B67865 Apply Palliative Approaches in Nursing Practice

He has clearly instruction stating that no resuscitation will be there if he collapse and he is here only for comfort care. Please have a look of attached instructions for other information.

Ramesh seems fatigued, tired and sick. Assistance with ADLs is much needed. He is on planned analgesics. Plan of Pain management is stated under:

1. Oxycodone 1mg/ hour running in the syringe driver.
2. PRN morphine 1mg 4/24. Last given was at 6am.
3. Panadol Osteo 600mg TDS.
4. Fentanyl patch 200 mcg/ 24 hrs.

To look after Ramesh you are the EN allocated this shift. In this shift a first year nursing student whose name is Caroline is allocated to work with you. Caroline already said that she is been here in the medical ward for weeks. Under the supervision of nursing staff only she is the one who helped Mr. Ramesh with his ADLs. Today, to look after Ramesh again she is been requested. The night nurse says during handover that Ramesh looks very weak, scowl with pain during pressure are care, he didn't have a dinner last night and for 4 days he hasn't opened his bowels .

In analysing you analysed that Ramesh has severe pain to left upper quadrant, when palpated he frowned with pain. Ramesh said that he was not hungry and didn't eat breakfast. He was tired and drained. His vitals at 8:00 AM are stated under:

• HR: 118/min
• BP: 95/55 mmHg
• Temp 36.6'C
• RR: 26/min
• SaO2: 90%

His spouse looks very troubled and established that her husband is constipated and it itches her to do something about his bowels.

You observed that Ramesh's condition has started to worsen around 12:00, he has become less receptive, only vocalizing, making abnormal noises while trying to breathing, moving all his appendages and he begun salivating, started hiccough and burping, he also started losing his consciousness. He started choking when his spouse tried to give him some sips of water.

After performing complete set of vital signs on him and the data is as follows:

• HR: 60/min
• BP: 85/45 mmHg
• RR: 10/min
• SaO2: 88%

While performing the assessment Ramesh had an episode of intemperance of excrement and urine both while outside the room his family was waiting for you.

At 12:45 the doctor who examined Ramesh rapidly called a code, as a consequence Ramesh was transferred to the ICU and was put on the ventilator supported by isotropic drugs. Meanwhile a Palliative care Nurse Consultant (PNC) attended Ramesh, nurse requested you to help her while she examines Ramesh. His wife burst into tears and started crying uncontrollably while witnessing all that was happening. Ramesh's daughter came to you and said “I know dad is deteriorating. In our culture we do special prayers during the end of lifetime. Can you please let us do that to my dad?”. She adds “Do you think he is suffering? Can you please make sure that he is not suffering? He is such a lovely person, and I don't want him to suffer” and started bawling her eyes out. Caroline the nurse student who was with you the entire shift also started sobbing. You relieved and advised her to go to staff room with one of your co-worker.

According to the scenario, you are required to answer the following question.

• How will you evaluate this pain and the current Pain management plan of Ramesh?

B. In order to reduce the pain for Ramesh state any two strategies.

C. In a case Ramesh has the  codeine induced constipation. Explain how you will address the medication which is evoked constipation in discussion with RN?

• Find out the requirement of the patients and explicit how they can be treated by you as a EN.

• Determine your character in this scene and state why it is crucial to work in this character and duty of inter-disciplinary team while planning for palliative care?

• Explicate the psychosocial effect of palliative care on Ramesh's spouse & family.

• How you will tackle the situation as an EN, when the daughter of Ramesh comes to you for discussing about the cultural and spiritual issues along with the needs of Ramesh.

• In order to provide a supportive environment to Ramesh and his family  and care during this crucial time in their life, identify any two  effective communication strategies and two support services that you could approach.

• Determine the clue of phase of death in this scenario. State the value of communion the accurate message to family.

• Depict the physiology of demise. Is it essential to inform the aforesaid to Ramesh's family unit or carer?
• Determine the gestural of respiratory suffering and swallowing trouble in this scenario. What management plan of action you will utilize in accordance with Ramesh's ACD?

• Note how will you negotiate the cancerous injury of Ramesh in accord with non-healing injury administration scheme?

• What are the mark of impairment reported to ACP or ACD programme? When & to whom should this clue be reportable?

• How you will assist the pride of an individual while furnishing care in their last period of time as well subsequently death?

• Denote and indicate the ethical issues in this scenario. Name the suitable individual to discuss some issue accordant to organisational policy?

• State the legal duty of the registered nurse when a patient expires who was under their precaution?

• Explicate the path concerned in care of death body in this scenario.  You are required to  consider standard precautions, respect, dignity and cultural, religious, spiritual, and individual customs in order to answer this question.

• Define bereavement/ mourning care. Cover the supportive needs of the family in accordance with this scenario. state  the availability of resources for ones who call for bereavement care?

• which kind of emotional support  you will cater to Ramesh's family in abstraction to grief, loss, and bereavement?

• Being  an EN, place your own necessity for self-care & support. Inform how will  you execute impelling plan of action in order to prolong your social and emotional well-being.

• Determine 2 philosophy  of Advanced care planning & advance care directives. Explicate how this implications can be stated.

• Explain the process of encouraging Carolyn in this scenario?  State  the value of professional debriefings at the workplace.

THE COMMUNITY NURSING 

B67865 Apply Palliative Approaches in Nursing Practice