Madeline: Pain and Suffering, Madeline S. is a 66-year-old

Madeline: Pain and Suffering

Madeline S. is a 66-year-old German woman  admitted to a home care agency for care related to end-stage cardiac  disease and renal failure.  She has complained of chronic generalized  chest pain, frequent cramps in her legs, and worsening arthritis pain  related to her immobility.  The home care nurse has been in contact with  Madeline's physician almost daily for the past week and her analgesics  have been steadily increased with little pain relief but an increase in  nausea, constipation and sedation.  The nurse feels frustrated as she  observes Madeline declining rapidly with worsening depression,  withdrawal and weeping.  Madeline's neighbor has noticed that her lights  are left on 24 hours a day and the nurse has noticed that Madeline has  several rosaries and prayer books now at her bedside.  Madeline has  refused referral to hospice but the home care nurse has requested a team  conference with assistance from the local hospice affiliated with the  home care agency.

Discussion Questions:

1. What disciplines should be included in the case conference? 2. What additional assessment might the nurse obtain? 3. How can this patient's pain and suffering best be treated?