Which of the following is the most important consideration in end-of-life care for a patient diagnosed with Huntington's Disease?

Administering aggressive medical interventions to prolong life.

Encouraging the patient to engage in physical therapy and exercise.

Providing comfort care and managing symptoms according to patient's wishes.

Providing respite care and support for the patient's family.

Answer and Explanation

The Correct Answer is C

A. Administering aggressive medical interventions to prolong life: In the end stages of Huntington's Disease, aggressive medical interventions are generally not the priority. Huntington's is a progressive neurodegenerative disease, and prolonging life without regard to the patient's quality of life is usually not the focus. The emphasis in end-of-life care is on comfort and symptom management rather than aggressive treatments.

B. Encouraging the patient to engage in physical therapy and exercise: While physical therapy can be important earlier in the disease progression to help maintain function and mobility, in the end stages of Huntington's Disease, the patient's focus is more on comfort care. At this point, physical therapy may not be practical or helpful in improving quality of life, so it is not the primary consideration.

C. Providing comfort care and managing symptoms according to patient's wishes: This is correct. The most important consideration in end-of-life care for a patient with Huntington's Disease is to focus on comfort and symptom management. This includes addressing pain, managing emotional and psychological symptoms, and ensuring that care aligns with the patient's wishes, values, and goals. End-of-life care should prioritize maintaining dignity and ensuring the patient's comfort.

D. Providing respite care and support for the patient's family: While providing respite care and family support are very important aspects of caregiving, the most important consideration is the patient's comfort and managing symptoms in alignment with their wishes. Respite care for the family is important but is not the central focus of end-of-life care for the patient.

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Correct Answer is B

Explanation

A. Insertion of a tracheostomy to maintain the airway: This is not the first step in the management of hypercapnic respiratory failure. A tracheostomy is usually considered in cases where prolonged mechanical ventilation is required or for patients who need long-term airway support. It would not be immediately prescribed in this situation.

B. Use of noninvasive positive pressure ventilation (BIPAP): The client is showing signs of hypercapnic respiratory failure, indicated by lethargy, slow response to commands, and low oxygen saturation (pulse ox 84%) despite receiving oxygen via a Venturi mask. BIPAP (Bilevel Positive Airway Pressure) is a form of noninvasive ventilation that can help improve both oxygenation and ventilation by providing positive pressure to help the client breathe more effectively. It is often used in cases of hypercapnic respiratory failure, especially when the patient is alert enough to tolerate the mask.

C. Endotracheal intubation with mechanical ventilation: While this may be necessary if noninvasive ventilation (like BIPAP) is not effective, endotracheal intubation is typically considered when the patient is unable to tolerate noninvasive ventilation or if their respiratory failure worsens significantly. Given that the patient is still responsive (though lethargic), BIPAP would likely be tried first.

D. Administration of 50% Venturi mask: Increasing the oxygen concentration is unlikely to resolve the underlying issue of hypercapnia (elevated CO2 levels) in this patient. Hypercapnic respiratory failure is primarily due to inadequate ventilation, not just oxygen deficiency. Therefore, a higher concentration of oxygen may not be sufficient and would not address the need for improved ventilation.

A. Teach the importance of hot showers to help relax. B. Have the patient prioritize activities early in the day. C. Schedule activities late in day and in the evening. D. Provide supplemental oxygen when fatigued.

Correct Answer is B

Explanation

A. Teach the importance of hot showers to help relax: While hot showers may help some people relax, they can also increase fatigue or exacerbate symptoms in conditions like MS or MG. Heat intolerance is a common symptom of MS, and in MG, fatigue can be worsened by hot environments. Therefore, hot showers may not be advisable for these patients.

B. Have the patient prioritize activities early in the day: Fatigue is a hallmark symptom in both Multiple Sclerosis (MS) and Myasthenia Gravis (MG), and patients often experience more energy in the morning. For this reason, it's crucial to schedule the most important and energy-demanding activities early in the day when the patient has more strength and stamina. This helps conserve energy throughout the day and manage fatigue more effectively.

C. Schedule activities late in day and in the evening: Fatigue typically worsens as the day goes on for patients with MS or MG, so scheduling activities later in the day when the patient’s energy levels are lower can worsen the fatigue and make it harder to complete tasks.

D. Provide supplemental oxygen when fatigued: Providing supplemental oxygen is generally reserved for patients who are experiencing hypoxemia or respiratory distress. Fatigue in MS or MG is usually not related to oxygen deficiency, so supplemental oxygen is not an appropriate intervention for general fatigue in these conditions.

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Which of the following is the most important consideration in end-of-life care for a patient diagnosed with Huntington's Disease?

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Correct Answer is B

Explanation

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