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Original Question

John Abbott, being admitted today. John is a 56-year-old male admitted with a hospice diagnosis of end-stage-heart disease. He lives in a rural area of Kentucky with his sister Karen, who has a known history of Opioid addiction. The home environment had minimal resources with evidence of mice droppings. The patient had a low BMI (17) and appeared malnourished. He had a poor appetite. He shared that he liked certain foods that his sister was willing to cook for him, but he wasn’t hungry. He was alert and oriented and rated his pain at 8 after being up in the chair, but it was a 3 after taking his pain medications. He was not on Oxycontin, but was on Duragesic 50 mcg, and Norco 5/325 prn for break through pain. He also had NTG for chest pain and oxygen prn. He was taking a stool softener and he reported regular bowel movements (yesterday). He had a history of chest pain (stage IV) but had no recent episodes. He shared that his other sister, Robin, had stopped by and offered for him to stay with her if he needed another place to go. He shared that he was divorced, and his ex-wife was not able to be his caregiver. He has no children. The patient has a Do Not Resuscitate (DNR) status. You completed the home visit and assessed that the patient’s sister and primary caregiver, Karen, appeared to be under the influence. Karen kept asking when we would be delivering the medications and could we get Oxycontin for him, as that worked best for his pain. You discussed this with the Hospice team, and it was determined that living with Karen was an unsafe environment. John consents to move in with his other sister, Robin. John has started to rapidly decline. He no longer wants to eat or smoke. Robin is upset and feels she is not doing a good job taking care of her brother. She feels overwhelmed and is worried she made a mistake taking this on with two small children. The family can be with John during his final hours and he dies with the team and family at the bedside. The nurse pronounces the patient’s death. The team spends time with the family and offers their support and condolences. John was able to die in a family member’s home, which was his wish. He was able to have his two sisters and nephews with him. The bereavement team is aware of the family dynamics and plans to reach out to both sisters. Question? Identify and predict the challenges for pain management in a home environment with substance abuse. ( maximum 2 pages) with references.

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