A nurse is planning care for a client who has terminal cancer and is nearing the end of life. Which of the following interventions should the nurse include?

Rationale:

A. Respite care: Respite care is designed to temporarily relieve caregivers of people with chronic conditions, typically elderly or disabled clients. It is not suitable for a young adult needing home IV therapy unless there is a primary caregiver experiencing burnout, which is not indicated in this scenario.

B. Adult day care: Adult day care services are intended for older adults who need supervision and social interaction during daytime hours. This service is not relevant for a young adult receiving home-based IV therapy, which requires in-home clinical support rather than daytime supervision outside the home.

C. Medicare Part A: Medicare Part A covers hospital stays, skilled nursing, and limited home health services but is generally for individuals over 65 or those with qualifying disabilities. A young adult living in poverty without a qualifying disability would not typically be eligible for this benefit.

D. Medicaid: Medicaid provides comprehensive health coverage for low-income individuals of all ages and is often used to fund home healthcare services, including IV therapy. It is a key resource for ensuring this client receives needed care at home.

E. Food Stamps: The Supplemental Nutrition Assistance Program (SNAP), commonly known as Food Stamps, helps low-income individuals afford adequate nutrition. This support is crucial for clients below the poverty level, especially while recovering and managing ongoing healthcare needs.

Rationale:

• Bloody stools: Bloody stools are not a typical finding in either acute pancreatitis or peritonitis. They are more commonly associated with lower GI pathologies such as diverticulosis, hemorrhoids, or inflammatory bowel disease. Their absence here does not support either condition.
• Hyperbilirubinemia: Hyperbilirubinemia (total bilirubin 3.7 mg/dL) may occur with pancreatitis, especially if there is biliary obstruction due to inflammation or gallstones. Obstructed bile flow leads to accumulation of bilirubin, causing jaundice as seen in this client’s yellow sclera and palate.
• Elevated WBC count: Leukocytosis (WBC 18,000/mm³) is a systemic inflammatory response commonly seen in both acute pancreatitis and peritonitis. In pancreatitis, this reflects the inflammatory process of autodigestion of the pancreas. In peritonitis, it reflects infection and inflammation of the peritoneal cavity.
• Abdominal pain: Severe abdominal and epigastric pain radiating to the back is classic for acute pancreatitis. Peritonitis can also cause diffuse abdominal pain with guarding and rigidity, particularly when the peritoneum becomes inflamed. The pain in peritonitis often worsens with movement, while pancreatitis pain may worsen with eating or lying flat.