Assignment task:
A 65-year-old male and his life partner for 33 years have just moved to this area and have yet to establish primary care. The patient's only medical history is asthma, and he takes an albuterol inhaler as needed. The patient was doing well at home until about 2 months ago when he noticed shortness of breath on exertion thought to be related to anxiety and recent inactivity with a 20-pound weight loss (current height 68" and 148lbs). One week ago, the patient fell on the left side due to weakness, and since then, his pain and shortness of breath have continued to increase and are persistent with rest. He went to the ED and was diagnosed with a closed left hip fracture and mediastinal lymphadenopathy with moderate pleural effusions. Lab tests were unremarkable. The patient was admitted for further evaluation. He underwent a biopsy of the mediastinal lymphadenopathy and left hip repair (open hip with internal fixation) but has struggled to work with physical therapy due to pain treated with intravenous morphine and shortness of breath. In addition, he was diagnosed with advanced stages of metastatic non-small cell lung cancer. He was very frightened and angry when he was told about the biopsy results. The patient and his partner wanted to get all possible treatments done. They met with the oncologist to discuss the possible treatment options and were told: "the patient has no treatment options available due to advance stages of the disease." The patient states, "I don't want to die."
1. What symptoms management options can you order for this patient?
2. What would have been the patient's perioperative risk for the hip surgery?
3. What would the appropriate discharge setting be for this patient?
4. How would you approach discussing end-of-life care with the patient and his partner? How would you educate on establishing DPOA-HC?
5. Do you have a code status designation form (POLST, MOLST, DNR, etc.) in Florida State?
6. Are Nurse Practitioners allowed to review these forms and sign these forms?