Case Study Discussion – Mrs. Georgia D’Angelo is 76 years old

Case Study Discussion

Topic: Case Study: Mrs. Georgia D’Angelo

Mrs. Georgia D’Angelo is 76 years old. She has been married to her husband Marcus for 58 years. Marcus is 80 years old. The D’Angelos live in a well-kept, middle class home. The D’Angelos have three grown children: two sons and one daughter. All of the children are married and only their daughter lives close to them. The two sons each live more than three and a half hours away. The D’Angelos are very close to their children and talk with the children every day. Four months ago, Mrs. D’Angelo noticed her skin was “yellowish” in color, and upon calling her primary care provider, she was told to go immediately to the emergency room for evaluation. After having a CT scan of the abdomen and laboratory studies, Mrs. D’Angelo was told she had pancreatic cancer and that she should immediately have a Whipple Procedure. This news was devastating to the D’Angelos and their family and friends. Mrs. D’Angelo called a friend who is a nurse and asked who she might go to for a second opinion. A second opinion was obtained and the second opinion reaffirmed the diagnosis of pancreatic cancer; however, the recommendation was to have chemotherapy prior to the Whipple Procedure. Mrs. D’Angelo began the chemotherapy and has suffered severe issues secondary to the chemotherapy and her quality of life is greatly impacted with a huge decrease in her functional status and activities of daily living. As of today, Mrs. D’Angelo has not discussed her fear of dying with you as the primary care provider or with her family. She has an excellent attitude about “fighting this horrible disease.”

Based on this case study, imagine you are the nurse practitioner providing primary care for Mrs. D’Angelo. Please address each of the following:

1. Discuss the advanced practice nurse role facilitating end-of-life care and advance directives for Mrs. D’Angelo.

2. Compare and contrast the types of advance directives and discuss the relevance of advance directives to this case study.

3. Describe how you would approach the topic/issue of advance directives with Mrs. D’Angelo.

4. Identify two ethical principles and two legal challenges related to end of life and palliative care for Mrs. D’Angelo that could be an issue if advance directives are not addressed at this time.

5. Describe communication strategies you will use as the nurse practitioner to effectively engage and collaborate with other members of the interprofessional healthcare team and Mrs. D’Angelo’s family.

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