Ms. Smith: Anorexia/Depression/Anxiety Ms. Smith is an 85-year-old woman with end-stage cardiac disease in a ?home hospice program. She has been very comfortable, not experiencing ?an

Ms. Smith: Anorexia/Depression/Anxiety

Ms. Smith is an 85-year-old woman with end-stage cardiac disease in a  home hospice program. She has been very comfortable, not experiencing  any other symptoms, and has been quite functional until the last two  weeks. Her family contacts the home hospice nurse concerning her lack of  appetite, “continual sadness,” and anxiety which they feel is affecting  her ability to function.

During a routine home visit by the hospice nurse, the patient relates  she has no appetite and is quite comfortable just having occasional  “snacks” when she pleases. However, her family remains adamant that she  requires better nutrition, and they request an IV be inserted. In  addition, the family believes Ms. Smith is depressed and “too antsy,”  and these contribute to her lack of appetite. Mrs. Smith states that she  has had trouble with depression for many years, but has always tried to  find “the brighter side” to fight off the sadness. She also  acknowledges that she becomes anxious when her children come to visit,  as they “don’t want to admit I am dying,” she says. She reports that she  does not always sleep well at night, because she is afraid to die and  leave her family behind. She says, “I wish I had raised my children  better. If I had, there might not be all of this fighting going on about  my care. I wish they would leave me alone, so I can die the way I want  to.”

Discussion Questions:

1. How might the hospice nurse incorporate interdisciplinary care for this patient?
2. What additional assessments would be needed?
3. What interventions might be considered?