Case #1- SymptomsMs. Smith: Anorexia/Depression/Anxiety Ms. Smith is an 85-year-old woman with end-stage cardiac disease in a home hospice program. She has been very comfortable, not experiencing any other symptoms, and has been quite functional until the last two weeks. Her family contacts the home hospice nurse concerning her lack of appetite, “continual sadness,” and anxiety which they feel is affecting her ability to function. During a routine home visit by the hospice nurse, the patient relates she has no appetite and is quite comfortable just having occasional “snacks” when she pleases. However, her family remains adamant that she requires better nutrition, and they request an IV be inserted. In addition, the family believes Ms. Smith is depressed and “too antsy,” and these contribute to her lack of appetite. Mrs. Smith states that she has had trouble with depression for many years, but has always tried to find “the brighter side” to fight off the sadness. She also acknowledges that she becomes anxious when her children come to visit, as they “don’t want to admit I am dying,” she says. She reports that she does not always sleep well at night, because she is afraid to die and leave her family behind. She says, “I wish I had raised my children better. If I had, there might not be all of this fighting going on about my care. I wish they would leave me alone, so I can die the way I want to.” 

Discussion Questions: 

1. How might the hospice nurse incorporate interdisciplinary care for this patient?
2. What additional assessments would be needed?
3. What interventions might be considered?