Ms. J. is 73 years old with severe end stage renal disease. She lives alone. Ms. J. never married but had several long term relationships.

Ms. J. is 73 years old with severe end stage renal disease. She lives alone. Ms. J. never married but had several long term relationships. She has one brother who lives across the country. She retired from her teaching assistant job four years ago because she just became too sick and the dialysis treatments were difficult to schedule around work. Ms. J. has always had “kidney” issues. She was born with one kidney which functioned moderately well most of her life. At one point she considered a transplant but because she is a “woman of faith” she felt that she should live with what she was given. When her kidney started to badly malfunction she did not consider a transplant because she did not think she had the finances to pursue it. So she went with what was available to her, dialysis. She now has limited income and must handle her medical care with care. She has wonderful neighbors who try to help her as much as they can. Ms. J. has become more severely ill over the last two weeks and she is not able to do much for herself now. When they can her neighbors come in and bring her food and one helps her shower. Ms. J. knows that she is soon to pass but would rather stay in her home with her beloved dog until that happens. You are a hospice nurse who was asked by Ms. J.’s doctor to visit her at home and assess her situation. In this Laboratory assignment you will be focusing on the following:

Case management – Develop a plan of action. What issues will need to be considered to manage this case? Focus on what resources she might need now? Consider what other health care personnel will be important resources. How will her medical expenses be paid?

1. End of Life Care – How will you handle her desire to stay at home given her current resources? What legal and ethical issues must be considered? What support systems and care does she need now at end of her life? How will her spiritual needs be met? How can you assist Ms. J. in achieving “quality of life”?

2. Demonstrates case management and end of life care.