Reference no: EM133270916
The Patient:
Tyler Morton is a 40-year-old man who spent is childhood and teenage years in Brisbane. Tyler, whilst growing up excelled in all sports and represented QLD in the state Cricket Team. Upon completing high school, Tyler graduated from the University of Queensland with a Bachelor of Business Management before joining the Royal Australian Airforce as a Pilot in 2004. Whilst training to become a Pilot, Tyler met is future wife Catherine in Newcastle and this is where the couple settled to commence their family. Tyler and Catherine have 3 Children. Catherine is a stay at home Mum to:
- Andrea (8 Years)
- Jessica (5 years)
- Erin (2 Years)
Being from Newcastle, Catherine's Family is very close to Tyler and Catherine and spend a lot of time together. Tyler's Family is in Brisbane and has only minimal contact with Tyler and his young Family. Unfortunately, Catherine and Tyler's mother Joyce do not get along and this causes a lot of conflict in the marriage.
Wednesday 24th March (Afternoon)
- Tyler's peg site appears to be less inflamed and redness has subsided a little. Tyler remains warm to touch. RN administered PRN oramorph to assist with Tyler distress and discomfort. Tyler has developed a wheeze. Repositioned to the semi- recumbent position to assist with breathing. Tyler appeared slightly confused, although was orientated place, person, and time. Tyler's mood appears low. He puts a brave face on when his daughters are around, however Catherine is noticing a significant difference in his demeanour.
- Thursday 25th March (Morning)
- Tyler is visited by the Palliative Care Registered Nurse. Catherine is out dropping the children at school. Tyler appears to be extremely short of breath and struggling to breathe. O2 2L via NP was insitu. The RN applied NIV to assist Tyler with his breathing.
- Thursday 25th March (Afternoon)
- When attending to Tyler's personal cares, Tyler made some requests to the RN. He asked for the CPAP machine to be removed, more analgesia for his increased pain and discomfort, he requested for arrangements to be made for a bed in the hospice and requested for his mother and brothers to be contacted. The RN spoke with Catherine regarding contacting Tyler's extended family. Time was spent with Catherine talking about Tyler's condition at present. Tyler was orientated to person, place and time.
- Catherine did not want to share this time with Joyce and Tyler's brothers and therefore she did not contact them
Friday 26th March (Morning) - Sunday 28th March (Morning)
Tyler was visited 3 times per day by the palliative care team. At different times nurses and social workers visited.
Symptom management included:
- Break through intermittent pain relief
- Pressure area care
- Dyspnoea relief - intermittent use of CPAP combined with 02 therapy
- Mouth cares
- Peg feeds continued
- Support and counselling given to Catherine
Sunday 28th March (Afternoon)
When the palliative care nurse visited Tyler, she found him to be restless and agitated. Tyler stated he was in pain, and he just wanted it all to be over. Tyler asked again after his mother and brothers and the chance of being transferred to the hospice. After a thorough assessment, talking to Tyler and Catherine extensively, the nurse implemented the following:
- Subcutaneous butterfly (waiting for the order for continuous analgesia infusion)
- Called the hospice and arranged a bed for the following morning
- Peg feeds discontinued
- Called Joyce to inform her of Tyler's condition
A syringe driver containing morphine, haloperidol and ondansetron was commenced after an order was received from the MO.
A hospice bed was arranged for transfer Monday afternoon.
Joyce and Tyler's brothers were making flight arrangements to be there asap.
Modified Karnofsky Score - 30
RUG-ADL - 17
Tyler is now in the Terminal Palliative Care Phase
Monday 29th March (Morning)
Upon arrival of the palliative care nurse, Tyler appeared still and comfortable. His breathing was short, shallow and laboured with a respiration rate of 5. Catherine was sitting by Tyler's bedside. Tyler's girls were visiting neighbours. Joyce and Tyler's brothers were due to arrive at 1pm.
At 1025 hrs, Tyler's respiration rate decreased further. Upon inspection, Tyler's peripheral extremities were cyanosed. Tyler's pupils were fixed and dilated, and he took is last breath with Catherine by his side in the family home.
Questions:
- Review and critique the care given to the patient against the CPG (Care for dying patient) you have selected and provide evidence to support your critique through additional research that you will undertake
- Highlight the importance of the National Palliative Care Standards and at least one of the NSQHSS and/or the NMBA Standards and how they influence our practice
- Demonstrate knowledge on the illness trajectory of Motor Neurone Disease (MND) in line with Palliative Care Principles