Laura Katherine Castano Barragan

Journal 7

Date: 8/4/2020

Professor El Kholy, Amira

I-Human, metastatic bladder cancer, 75%

I started the scenario in I-Human with A. J, 72-year-old male who was admitted for

restlessness and uncontrolled pain. I achieved a score of 75%. The patient was diagnosed with

metastatic bladder cancer stage IV 8 months ago. After trying chemotherapy and not seeing

results, he began receiving hospice care at home. However, since las week, he had been restless,

uncomfortable, and stopped taking anything by mouth. The Pt had a medical history of COPD,

hypertension, pace maker placed 10 years ago, hernia 15 years ago, appendectomy 25 years ago,

heart failure last EF 35%, permanent O2 for 2 years. Wife died recently. He had two sons and a

daughter. He lived with the daughter and husband. Vitals signs in assessment were as follows:

BP: 90/60, HR:120, RR: 22 labored Cheyney-stokes, SpO2: 90%, temp: 100.1. His code status

was DNR and he signed physician orders for life-sustaining treatment (POLST) six months ago.

Patient was still restless, in pain, slightly arousable, with coarse crackles in lungs, tachycardia,

tachypnea, mottling, capillary refill of 4 in fingers and toes, tenting of the skin, chapped lips, and

dry mouth mucosa. Patient was moaning and grimacing during assessment. Pt’s Daughter was

concerned about a loud rattling sound in her father’s throat. He had a PCA. Dose of morphine

was increase twice for unrelieved pain per doctor’s orders, however the pain was still unrelieved.

I recommended that the HCP reevaluate the treatment plan for the patient since there were
changes in respiratory secretions and pattern, plus pain is still unrelieved. Also, pastoral should

come again to talk to the patient and family. Education about terminal secretions and use of

therapeutic communication to talk to family was very important at this moment, taking into

account that they were still grieving the death of their wife/mother and their dad was about to

die. This case scenario reminded me of my grandmothers’ death. She stopped eating and her

respiration were more and more depressed before her death. Also moaning and grimacing were

present just like with this patient. My strength in this scenario was recognizing the need for

better measures to manage pain and the report of new s/s symptoms found in the assessment. I

consider my communication skills are good for this kind of situations when the patient’s

imminent dead was close. I could have deepened more in the interview I had with the daughter.