Mr. C has quite a cardiac history.

His first MI at age 45 is illustrative of how long his health issues have
been affecting his life. This description of Mr. C tells me he is an engineer and has always led an active
life. The fact that his is African American, holds at least a bachelors degree in engineering, and is 75 tells
me he has real determination. Assuming he graduated from college in the mid -1960s, he was among an
elite population of minorities earning advanced degrees in that era. Engineering degrees are a rigorous
course of study as well. This is a very determined man. His comments of having no ambition and feeling
worthless are especially remarkable to me. He has accomplished great things in his life.
The first concern is his dyspnea. The first intervention I would employ would be pharmacologic. I would
think trying a small dose of an opioid might be beneficial in helping Mr. C breath. (Smith 2011) Careful
attention would need to be paid to the potential for respiratory and mood depression. Hopefully a
balance could be found to increase his ease in breathing without robbing him of energy. I would next
look at his depression. I would suggest adding an antidepressant to his plan and include some
psychological support. Psychotherapy is often more productive after depressed clients respond to
antidepressant drug therapy (Timby. p.235). As mentioned previously, Mr. C may be really struggling
with his feelings of feeling useless. My hope would be that some talk therapy would be beneficial for
him. If his cough persists following an assumed successful narcotic intervention; perhaps a cough
suppressant would be in order. Next I would address patent and family teaching. I would need to assess
what Mr. C and his family know about end-stage cardiac disease. I dont feel I could make an education
plan until I determined what their needs were. An essential part of education would be to make sure
they all knew what was to be expected with Mr. Cs diagnosis and prognosis. The teaching would
include direction about and completion of and advance directive. As far as cultural considerations are
concerned, I would first speak with Mr. and Mrs. C about what family involvement they are comfortable
with and what hierarchal structure they are accustomed to. Many text books discuss that many cultures
have differing customs and structures. I would not assume anything about the culture of Mr. and Mrs. C
based on skin color alone. Culturally competent nursing care has been identified as effective,
individualized care that demonstrates respect for dignity, personal rights, preferences, and beliefs of the
person receiving care (Smeltzer. P.127). Based on what the Cs are comfortable with it would be time
to secure hospice or other long-term planning they might select. If the Cs chose hospice for end-of life
care, I would approach the physician and ask how he or she and I could work together to grant the
wishes of the C family. Being a patient advocate is one of the most important roles of a nurse. If the
physician was still reluctant, I would contact a social worker and hospice representative to reach out to
the physician. If he or she were still opposed to serving the desires of the Cs, I would contact the
hospital ethics board. I would not stop until I felt I had done all I could for the Cs.
William
Smith, S., Duell. D.,Martin, B., (2012). Clinical nursing skills. Upper Saddle River, NJ: Pearson
Timby, B., Smith, N., (2009) Essentials of nursing. Philadelphia, PA: Lippincott Williams & Wilkins
Smelter, S., Bare, B., Hinkle, J., Cheever, K. (2008) Textbook of medical-surgical nursing. Philadelphia ,
PA: Lippincott Williams & Wilkins