Jack Storis Room
Jack Storis - Community Health Swift River
Jack Storis Room
Jack Storis, 39-year-old male with diagnosed glioblastoma mulitforme (GBM).
Jack underwent a craniotomy a year ago for removal of glioblastoma and
subsequent fractional radiation therapy and chemotherapy. Jack’s prescribed
level of care is routine, intermittent home hospice care. Jack’s neurologic
function has rapidly declined over the past 4-6 weeks. He is experiencing
generalized muscle weakness with left unilateral loss of function, extreme
lethargy, frequent seizures, and has had a notable decline in his mental
function. Jack has been taking medications for depression and anxiety since
his diagnosis a year ago. Jack is 6 foot 3 inches tall and currently weighs 195.
He has had a 30-pound weight loss over the past few months. Medications:
Levetiracetam 500 mg orally twice a day Decadron 4 mg orally twice a day
Lorazepam 4 mg orally twice a day Amitriptyline 100 mg orally once daily.
Surgical history: Significant for craniotomy 1 year ago for removal of the
GBM. Social history: Jack lives at home with his wife and 5-year-old son. His
mother spends a significant amount of time at the house assisting with his
care. He is currently unemployed. Jack previously worked in road
construction has been unable work for the last 3 months due seizures and
decrease in his neurologic function. The family has a hospital bed set up in
their living room. The family is interested in obtaining other equipment for
the home and additional assistance in his care. Jack has met the eligibility
criteria for home hospice care.
You responded correctly to 4 out of 10 evaluations:
Your
Category response Explanation
Community Assessment Increased The client is receiving care at home and does not need additional
acuity community resources.
Culture/Beliefs/Spirituali Increased There is no mention of needs in this area, although hospice clients may
, Jack Storis Room
Your
Category response Explanation
ty acuity seek out spiritual resources.
Disease/Illness Increased Because Jack is terminal, and is receiving routine, intermittent home
Prevention acuity hospice care for glioblastoma multiforme (GBM), his care will focus on
comfort measures versus reducing the development of other chronic
diseases.
Education/Counseling Normal The client and caregivers will have an increased need for education and
acuity counseling on hospice care, comfort care medications, dietary
requirements, safety, and symptom management.
Resource Identification Increased Jack and his family have an increased need with resource identification
acuity to assist with his care, supplies, and equipment.
Social Determinants of Normal The client will be receiving care in his home.
Health acuity
Surveillance Increased The client does not require care that includes public health
acuity surveillance.
Health Promotion Normal The client is receiving routine, intermittent home hospice care for
acuity glioblastoma multiforme (GBM). It is not an expectation that he will
increase control over or improve his health status.
Risk Reduction Normal The client has increased need for risk reduction. Jack is at risk for
acuity pressure ulcers and is at fall risk due to unilateral loss of function,
generalized weakness, and decline in his mental status.
Self-management Increased The client has increased need for physical and emotional symptom and
acuity dietary management. As the client’s status changes, the family will
assume management of care and will require support.
Jack Storis Scenario 1
The hospice nurse visits Jack, his wife, and Jack’s mother. Jack, with his
family’s support, has declined disease-directed therapy and is requesting
only comfort care measures. Comfort care measures include medication by
any route, positioning, wound care and other measures to relieve pain and
suffering, and oxygen, suction and manual treatment of airway obstruction
as needed for comfort. Over the past month, Jack has had a decrease in his
physiologic function as demonstrated by a decrease in the Palliative
Performance Scale (PPSv2). Jack is now bed-bound and requiring total
assistance with self-care, has reduced oral intake, and has episodic
confusion. The nurse reviews the following comfort care medications with the
family. The comfort care medications include: • Acetaminophen 650 mg
suppository rectally every six hours as needed for mild pain or fever, •
Hyoscyamine 0.125 mg sublingual tablets every four hours as needed for
secretions, • Lorazepam 0.5 mg tablet 1 tablet orally every four hours as
needed for anxiety, • Morphine Sulfate 20 mg/ml (100 mg/5 ml) 0.25ml (5
mg) orally every two hours as needed for dyspnea or pain, •
Prochlorperazine 10 mg tablet orally as needed for nausea and vomiting, •
Senna-docusate sodium 1 tablet orally daily as needed for constipation, •
Bisacodyl 10 mg suppository rectally daily as needed for constipation. What
items and/or services would be appropriate for Jack’s hospice plan of care?
