problem here. you can't make anyone do anything, i.e. deal with their smoking, unless they are going to be agreeable with the plan. read about this in dealing with addiction. about the best you might be able to do is point out why it is not good for them and the safety issues surrounding smoking as a knowledge deficit problem. end of life issues involve keeping the patient comfortable. the bottom line of goals, the expected results of interventions, are that they

• improve the patient's nursing problem
  
• stabilize the patient's nursing problem
  
• support the deterioration of the patient's condition/problem
  

so, whatever interventions you decide to use, they must address the nursing problem that you diagnosed. it is ok if they do not cure or ablate the problem, but support it instead. i don't know what kind of assessment your nursing program taught you, but i think assessing respiration, safety and teaching/learning is important here in getting to a nursing diagnosis for this patient. there is an assessment form in the middle of taber's cyclopedic medical dictionary listed under "nursing" that has these assessment items and what to look for in assessing. abnormal responses become the data that support a nursing problem (nursing diagnosis). abnormal data is also what you aim your nursing interventions at.

you didn't mention it, but i would be curious to know what this patient's terminal illness is.

here are websites that give information and advice about end of life care. i honestly don't know if smoking is addressed on them.

• http://www.stvincent.org/ourservices/hospice/preparing/default.htm - links are on the left side of the page
  
• http://www.mywhatever.com/cifwriter/library/eperc/fastfact/ff_index.html
  

[supafly]

thk u, thk u.

this is for a case study presentation @ end of life care for a hypothetical pt who just learned that her lung cancer is no longer treatable, then becomes confused n angry. a subtopic that needs to be addressed is care and available interventions if this pt is addicted to cigarettes.

i'm gonna have to mull this over. i'm sure i'll have more Qs later. lol.

[Daytonite, BSN, RN]

oh, you left out some critical information--the lung cancer and that the patient is angry! before you can do any interventions you need to complete assessment activities as part of the first step of the problem solving process.

assessment

(collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)

in the real world that includes

• a physical assessment of the patient
  
• assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
  
• data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
  
• knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
  

for a hypothetical case scenario you fudge what you can. you need to be looking up the signs and symptoms of lung cancer as well as the stages of dying of which anger is one. as i mentioned previously, i think "smoking addiction" is very possibly a medical diagnosis (i worked on an alcohol and drug detox unit) and you should look up the symptoms of addiction. why get a list of all these different symptoms? because nursing diagnoses (patient problems), goals and interventions are based upon the symptoms that the patient has. with hypotheticals you kind of have to assume that they have all the symptoms of the medical diagnoses you have been given unless certain symptoms have been specifically laid out for you to address. your nursing interventions are aimed at those symptoms in much the same way that medical interventions by the doctors are often aimed at and treat the symptoms as well. make logical sense?

you will find a lot of information about the specific lung cancers on the website of the national cancer institute (http://www.cancer.gov/). they will have an online booklet you can pull up that describes the diagnosis and treatment of lung cancer. the american cancer society (http://www.cancer.org) will also have care information if you search by topic on their site. try this site for information on addiction: (http://www.addictionca.com/index.htm - narconon (drug addiction and rehab). for smoking cessation see the website of the american lung association as well.