An unresponsive client with terminal heart failure resides in a long-term care facility under a comfort-measures-only plan. The client begins exhibiting alternating periods of deep, rapid breathing and brief apnea. The client's distressed spouse intercepts the licensed practical nurse in the hallway, stating, 'My husband can't catch his breath! You have to call 911 and get him on a ventilator immediately!' Which is the priority therapeutic response by the nurse?
- "It must be very frightening to see him breathe this way. These breathing changes are an expected part of the body's natural dying process."Answer
- B"I understand your concern, but his advanced directives legally prevent us from initiating intubation or calling 911."
- C"It is normal for you to be in the denial stage right now, but we must accept that his body is shutting down."
- D"Let me quickly check his oxygen saturation and apply a high-flow oxygen mask to help him breathe easier."
Answer
The nurse should validate the spouse's feelings by stating that it must be frightening to witness, and then explain that these breathing changes are an expected part of the natural dying process.
The correct response utilizes the therapeutic techniques of validation and information giving. It addresses the spouse's immediate emotional distress by acknowledging how frightening the situation is, while simultaneously providing essential education that Cheyne-Stokes respirations (deep breathing followed by periods of apnea) are a normal, expected part of the dying process. This helps de-escalate the panic without resorting to non-therapeutic communication blocks or inappropriate medical interventions.
Step-by-Step Solution
Key Concept
Therapeutic Communication and Symptom Management at End of Life