Mr. Chapman Case Study

Case 3 Part A Mr. Chapman is a forty-six year old man, and he has been receiving home-based hospice care, for the past three weeks. Mr. Chapman is an avid smoker, who has smoked two to three packs of unfiltered cigarettes for thirty years. Currently, he is experiencing wheezing, fatigue, weakness, poor endurance, and frequent coughing spasm. He is consistently losing weight, and he can only swallow clear soup and a few sips of water. To cope with his pain, he takes transdermal fentanyl and an occasional oral morphine. Also, he is on one to two liters of oxygen a day. Recently, Mr. Chapman’s wife asked that he does not smoke because she is worried about starting a fire, and people being hurt; however, Mr. Chapman claims that hospice employees

Multiple problems arise with Mr. Chapman’s request. The hospice care team wants to make him feel comfortable at the end of life, but allowing him to smoke is a safety hazard for both him and the people around him. A fact sheet from the NFPA states safety tips including, “Never smoke in a home where oxygen is used, and when more oxygen is present, any fire that starts will burn hotter and faster than usual” (Ahrens, 2008). Possible interventions are the use of a nicotine patch, medication, or counseling to help cope with Mr. Chapman’s anxiety. Anxiety medication can help him relax and is a safe alternative to smoking. A study about terminally ill patients and their anxiety states, “the management of anxiety consists of counseling and supportive therapy. Benzodiazepines are the drugs of choice” (Fine, 2001). The patient, Mr. Chapman, wishes to smoke cigarettes, at the end of his life, so he is not anxious. Right now, Mr. Chapman has a low quality of life, and needs assistance for most activities; however, smoking in the presence of oxygen causes an immediate hazard. The patient lives on a farm with his wife and two kids. Due to a drought last year, the family is struggling financially, but his wife carries insurance