HESI CASE STUDY: LOSS, GRIEF,
DEATH
A client who is elderly suffered a stroke a year ago remains weak, has right-sided
paralysis, and dysphagia. Her spouse has been caring for her at home. A home
health nurse visits every other day and the community has been providing one
meal a day. The client's adult child lives several states away.
Stage 1The client was sitting upright while her spouse fed her broth from chicken
noodle soup. She started coughing and spitting out the broth, then becomes
short of breath. The spouse stopped feeding her and patted her back forcefully.
The client was able to catch her breath. Two days later during a scheduled visit,
the spouse informs the home health nurse about the incident The nurse
assessent reveals that client's level of consciousness (LOC) has declined, she
has an oral temperature 102° F (38.9° C) and diminished breath sounds with
crackles in the right lung. The home health nurse reports the assessment
findings to the healthcare provider (HCP). The HCP admits the client to an acute
care facility with the diagnosis of aspiration pneumonia.
Which assessment should the nurse complete immediately after hearing the
client choked while eating?
A. The caregiver's knowledge about feeding a person who is dysphagic.
B. Auscultate the client's lungs for adventitious breath sounds.
C. Assess the client's LOC with the mini-mental status exam.
D. Determine the client's ability to swallow liquids.
B. Auscultate the client's lungs for adventitious breath sounds.
RATIONALE: The client's lungs should be assessed immediately for adventitious breath
sounds since she is at risk for aspiration pneumonia secondary to the choking incident.
The nurse assessment reveals the client's diminished breath sounds with
crackles in the right lung, her level of consciousness (LOC) has declined, and she
has an oral temperature 102° F (38.9° C).
After the client assessment is complete, what does the nurse determine is the
BEST course of action?
A. Report the assessment findings to the health care provider.
B. Elevate the head of the clients bed to 45 degrees and instruct spouse to leave
it elevated.
C. Inform the spouse to give the client acetaminophen.
D. Provide directions on how to properley feed a person with dysphagia to the
spouse.
A. Report the assessment findings to the health care provider.
, Communicating with the health care provider is essential in order to advocate for the
client's well-being.
Legal ConsiderationsThe Healthcare Provider (HCP) orders the client be admitted
to the hospital. They also order a CMP, CBC, swallow evaluation, and saline lock.
During the admission procedure, what is the nurse's responsibility regarding
advance directives?
A. Determine if the client has completed a Living Will and a durable power of
attorney for healthcare (DPAHC).
B. Explain that the Patient Self-Determination Act (PSDA) requires a living will.
C. Instruct client's spouse to have the client sign a Living Will when she is no
longer disoriented.
D. Ask the client's spouse if they would like to make any changes.
A. Determine if the client has completed a Living Will and a durable power of attorney
for healthcare (DPAHC).
The Patient Self-Determination Act (1991) requires healthcare institutions to provide
written information concerning the client's rights to refuse treatment and formulate
advance directives. The nurse should ask the client's spouse if the client has completed
a living will and a durable power of attorney for healthcare (DPAHC).
The client's spouse has a copy of the client's Living Will and durable power of
attorney for health care. The spouse states, "I do not want her to suffer."
The nurse assures the spouse that the physicians and staff will make every effort
to keep the client comfortable. After making sure the client and her spouse are
settled and do not require anything further at this time, what action should the
nurse take?
A. Document that the client is aware of the Patient Self-Determination Act.
B. Place a copy of the Living Will in the medical record and document its
presence.
C. Notify the HCP that the spouse desires euthanasia for the client.
D. Report to the charge nurse the spouse seems to be in denial about the
seriousness of the client's condition.
B. Place a copy of the Living Will in the medical record and document its presence.
The nurse is responsible for placing a copy of the living will in the medical record and
documenting its presence.
Nutritional IssuesThe client is diagnosed with pnuemonia and is prescribed
intravenous antibiotics for treatment. The client's swallow study determined that
she should be on honey thick liquids and pureed foods. The spouse comes to
visit the client and notices the "Swallow Precautions- thickened liquids" sign and
asks the nurse what it means. The nurse explains since the client does not have
adequate swallowing ability thin liquids may go into the trachea and then the
lungs instead of the stomach and cause pneumonia. Suddenly, the spouse gets a
DEATH
A client who is elderly suffered a stroke a year ago remains weak, has right-sided
paralysis, and dysphagia. Her spouse has been caring for her at home. A home
health nurse visits every other day and the community has been providing one
meal a day. The client's adult child lives several states away.
