Reference no: EM133125512

APN105 Applying nursing practice

Introduction

Palliative care services in hospitals and care facilities has increased by 25.6% between the years 2012 - 2017. In 2017 almost 77,400 patients were receiving palliative care in a healthcare setting. With the current growth and aging population in Australia it is expected that the number of patients requiring palliative care services will continue to grow. (Australian Institute of health and welfare)

Palliative care aims to provide holistic care to the client and their families and loved ones by enhancing the quality of life, maintaining independence, anticipating, preventing and / or managing suffering to any person with a serious or chronic illness. Palliative care is a multidisciplinary team (MDT) approach, including doctors, nurses, allied health, support personnel (for example Chaplin, priest), families, loved ones and the client. The aim of the MDT is to address the physical, intellectual, emotional, social, and spiritual needs of client and their families and loved ones.

Summary
This assessment requires you to respond to a number of questions based on a case scenario and develop a plan of care for a client based on the responses to your questions.
The case scenario presents an older person and their family, dealing with issues that need to be analysed, understood and planned for, using accepted nursing interventions.
Please refer to the Task Instructions for details on how to complete this task.

Task Instructions
To complete the assessment, you must respond to a number of questions, which are based on the case study and to develop a plan of care for the client. These questions must be answered in full. When responding to the questions, please pay attention to the entire question being asked, as well as the prescribed word count, if provided. Use the correct medical terminology when answering all questions.

Case Scenario:
You are an Enrolled Nurse working in a residential facility. Mrs Hong has been a resident at your facility for 10 months. After the initial settling in period, which Mrs Hong found difficult due to her limited English and early dementia, she is now settled and has a good routine that she and her daughter are happy with. Mrs Hong's daughter Yu Yang visits her mother daily and assists with bringing in Asian food for Mrs Hong. At times however, Mrs Hong still finds it challenging to interact with other residents and staff and can become quite upset and distressed, especially if her daughter is late with her food.
5 months ago, it was noted that Mrs Hong had a deformity in her right breast. On examination it was determined that Mrs Hong had stage 3C breast cancer. Mrs Hong and her daughter Yu Yang were provided with information relating to the condition and the options available and have decided to opt for palliative care. Mrs Hong does not want any active treatment and an advanced care directive has been completed with her instructions. In the last 2 days, Mrs Hong has shown signs of deterioration with her condition, is unable to eat or drink and is confined to bed. She remains conscious at present and her daughter Yu Yang is with her for most of the day.

As part of your role, you are working with a Registered nurse to provide care for Mrs Hong considering her choices for palliative care.

Character Briefs reviewed:
Mrs Fei Hong: Mrs Hong is a 70 year old lady of Chinese origin. Mrs Hong's background includes: -
• Comes from one child family Chinese background
• Speaks little English
• Has no extended family
• Came to Australia to help her daughter, Yu Yang raise her son 19 years ago.
• Is beginning to demonstrate signs of dementia
• Interferes in parenting of twins
• Dictates cooking must be Asian
• Has hearing and sight impairment

Mrs Yu Yang McFarlane: Mrs McFarlane is Mrs Hong's daughter. She is 38 years old and married to George McFarlane. She has a son Jason and 3 year old twins.
Mrs McFarlane's background includes: -
• Came to Australian as a University student
• Fell pregnant at the age of 19 - did not marry
• Married George 5 years ago
• Has 3-year old twins at home
• One twin has developmental disorder
• English language is good
• Was/Is isolated with no extended family
• Her issues will be those of isolated immigrant
• Prefers to cook Asian food
• Needed help with raising child and invited Chinese mother to Australia to help out
Mr George McFarlane: Mr McFarlane has been married to Yu Yang for 5 years. He is 53 years old. Mr McFarlane is reliant on Yu Yang to complete all domestic duties as he is not self-sufficient. He is a long haul truck driver and is often away for work. He earns good money.

Part 1: Medium Response Question

Question 1. Describe the term ‘holistic care'
Provide examples of how you would provide holistic palliative care to Mrs Hong and her family in the following 10 aspects

Question 2. What document would outline Mrs Hong's wishes for her care if she was unable to tell you?
What details might this document include?

Question 3.

a) Reflect on your values, beliefs and attitude towards death and dying- - outline your beliefs and values.

b) State how your beliefs and values may affect your provision of care to the client.

Question 4. What is the scope of practice for an Enrolled nurse when caring for a dying client?
(refer to the NMBA Enrolled Nurses standards for practice and Code of Conduct 3.6- End of Life Care, any other code)

Describe how these standards and codes dictate the care ENs provide.

Question 5. Identify physiological changes by body system that you may observe in a client who is dying

Question 6. Provide examples of 3 members of the MDT and explain how each one will provide holistic care to Mrs Hong and her family.
NB- If including nurses please include specialist Nurses - state their
specialty)

Question 7. Identify (when eating or drinking),
a) 3 signs of swallowing difficulty and
b) 3 signs of breathing difficulties.

c) What nursing management strategies could you use in each case?

d) Explain why oral care is important to consider in a client who is unable to eat or drink?

Question 8. Mrs Hong's breast tumour has developed into a malignant wound.

Explain what malignant wound means and describe how would you care for the wound?

Question 9. What signs/ changes may you observe in Mrs Hong that may indicate that she has deteriorated further? Who would you report these changes to?
How would you support Mrs Hong's daughter?

Question 10. What is the most appropriate nursing tool to use and what else can you observe to assess Mrs Hong's pain

Question 11. Mrs Hong is no longer conscious but is demonstrating signs of distress by groaning in pain - you have assessed Mrs Hong and decided to assist in decreasing her distress.

a) What pain relief options would you consider for decreasing Mrs Hong's distress now she cannot take oral medications?

b) Outline 4 methods used to administer pharmaceutical pain relief to Mrs Hong now she is unconscious and no longer able to swallow

Question 12. Discuss and recommend 3 nursing activities which will be required for Mrs Hong now that she is unconscious and no longer able to provide for her own self care needs

Question 13. You assess Mrs Hong and believe she has died. a)What action should you take within your scope of an Enrolled Nurse?
b) What is the legislation for the notification of a death in a healthcare facility in your state?
c) In what circumstances should a death be referred to the coroner?

Question 14. What care activities are undertaken once a person dies?
How would you maintain respect and dignity for a client when preparing their body after death (include one cultural or religious practices)?

Question 15. How does the care requirements change for a patient after death who requires;?
• An autopsy
• Wants to be an organ donor
Please complete the table

Question 16. List three ethical and legal considerations for organ donation?

Question 17. How would you provide support to Mrs Hong's daughter (Mrs McFarlane) after her mother's death?
Outline 3 community services could you refer Mrs McFarlane to to support her in her time of grief and loss?

Question 18. How would you support your own self-care after caring for a long - term client who has died? Provide 3 examples of ways you could take care of your own
wellbeing

Question 19. What services are available in your area which can assist you and your healthcare colleagues to debrief after a death in your workplace? (Provide 2 - 3 examples of general services available and how they can assist with debriefing and supporting healthcare professionals)
Also provide one example of a service in your local area

Attachment:- Applying nursing practice.rar