Bill is a 67-year-old retired steel worker who has smoked for over 50 years. Although he developed heart disease that required by-pass surgery twice, he continued to smoke. Bill was hospitalized after he became severely short of breath and passed out, which frightened his wife, Helen. Bill was found to be in respiratory failure from COPD with bilateral pneumonia and heart failure. Upon discharge from the hospital, his hospitalist indicated that Bill would need further counseling and support to help understand the nature of his progressive disease and his continued resistance to treatment options including pulmonary rehab, home oxygen, smoking cessation and advanced care plan options. Bill’s wife was very anxious that he may collapse again at home. A ProMedica Care Partners Palliative Services's nurse practitioner was consulted. She began discussion regarding what Bill and Helen understood from the hospitalist regarding Bill’s condition. The NP addressed the nature of Bill’s disease, ways of coping and treatment options available. She also recommended an Alert Bracelet and First Responder Alarm and provided Helen with a referral to a support group. Bill agreed to the use of supplemental oxygen therapy and is now on a combination bronchodilators and inhaled corticosteroids for symptom management of chronic, progressive dyspnea.

Mary is a 58-year-old female who is married and has two children. She was diagnosed five months ago with advanced head and neck cancer. She has been receiving curative treatments including surgical resection, chemotherapy and radiation therapy. Last week her physician informed her that the cancer progressed to her lung. She is at home with her family and up until she was diagnosed, she was assisting with caring for her elderly father who still lives in his own home. In addition, her daughter is due to be married in one month. Over the last few weeks, Mary has experienced the feeling of suffocation which has increased her anxiety level. Her physician prescribed intermittent oral morphine to relieve her sensation of breathlessness, but Mary has been hesitant to use it as she heard it was “addicting.” At this point, Mary’s physician made a referral to ProMedica Care Partners Palliative Services requesting that the NP assist with education and support to Mary and her family regarding misconceptions associated with morphine use. Based upon the NP’s observations with Mary and her family, the plan of care was adjusted to increase psychosocial support to Mary. In addition, the NP prepared the patient and family on treatment strategies, drug choices and therapeutic ranges of doses specific to the needs of this type of cancer and its potential progression.

Rebecca is 80-years-old and has had dementia for seven years. She is in the advanced stage of the disease and has been experiencing frequent silent aspiration with bilateral pneumonia for which she has been re-hospitalized three times in the last five months. She is currently in an assisted living facility that specializes in dementia care. Rebecca was evaluated by speech therapy four months ago at which time a feeding tube was recommended secondary to poor swallowing with risk of repeated aspiration. Her family refused the recommendation for feeding tube placement as well as a referral for hospice services. ProMedica Care Partners Palliative Services's nurse practitioner was contacted for a consult. ProMedica Care Partners Palliative Services is providing education to the family regarding the risks and/or benefits associated with feeding tubes and support with discussion regarding advanced care planning.

Ninety-one-year-old Harold is battling with metastatic prostate cancer. He struggled to communicate about and deal with his disease and pain. While Harold was in the hospital, a ProMedica Care Partners Palliative Services's nurse practitioner was asked to consult. The nurse practitioner took the time to learn to communicate with Harold and answered all of his questions about his disease process and the pain. She reviewed pain control solutions with him and explained what to expect. He has rebounded and this has made a huge impact on him and his family’s well-being.