HLTEN511B Provide nursing care for clients requiring palliative care

need in text citation and references as well, book is Fundamental of nursing, Crisp & Taylor and some of the google search

Q1: Provide a definition of health and discuss what a ‘holistic view of health is’.
A1: Holistic view of health is assessment that include physical assessment, mental assessment, socio-economical assessment and spiritual assessment.

My.tafe.qld.gov/HLTEN608B/ Document library

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Q2: What subjective and objective information would you obtain when conducting a holistic assessment of a palliative client and what tools (equipment and written would be used in this process? (put the answer under two headings)
Answer:
Subjective:

Objective :

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Q3: Research: ‘Palliative Care Australia Standards’ and list the guiding Principles/characteristics from these standards and briefly explain each. There are 13 of these
A3:

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Q4: Source the ‘Standards for Providing Quality Palliative Care for all Australians’ (as above)and state which standard addresses the area of:
• Respect.
• Holistic care.
• Unique needs, comfort and dignity of the client are recognised.
• Assessment and care planning is undertaken that enables care is unique to and the wishes of the client, their caregiver(s) and family.
(Palliative Care Australia, 1999)
A4:

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Q5: Any health provider organisation that you work for will have policies and procedures.
What are your responsibilities in relation to the policies and procedures (How will these influence your practice as an EN endorsed)?
A5:

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Q6: We need to be able to provide the best care for our clients, to do this we need to have an understanding of ‘caring’. What is the benefit of ‘knowing your client’?
A6:

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Q7: What does ‘providing presence’ mean in the context of nursing and why would it be important in nursing a palliative care client and their family?
A7:

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Q8: What are the benefits of ‘listening’ to your client?
A8:

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Q9: List at least 8 ways that nurses show respect.
A9:

( rescept about culture, choice,

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Q10: Discuss your roles and responsibilities in developing a plan of care for your palliative client.

Answer10:
Quality and safe care
Assessor
Support family and carers
Privacy
Co-ordinate care/ task through shift
RN delegation
Work with multidisciplinary team
Client and family education

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SCENARIO
Your case mix of clients that you are looking after includes Mrs Net who is 65 years old. She is being treated for terminal Lymphoma. You have been informed by the Registered Nurse that Mrs Net is to have a long-term, percutaneous intravascular catheter inserted today. You are aware that Mrs Net has not had an intravenous line before. She is on an opioid regime for pain management. She is the principal carer for her husband who has dementia and is currently in emergency respite care. Her daughter has enduring Power of Attorney over financial and health matters. Mrs Net has not given a clear indication to her daughter of how ill she is. Physically she presents as emaciated and anorexic due to the disease process (you may find it beneficial to research these two words)

Q11: Describe the pathophysiological changes associated with terminal non-Hodgkin’s Lymphoma.
A11:

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Q12 (a): Complete the following care plan from the information provided above in question 11 and the scenario.
A12 (a):
Assessment
Holistic Nursing Dx Goals Implement Rationale
Subjective and objective data
List the information and any assessments that would be obtained
Eg T.P.R. B/P
Anxious Anxiety related to procedure Alleviate anxiety

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Q12 (b): Discuss the process of monitoring effectiveness of care, how modifications to care are determined and the EEN role in evaluating care and care plans.
Answer12 (b):

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Q12 (c): Discuss how you as a nurse know that care is appropriate and meeting the needs of the client.
A12 (c):

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Q13 (a): What impact does Palliative care have on a person’s ability to manage their ADL’s?
A13 (a):

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Q13 (b): Discuss how you would support your palliative care client in managing their ADL’s.
A13 (b):

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Q14: There are other health workers other than the nursing staff and medical officers who would be involved in the care of Palliative clients.
List 6 of these and discuss their role in providing care
Answer 14:
1. Pharmasist:- Check prescription and supply medications, advice how to tak medications.
2. Physiotherapist:- Assessment and assist with mobility
3. Ocuupational Therapist:- Assessment of patient and modify the house enviorement such as toilet, bathroomor shower chair, kitchen, lighting,and rails as per patient’s need.
4. Podiatrist :- Poditrist assess, treat and prevent serious ailments of the foot or lower limb, related with Aethritis, soft tissues and muscular disorder and nerve disesases. They manage diabitic pressure are and prevent ulceration to keep patient mobile.
5. Dietitian :- Dietcians are expert in nutrition science. They work with the community to maintain their healthy balanced diet, management of weight and food allergies.
6. Community Social Worker :- The role of social worker is to counsel and solve the families personal problems caused by illness or injury. With the help of existing community groups and resources they assists the individual and the family to deal with different social, domestic, financial and emotional implications.