Jack Storis - Community Health Swift River
Jack Storis Room
Jack Storis, 39-year-old male with diagnosed glioblastoma mulitforme (GBM).
Jack underwent a craniotomy a year ago for removal of glioblastoma and
subsequent fractional radiation therapy and chemotherapy. Jack’s prescribed
level of care is routine, intermittent home hospice care. Jack’s neurologic
function has rapidly declined over the past 4-6 weeks. He is experiencing
generalized muscle weakness with left unilateral loss of function, extreme
lethargy, frequent seizures, and has had a notable decline in his mental
function. Jack has been taking medications for depression and anxiety since
his diagnosis a year ago. Jack is 6 foot 3 inches tall and currently weighs 195.
He has had a 30-pound weight loss over the past few months. Medications:
Levetiracetam 500 mg orally twice a day Decadron 4 mg orally twice a day
Lorazepam 4 mg orally twice a day Amitriptyline 100 mg orally once daily.
Surgical history: Significant for craniotomy 1 year ago for removal of the
GBM. Social history: Jack lives at home with his wife and 5-year-old son. His
mother spends a significant amount of time at the house assisting with his
care. He is currently unemployed. Jack previously worked in road
construction has been unable work for the last 3 months due seizures and
decrease in his neurologic function. The family has a hospital bed set up in
their living room. The family is interested in obtaining other equipment for
the home and additional assistance in his care. Jack has met the eligibility
criteria for home hospice care.
You responded correctly to 4 out of 10 evaluations:
Your
Category response Explanation
Community Assessment Increased The client is receiving care at home and does not need additional
acuity community resources.
Culture/Beliefs/Spirituali Increased There is no mention of needs in this area, although hospice clients may
, Jack Storis Room
Your
Category response Explanation
ty acuity seek out spiritual resources.
Disease/Illness Increased Because Jack is terminal, and is receiving routine, intermittent home
Prevention acuity hospice care for glioblastoma multiforme (GBM), his care will focus on
comfort measures versus reducing the development of other chronic
diseases.
Education/Counseling Normal The client and caregivers will have an increased need for education and
acuity counseling on hospice care, comfort care medications, dietary
requirements, safety, and symptom management.
Resource Identification Increased Jack and his family have an increased need with resource identification
acuity to assist with his care, supplies, and equipment.
Social Determinants of Normal The client will be receiving care in his home.
Health acuity
Surveillance Increased The client does not require care that includes public health
acuity surveillance.
Health Promotion Normal The client is receiving routine, intermittent home hospice care for
acuity glioblastoma multiforme (GBM). It is not an expectation that he will
increase control over or improve his health status.
Risk Reduction Normal The client has increased need for risk reduction. Jack is at risk for
acuity pressure ulcers and is at fall risk due to unilateral loss of function,
generalized weakness, and decline in his mental status.
Self-management Increased The client has increased need for physical and emotional symptom and
acuity dietary management. As the client’s status changes, the family will
assume management of care and will require support.
Jack Storis Scenario 1
The hospice nurse visits Jack, his wife, and Jack’s mother. Jack, with his
family’s support, has declined disease-directed therapy and is requesting
only comfort care measures. Comfort care measures include medication by
any route, positioning, wound care and other measures to relieve pain and
suffering, and oxygen, suction and manual treatment of airway obstruction
as needed for comfort. Over the past month, Jack has had a decrease in his
physiologic function as demonstrated by a decrease in the Palliative
Performance Scale (PPSv2). Jack is now bed-bound and requiring total
assistance with self-care, has reduced oral intake, and has episodic
confusion. The nurse reviews the following comfort care medications with the
family. The comfort care medications include: • Acetaminophen 650 mg
suppository rectally every six hours as needed for mild pain or fever, •
Hyoscyamine 0.125 mg sublingual tablets every four hours as needed for
secretions, • Lorazepam 0.5 mg tablet 1 tablet orally every four hours as
needed for anxiety, • Morphine Sulfate 20 mg/ml (100 mg/5 ml) 0.25ml (5
mg) orally every two hours as needed for dyspnea or pain, •
Prochlorperazine 10 mg tablet orally as needed for nausea and vomiting, •
Senna-docusate sodium 1 tablet orally daily as needed for constipation, •
Bisacodyl 10 mg suppository rectally daily as needed for constipation. What
items and/or services would be appropriate for Jack’s hospice plan of care?
