Mr. D. is 47 years old and was diagnosed with colon cancer 2 years ago. He had not gone to the doctor until he was in severe pain. Mr. D. does not like doctors or hospitals. When diagnosed he decided

Mr. D. is 47 years old and was diagnosed with colon cancer 2 years ago. He had not gone to the doctor until he was in severe pain. Mr. D. does not like doctors or hospitals. When diagnosed he decided to have surgery even though he did not want it. He did it only because he thought it would ease his pain. He refused the radiation and chemotherapy that his doctor thought was needed after surgery. His wife was very upset because she knew that if he had the follow up treatment his chances of survival would improve. She is a breast cancer survivor of 8 years. Mr. D.'s cancer has now spread to his pancreas and his pain has returned. It is so severe that he is not able to work any longer as a landscaper for the city. He loved his job and misses not having the life he was used to. The doctor believes that chemotherapy might still be of some value to extend his life as Mr. D. refuses further surgery. They have three children with two living at home. One child is 10 years old and the other is 14. The 10 year old has asthma and lately he has been having many more acute attacks. The 14 year old has been acting out and Mrs. D. thinks she is taking drugs. Mrs. D. works only part-time as a secretary and would rather not have to work full-time. Mr. D.'s insurance has been covering the family's medical expenses. You have been asked to case manage this client and his family.In this Laboratory assignment you will be focusing on the following:

1. Case management - Develop an initial assessment as the first step to a case management plan. What issues will need to be considered to manage this case? Focus on what resources he might need now that he is not working. Consider what other health care personnel will be important resources. How will his medical expenses be paid?
2. Transitional Care - What type of transitional care might be needed? Will he need to go back to the hospital? What other healthcare facilities might be helpful?
3. Palliative Care - What approach should be taken to manage his pain? What types of pain management methods might work? In what ways can Mr. D. achieve "quality of life"?
4. Therapeutic Communication - Focus on engagement. What are his concerns and worries?
5. Family Support - What support and resources can you provide this family? What role can the wife play that will be helpful. What resources and care might be provided for the children?

Ms. J. is 73 years old with severe end stage renal disease. She lives alone. Ms. J. never married but had several long term relationships. She has one brother who lives across the country. She retired from her teaching assistant job four years ago because she just became too sick and the dialysis treatments were difficult to schedule around work. Ms. J. has always had "kidney" issues. She was born with one kidney which functioned moderately well most of her life. At one point she considered a transplant but because she is a "woman of faith" she felt that she should live with what she was given. When her kidney started to badly malfunction she did not consider a transplant because she did not think she had the finances to pursue it. So she went with what was available to her, dialysis. She now has limited income and must handle her medical care with care. She has wonderful neighbors who try to help her as much as they can. Ms. J. has become more severely ill over the last two weeks and she is not able to do much for herself now. When they can her neighbors come in and bring her food and one helps her shower. Ms. J. knows that she is soon to pass but would rather stay in her home with her beloved dog until that happens. You are a hospice nurse who was asked by Ms. J.'s doctor to visit her at home and assess her situation.

In this Laboratory assignment you will be focusing on the following:

1.Case management - Develop a plan of action. What issues will need to be considered to manage this case? Focus on what resources she might need now? Consider what other health care personnel will be important resources. How will her medical expenses be paid?

2.End of Life Care - How will you handle her desire to stay at home given her current resources? What legal and ethical issues must be considered? What support systems and care does she need now at end of her life? How will her spiritual needs be met? How can you assist Ms. J. in achieving "quality of life"?