( my.tafe.qld.gov.au/HLTEN 608B,)
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Q15: A regular feature of Palliative Care is case conference, what and how is this achieved?
Answer 15:
Google,it

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Nursing and nurses operate under a Code of Ethics.
Q16 (a): Using a dictionary or other source provide a definition of ‘Ethics’.
A16 (a):

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Q16 (b): Discuss how your personal ethics may impact on your caring role.
A16 (b):

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Q16 (c): If you were to apply the definition identified from question 16 (a) above and incorporate them into the care you give how will this differ from your personal ethics? [How do you apply ethics into your work practice?]
A16 (c):

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Q16 (d): State what each of the following words mean and how it applies to your nursing practice.
A16 (d):
Fidelity:
Veracity:
Confidentiality:
Privacy:

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Q16 (e): There are four (4) ethical principles, explain what each means.
A16 (e):
1. Autonomy:
2. Beneficence:
3. Non-maleficence:
4. Justice:

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Q16 (f): Write a short paragraph on each explaining how these are incorporated into your work practice.
A16 (f):

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Q16 (g): If your client needed a suppository to manage constipation but the client didn’t want it as it caused them embarrassment. How would you manage this situation? If you administered it, would you be in breach of any of the above or not? Justify your answer.
A16 (g):

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Q17: Your client is twelve years old. They are dying but their family don’t want them to be told. Whilst caring for this patient, they say “I’m dying aren’t I, why won’t anyone talk to me about it”?
(a) Discuss the level of understanding of death for this age group (12 years) and how you will answer their question. What would you like to see as the outcome of this question?
A17 (a):

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Q17 (b): Crisp & Taylor 2009 recognises four (4) spiritual needs. List these
Answer 17 (b): They are:
1. Search for meaning
2. Sense of forgiveness
3. Need for love
4. Need for hope
5.
Fundamental of nursing, Crisp and Taylor page 477

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Q17 (c): How would you respond to your client and what would you do with what is being asked?
A17 (c):

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Q18: What part of Nursing Ethics is involved in the above situation? (List)
A18:

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Q19 (a): Conduct research and state what an ‘Advanced Health Care Directive’ is and what information it may contain? Include in your answer any information you can find on Queensland Legislative requirements.
A19 (a):

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Q19 (b): Discuss your role and responsibility in fulfilling care under and Advanced Health Care Directive?
A19 (b):

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Q19 (c): Advance Care Directives may change as the client’s condition changes and directives are reviewed. What is your role in this?
A19 (c):

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Q19 (d): How would you manage a situation where the client has an Advance health care directiveand the family are actively asking for intervention which is not in line with the directive?
A19 (d):

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Q19 (e): What are the legal and ethical implications of an Advance Health Directive?
A19 (e):

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Q20: Conduct some research and explain what is and Enduring Power of Attorney?
A20:

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Q21: Conduct some research and explain Advocacy.

Answer 21: Advocacy is supporting client and talking with multidisciplinary team for clients better health outcome. As an EEN my role is to advocate my client if necessary. If my client is not getting the care she/he should be getting then it is my duty to talk on her behalf . I can be the voice of client .