Stage 1The client was sitting upright while her spouse fed her broth from chicken
noodle soup. She started coughing and spitting out the broth, then becomes
short of breath. The spouse stopped feeding her and patted her back forcefully.
The client was able to catch her breath. Two days later during a scheduled visit,
the spouse informs the home health nurse about the incident The nurse
assessent reveals that client's level of consciousness (LOC) has declined, she
has an oral temperature 102° F (38.9° C) and diminished breath sounds with
crackles in the right lung. The home health nurse reports the assessment
findings to the healthcare provider (HCP). The HCP admits the client to an acute
care facility with the diagnosis of aspiration pneumonia.
Which assessment should the nurse complete immediately after hearing the
client choked while eating?
A. The caregiver's knowledge about feeding a person who is dysphagic.
B. Auscultate the client's lungs for adventitious breath sounds.
C. Assess the client's LOC with the mini-mental status exam.
D. Determine the client's ability to swallow liquids.
B. Auscultate the client's lungs for adventitious breath sounds.
RATIONALE: The client's lungs should be assessed immediately for adventitious breath
sounds since she is at risk for aspiration pneumonia secondary to the choking incident.
The nurse assessment reveals the client's diminished breath sounds with
crackles in the right lung, her level of consciousness (LOC) has declined, and she
has an oral temperature 102° F (38.9° C).
After the client assessment is complete, what does the nurse determine is the
BEST course of action?
A. Report the assessment findings to the health care provider.
B. Elevate the head of the clients bed to 45 degrees and instruct spouse to leave
it elevated.
C. Inform the spouse to give the client acetaminophen.
D. Provide directions on how to properley feed a person with dysphagia to the
spouse.
A. Report the assessment findings to the health care provider.
, Communicating with the health care provider is essential in order to advocate for the
client's well-being.
Legal ConsiderationsThe Healthcare Provider (HCP) orders the client be admitted
to the hospital. They also order a CMP, CBC, swallow evaluation, and saline lock.
During the admission procedure, what is the nurse's responsibility regarding
advance directives?
A. Determine if the client has completed a Living Will and a durable power of
attorney for healthcare (DPAHC).
B. Explain that the Patient Self-Determination Act (PSDA) requires a living will.
C. Instruct client's spouse to have the client sign a Living Will when she is no
longer disoriented.
D. Ask the client's spouse if they would like to make any changes.
A. Determine if the client has completed a Living Will and a durable power of attorney
for healthcare (DPAHC).
The Patient Self-Determination Act (1991) requires healthcare institutions to provide
written information concerning the client's rights to refuse treatment and formulate
advance directives. The nurse should ask the client's spouse if the client has completed
a living will and a durable power of attorney for healthcare (DPAHC).
The client's spouse has a copy of the client's Living Will and durable power of
attorney for health care. The spouse states, "I do not want her to suffer."
The nurse assures the spouse that the physicians and staff will make every effort
to keep the client comfortable. After making sure the client and her spouse are
settled and do not require anything further at this time, what action should the
nurse take?
A. Document that the client is aware of the Patient Self-Determination Act.
B. Place a copy of the Living Will in the medical record and document its
presence.
C. Notify the HCP that the spouse desires euthanasia for the client.
D. Report to the charge nurse the spouse seems to be in denial about the
seriousness of the client's condition.
B. Place a copy of the Living Will in the medical record and document its presence.
The nurse is responsible for placing a copy of the living will in the medical record and
documenting its presence.
Nutritional IssuesThe client is diagnosed with pnuemonia and is prescribed
intravenous antibiotics for treatment. The client's swallow study determined that
she should be on honey thick liquids and pureed foods. The spouse comes to
visit the client and notices the "Swallow Precautions- thickened liquids" sign and
asks the nurse what it means. The nurse explains since the client does not have
adequate swallowing ability thin liquids may go into the trachea and then the
lungs instead of the stomach and cause pneumonia. Suddenly, the spouse gets a
