NewsLine - July 2012 - (Page 22)

continued from previous page The Changing Role of Complementary Therapies in End-of-Life Care By Valerie Hartman, RN, CHPN, CTRN Case Study: Mr. A Mr. A suffered a stroke at age 84. After one year and several strokes later, he found himself on hospice home services. He was weak, had difficulty swallowing, and complained of chronic head pain every day. Mr. A described his pain as a constant ache. With a selfreported pain score of 4/10, he was prescribed Percocet before he signed onto hospice care. On the day of hospice admission, the nurse case manager discussed the impact of pain on his daily living and introduced a few other medication options for consideration. Mr. A was taking one to two Percocet every four to five hours around the clock, and still had incomplete relief of his head pain and was at risk of liver toxicity from Tylenol intake. Mr. A’s case was presented at the interdisciplinary team meeting. In addition to head pain, Mr. A was described by his hired live-in caregivers as “stoic” and his son observed facial grimacing that concerned him. Mr. A would rub the back of his head often, but denied feeling anxious or excessively worried. He was alert and oriented, but forgetful at times. The home was set up for safety with a hospital bed, commode, shower chair and walker, allowing him to be as independent as possible. He had also been given a physical therapy referral. He rested 16 hours a day, sitting in one of two reclining chairs in the living room. One chair was for his wife and the family cat that curled up on her lap every day. He chose the chair closest to the fireplace with the well-tended fire and the fish tank emanating soothing water sounds. The two of them watched their favorite television shows together. Friends would come and read to them. The social worker reported no outstanding concerns. The spiritual care counselor noted that Mr. A was well integrated into a spiritual community. Managing Mr. A’s head pain became the priority discussion at this meeting. The team was in agreement that the ideal plan of care would relieve his pain while preserving his mental clarity, safety, independence and quality relationships for as long as possible. The physician suggested a trial of muscle relaxant versus a change to low-dose short-acting narcotic analgesic, in addition to ongoing physical therapy and a complementary therapy referral for massage. 22 NewsLine

Table of Contents for the Digital Edition of NewsLine - July 2012

Improving Physician Narratives
A Message From Don
NHPCO Resources for Physicians
When Life Gets Serious…Glatfelter Healthcare Practice (display ad)
Simione: Solving Your Hospice Challenges (display ad)
A Study in Green Building
The Steward Center for Palliative Care
The Voice of NCHPP
The Changing Role of CT
My.NHPCO—a Great Resource for Allied Therapists
Physician Guide to Hospice Care (display ad)
Ethical Issues: Tools to Support Your Practice
Results From 2012 NHDD
2013 Circle of Life Award Nominations
New (and Free) Resources From WHV
Exploring PC Support in Our Schools
Hospice in the Media
Member News and Notes
Compliance Tip of the Month
2012 CTC (display ad)
Resource Links to Bookmark
Videos Worth Watching

NewsLine - July 2012