National Palliative Care Standards – Nursing Assignment Help

National Palliative Care Standards – Nursing Assignment Help
Assignment Task

Assessment Task Details 


Students are to provide a critique of the provided case study using only ONE CPG.  


To complete this task, you will need to discuss and critique relevant elements of the CPG and case study whilst upholding the National Palliative Care Standards at least one of:


• NSQHS


• NMBA standards and/or

Purpose


Students are required to demonstrate an understanding of how theory translates into practical nursing care and how evidence underpins best practice. Each student will review and critique the care given in the Case Study provided according to their choice of ONLY ONE of the provided Clinical Practice Guidelines (CPG’s) best suited to the highlighted discussion.

Where will I find the CPG’s that you want me to use?


You are provided with CPG’s for this task, in this booklet .You need to choose one of these only to demonstrate the area of care that you are providing a critique of.  You are not expected to look for other CPG’s to support your work, however evidence based practice of peer reviewed journal publications are expected to further reinforce the critique.

Assessment criteria: The assessment will be marked using the criteria-based rubric. Please note that in-text citations are included in the word count whilst the reference list is not included in the word count. Words that are more than 10% over the word count will not be considered

Booklet


Aetiology of Motor Neurone Disease


Motor neuron disease (MND) is a progressive neurological disorder characterised by loss of motor neurons (Brown, Edwards, Buckley & Aitken, 2017). There are 4 main types of MND, depending of the level of motor neurone involvement and where symptoms begin. These include:


·         Amyotrophic lateral sclerosis (ALS)


·         Progressive bulbar palsy (PBP)


·         Progressive muscular atrophy (PMA)


·         Primary lateral sclerosis (PLS)


MND usually leads to death 20-48 months after symptoms begin, however 5%- 10% of patients may survive for more than 10 years (MND New Zealand, 2018). The onset of MND is usually between 40 and 70 years of age and is more common in men than women by a ratio of 2:1 (MND Australia, 2018). The prevalence is approximately 8.7 in 100 000 in Australia (MND Australia, 2018).

Motor neurons in the brainstem and the spinal cord gradually degenerate. Dead motor neurons cannot produce or transport signals to muscles. Consequently, electrical and chemical messages originating in the brain do not reach the muscles to activate them. The typical symptoms for diagnosis of MND are limb weakness, dysarthria and dysphagia (Brown et al., 2017). Muscle wasting and fasciculations results from the denervation of the muscles and lack of stimulation and use. Other symptoms include pain, sleep disorders, spasticity, drooling, emotional liability, depression, constipation and oesophageal reflux (Brown et al., 2017). Death usually results from respiratory tract infection secondary to comprised respiratory function.

Throughout the illness trajectory for MND, the patient remains cognitively intact while physically declining. The patient should be encouraged to partake in moderate intensity, endurance type exercise for the truck and limbs as this may help reduce MND spasticity.


Nursing interventions include but are not limited to (Brown et al., 2017): 


·         Facilitating communication


·         Reducing risk of aspiration


·         Facilitating early identification of respiratory insufficiency


·         Decreasing pain secondary to muscle weakness


·         Decreasing risk of injury related to falls 


·         Providing diversional activities such as reading and companionship


Consider the Patient Situation


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(Levett-Jones, 2018)


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.


18 months ago


Tyler experienced some weakness in his left hand. His grip strength was not a strong as his right hand and he found he would be dropping anything that he picked up. Tyler also noted he was getting short of breath without exertion. Considering his general fitness is quite good, this was highly abnormal. Tyler made an appointment with the GP on the Airforce base to discuss this concern.


After multiple MRI’s and blood tests and lumbar punctures (over a 3-month period), Tyler was diagnosed with Amyotrophic lateral sclerosis (ALS). At the time of diagnosis, Tyler’s weakness in his left hand had progressed to his right hand and he had developed a foot drop in his left ankle.


Upon diagnosis, Catherine was adamant that the children were not going to be told the reason that Dad is no longer working. Tyler’s diagnosis also caused more stress and tension with the relationship between Catherine and Joyce. Joyce wanted to visit and be there with her son, however Catherine was not supportive of Joyce and Tyler’s brothers visiting.


12 months ago


Around 6 months after initial symptoms and 3 months after diagnosis, Tyler’s condition had deteriorated. Tyler now required a walking frame to mobilise. His dyspnoea has increased, he was suffering from headaches and was generally fatigued. Tyler was being assessed by a respiratory specialist for the requirement of Non-invasive ventilation (NIV) especially at night. Tyler now suffers from dysphagia and was being assessed in consultation with the respiratory specialist and dietician for the need for a gastrostomy.


