A 78-year-old with end-stage pancreatic cancer is admitted t… | MyMerci
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Basic Care and Comfort

A 78-year-old with end-stage pancreatic cancer is admitted to the medical ward. After reviewing the EHR tabs (History, Vitals, Labs, Notes, Orders), which intervention should the nurse prioritize first?

Chart/Exhibit

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History
Vitals
Labs
Orders
Notes
78-year-old female. Stage IV pancreatic adenocarcinoma diagnosed 9 months ago, declining further chemotherapy. Lives with spouse; daughter is healthcare proxy. Five Wishes / advance directive on file: comfort measures, DNR/DNI, no artificial nutrition or hydration.
BP 102/64, HR 96, RR 22, SpO2 91% on 2 L NC, T 37.1 C, Pain 6/10 in epigastrium, dyspnea at rest.
Hgb 8.6 g/dL, albumin 2.4 g/dL, total bilirubin 4.8 mg/dL, BUN 38 mg/dL — labs consistent with disease trajectory; team has agreed not to retrend.
Morphine 2-4 mg SC q2h PRN pain or dyspnea. Senna 2 tabs PO BID. Polyethylene glycol 17 g PO daily PRN. Reposition q2h for comfort. Mouth care q2h. Family permitted at bedside.
Hospice consult completed; family meeting documented. Goal-of-care: comfort. Patient verbalizes pain control and feeling less short of breath as primary goals. No further imaging or aggressive workup planned per family meeting note.
Explanation
The patient has a documented comfort-focused goal of care, DNR/DNI, and is on hospice consult. The priority is symptom management — scheduled opioid for pain and dyspnea (morphine is first-line for both), bowel regimen to prevent opioid constipation, and gentle repositioning for skin integrity and comfort. Aggressive nutritional support (1, 3) and diagnostic workup (4) contradict the documented comfort plan.
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