(Fundamental of nursing, Crsip & Taylor pg 46)

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Q22: Research what or who is a ‘Medical Agent’?
A22:

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There are many symptoms that a palliative care client may experience which are related to the disease process and treatments.
Q23: List six (6) side effects and complications that palliative care clients may experience.
A23:

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Q24 (a): List five (6) causes of nausea and vomiting.
A24 (a):

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Q24 (b): Research and discuss the management of nausea and vomiting including the medications that could be used to help manage nausea and vomiting.
A24 (b):

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Q25: Describe in detail the nursing interventions for the following symptoms.
A25:
Dry mouth:

Constipation:

Nausea and vomiting:

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Q26 (a): List medications that could be used to manage constipation.
A26 (a):

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Q26 (b): Discuss their contraindications and side effects.
A26 (b):

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Q27: Breast cancers can metastasis into bone cancer.
A27:
(a) Discuss what are metastases?
Answer: Metastases

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(b) Research symptoms a person would have if suffering from metastases in the bone exhibit?

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(c) State a nursing diagnosis for each and explain how each symptom would be managed.

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Q28 (a): What is Hodgkin’s disease?
A28 (a):

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Q28 (b): What would be the impact on managing daily living activities for a male teenager suffering from Stage IV Hodgkin’s disease?
A28 (b):

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Q28 (c): What signs and symptoms would be exhibited at this stage?
A28 (c):

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Q28 (d): How would you as the nurse help to manage the activities of daily living and the signs and symptoms the patient is experiencing?
A28 (d):

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Q29: Research hydration and nutritional requirements during palliation care and at end of life and discuss.
A29:

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Q30 (a): A benefit of using a pain assessment tool (e.g., pain scale) in the palliative care patient is the ability to: (mark the correct answer)
A30 (a):
0 (a) Observe a trend in the patient’s response to analgesic therapy.
0 (b) Treat the adverse effects of pain medications.
0 (c) Detect symptoms of drug withdrawal.
0 (d) Differentiate true pain from drug-seeking behaviour.

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Q30 (b): Discuss the difference between:
A30 (b):
i. Nociceptive pain
ii. Neuropathic pain

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Q30 (c): Explain what the following types of pain relief are and give an example of each.
A30 (c):
i. non opioid

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ii. opioid

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iii. adjuvants (in relation to pain relief)

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Q30 (d): Discuss some complications of opioids.
A30 (d):

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Q30 (e): Your client is refusing pain medication even though in a lot of pain. What is your responsibility to your client and how will you manage this situation. Your answer should also address how pain medication works and the uptake of medication/dependence.
A30 (e):

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Q31: Discuss alternative ways in which pain can be managed other than with medication and complimentary therapies.
A31:
Massage therapy
Music therapy
Ocupunchure
Reposition
Heat pack

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Q32: Many clients find complementary therapy helpful during palliative care.
List these therapies and choose one (1) to discuss how it helps the client feel comfortable and give symptom relief to the client.
A32:

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Q33 (a): Discuss some strategies to maintain skin integrity in the Palliative care client.
A33 (a):

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Q33 (b): Briefly discuss the management of wounds in a palliative situation.
A33 (b):

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Q34: An adult patient is concerned about the emotional effect of his terminal illness on his 7-year- old child; the nurse should explain that: (mark the correct answer)
A34:
0 (a) A 7-year-old child is not old enough to understand serious illness and death.
0 (b) Changing family routines will help the child come to terms with the illness.
0 (c) There are age-appropriate ways to assist a child through the grieving process.
1 (d) It is helpful to let the child overhear other family members talking about the death of the parent rather than having a direct conversation.

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Q35: Discuss issues of loss and grief on the following persons. (Consider different family scenarios)
A35:
Patient:

Carer:

Family:

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Q36 (a): List the stages of emotion that people might experience as identified by Elisabeth Kubler- Ross.
A36 (a):

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Read the following scenarios and identify the stage of emotion that the client is displaying. Choose one from the selection you wrote above.
Q36 (b): Your female client is to undergo a radical mastectomy with radiation therapy to follow. Her minister visited her the night before the surgery and found that the client only wanted to talk about the fact that she will no longer be a complete woman.
A36 (b):

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Q36 (c): Your client has end stage chronic renal failure and has been living with this for some considerable time. Your client has been telling stories of his life to his children. His desire is that his children will share with their children who are still quite young.
A36 (c):

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Q36 (d): Your client was diagnosed with non-Hodgkin’s lymphoma and has often talked about their illness calmly and seemed at peace. Your client has talked openly with their children including their future and the fact that she would not be around to share it with them. On this day you walked into her room to find her slamming her fist into her bed and saying “it’s not fair” “it’s not fair”.
What stages of grief are represented in this above scenario? How do you explain that the client has changed stages?