6 months ago


Tyler’s condition has continued to deteriorate. Due to insufficient nutritional intake secondary to dysphagia, Tyler had a gastrostomy inserted. Since insertion, he has had numerous infections at the insertion site. Tyler also requires assistance of NIV mainly at night, however the demand has increased significantly over the last couple of weeks. Tyler’s mobility is limited. He walks intermittently with the use of an aid and one person. His mobility is limited due to progressive foot drop and increased dyspnoea. With his condition worsening, Tyler initiated the difficult conversation with Catherine about his mortality. Catherine is still not accepting of Tyler’s condition nor is she wanting the Children to know the extent of Tyler’s condition. Tyler completed an Advanced Health Care Directive and he ensured both Catherine and his mother Joyce had a copy. Tyler is currently visited weekly by the Community Palliative Care Team and he has daily support from Community nurse to assist with his activities of daily living.


Despite Tyler’s progressive physical deterioration and the ongoing tensions with Catherine’s inability to accept his condition, Tyler values the time he gets to spend with his 3 girls. Watching them play together and their interactions are invaluable to Tyler. Tyler has insisted that his mother and brothers are able to visit monthly. When his family visit, Catherine generally takes the girls and leaves Tyler at home. Although this an ideal situation, Tyler has come to accept the conflict between Catherine and Joyce. Tyler is also still in contact with his colleagues from the Airforce who visit him frequently.


Collect Cues and Information


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(Levett-Jones 2018)


 


Past Medical Hx


# R) Wrist as a child


Asthma


Current History


Weakness in left and right hands


Increase in dysponea on exertion and at rest


Restlessness/ sleeplessness nocte


Headaches


Dysphagia


Low mood


Constipation


Foot drop left foot


Increase demand for NIV


02 Therapy


Peg Feeds


Intermittent infections Peg site


Gathering new Information 


Thursday 19th March


Tyler’s vital signs when visited by the Palliative Care Nurse:


0900 hrs


RR: 24


HR: 60


BP: 120/70


SaO2: 92% on 2Lmin NP


GCS: 14/15


Temp: 38.2 degrees


1300 hrs


RR: 24


HR: 70


BP: 120/70


SaO2: 92% on 2Lmin NP


GCS: 14/15


Temp: 38.6 degrees


1900 hrs


RR: 26


HR: 88


BP: 120/70


SaO2: 92% on 2Lmin NP


GCS: 14/15


Temp: 39.2 degrees

Patient Notes from Community Nurses over 24-hour Period:


“Patient’s mobility has decreased. He is now spending more time in bed secondary to weakness in arms and legs. Increased requirement of care from 1 person to 2 people to transfer patient. Patient appears more SOB. O2 therapy and NIV continues. Peg feeds continuing as per regimen. Patient’s mood appears low. Friends in attendance during visit. Patient communicating in short bursts.” 


“Patient RIB during visit. Patient’s position altered. Patient sleeping for most of nursing visit. Patient appears more fatigued. Extra analgesia administered as per patients request. Peg feeds continue as per regimen. Wife and youngest child in attendance during visit. Patient appears warm to touch. Fan applied to assist with climate control.”


“Patient appears very drowsy throughout visit. Patient appears flushed in the face and remains warm to touch. Peg feed disconnected as per regimen. Peg site appears red and inflamed. Swab taken from Peg site for pathology. Patient appears in discomfort. Paracetamol 1gram given via peg. Oramorph 5mg given via PEG. NIV connected. Patient repositioned in bed. Patient’s wife was attending to children during nursing visit. Wife reports spending more time sleeping throughout the day. Voice message left for doctor review mane.”


Regular Medications Dose Indication


Diazepam 5mg Nocte Anxiety


MS Contin Suspension Controlled Release 20mg BD Pain


Movicol 1 Sachet BD Constipation


Amitriptyline 25mg Nocte Sialorrhea


Multivitamin Suspension 20mls OD  


Paracetamol 1g QID  Pain


     


PRN Medications    


Oramorph 5mg 4/24 Pain/ Discomfort


Clonidine 0.1mg Nocte Sialorrhea


Microlax Enema 1 tube Constipation


Processing Information


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Review of Medical Officer from Palliative Care Community Service


Friday 20th March


The medical officer (MO) reviewed Tyler after concerns raised by Registered Nurse. Tyler had developed another peg site infection. It was discussed with Tyler the need for IV antibiotics. The MO suggested admission to hospital for treatment, however Tyler was not keen on this suggestion. After discussing hospital admission with both Tyler and Catherine together, it was decided that this was not an option. The Community Palliative Care Team would provide further care to Tyler with provision of IVAB’s in the home. It was arranged for Tyler to have a day visit to the local hospital for insertion of a PICC line due to expected long duration of antibiotics.Post review of Medical Officer from Palliative Care Community Services:


Regular Medications Dose Indication


Diazepam 5mg Nocte Anxiety


MS Contin Suspension Controlled Release 20mg BD Pain


Movicol 1 Sachet BD Constipation


Amitriptyline 25mg Nocte Sialorrhea


Multivitamin Suspension 20mls OD  


Paracetamol 1g QID IV Pain/ Febrile


Cephalothin 2g BD IV Infection


Metronidazole 2g BD IV Infection


     


PRN Medications    


Oramorph 5mg 4/24 Pain/ Discomfort


Clonidine 0.1mg Nocte Sialorrhea


Microlax Enema 1 tube Constipation

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