A36 (d):
…………………………………………………….. and then ………………………………………………..
(IT IS NORMAL FOR PEOPLE TO SWING BETWEEN DIFFERENT STAGES OF GRIEF)

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Q37: Discuss cultural, religious and spiritual factors that underpin choices at end of life.
A37:

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Q38: You are caring for an Arabic/Muslim client. Discuss the following under the following headings?
A38:
Preferred place of treatment:

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Communication of the diagnosis/prognosis:

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Role of family/relative/friends:

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Role of health professionals:

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Attitude to pain relief:

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Taboo words:

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Preparation of the body:

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Burial:

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Respect and Dignity

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Culture:

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How are any of these considerations different for the Arabic Coptic faith? Research is needed

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Q39: Your Australian Indigenous client has just passed away. Discuss the care of the body after they have died. What factors need to be considered under the following headings?
A39:
Preparation of the body:

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Respect:

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Culture:

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Dignity:

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Spiritual:

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Client choices:

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Q40: A terminally ill patient is showing decreased awareness of his surroundings, decreased oral intake of solids or liquids, and is no longer able to get out of bed.
The most likely explanation for this constellation of findings is: (mark the correct answer.)
A40:
1 (a) Loss of hope.
0 (b) Impending death.
0 (c) Depression
0 (d) Urinary retention.

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Q41: If a person is in a coma, they do not feel pain?
A41:
True / False

Answer: True

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Q42: If a radial pulse cannot be palpated it might be necessary to take an ………………… pulse.
A42:
0 (a) Brachial.
0 (b) Femoral.
1 (c) Apical.
0 (d) Temporal.

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Q43: Dysphagia is difficulty swallowing.
A43:
True / False

Answer: True

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Q44: Dyspnoea is:
Answer44: Dyspnoea is a uncomfortable condition to breathing or difficult breathing cause by others disorder such as a heart, respiratory condition and anxiety.

(Mosby’s Dictionary, page 598)

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Q45: Discuss the physiological changes and symptom management during the dying process. (Over the last few weeks and days.) This will require web searches.
A45:

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Q46: What are the signs that death has occurred.

Answer 46: we can see following sign when death has occurred,
1. The heart stops beating
2. Breathing stops
3. Pupils of eye become fixed
4. Body colour becomes pale
5.
6. Body temperature drops
7. Urine and stool may be released
8. Eyes may remain open
(Fundamental of nursing, crisp & Taylor, page 518)

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Q47: Your patient has just passed away and you now need to support the family who have been in attendance for the last two day.
Discuss how you will do this.
A47:

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Q48 (a): When is an Autopsy performed and what do you need to do for the body in such a case?
Answer 48 (a): Autopsy is dissection and examination of dead body to find out cause of death.

(Mosby’s Dictionary, page 173)

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Q48 (b): When would a coroner’s enquiry be undertaken?
Answer48 (b): All suspicious and unexpected death such as
• The death was violent and unnatural such as a suicide; drug, alcohol and poison related deaths;
• The death directly or indirectly, from an accident or injury.
• The death occurs during a medical procedure or following a medical procedure where the death is or may be causally related to the medical procedure and a registered medical practitioner would not, immediately before the procedure was undertaken, have reasonably expected the death.
• A Medical Certificate of Cause of Death has not been signed and is not likely to be signed;
• The identity of the person is unknown.
http://www.rch.org.au/clinicalguide/guideline_index/Death_of_a_Child_Reporting_a_death_to_the_Coroner/

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Q49: How would the nursing staff know if the client wished to organ donate?

Answer 49: An Advance Health Directive is a document that states patient’s wishes to organ donate.

Click to access advance-health-directive.pdf

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Q50: What would you do to look after and care for yourself as a worker in the Palliative Care environment and what resources are available to you?
A50:

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