Care Plan Case Study

Case Study

Answer the questions related to the information provided in the case study

Your research must be appropriately referenced using APA guidelines. The total word limit for your responses is approximately1,500 words (+/- 10%).

As this unit is not directly assessed in the clinical workplace, both assessment tasks need to reflect a simulated clinical work environment demonstrating critical thinking applied to clinical conditions.

Case Study

William Smith is a 68 year-old man who was transferred to the Palliative Care ward three days ago from a surgical ward. He was admitted on 26/01/2013 for excision of a sacral abscess which had been causing him a lot of pain. After surgery his future management was assessed and it was decided that he would be transferred to the Palliative Care ward as he could not be discharged home.

Social History

Care Plan Case Study

· Mr Smith lives alone in a unit with 23 stairs. He is unable to care for himself and refuses any home help.

· According to his daughter who was contacted by the Social Worker, Mr Smith has a past history of domestic violence and abuse towards his former wife and children. His son and daughter are finding it hard to visit him even at this end stage of his life and have stated that they are not willing to care for him at home.

· Mr Smith identifies himself as an indigenous Australian (a person of Aboriginal or Torres Strait Islander descent). He was born in Arnhem Land but moved firstly to a rural township in the Northern Territory before settling in his current home in a metropolitan city at age 65 to be nearer to his estranged children.

· He has a past history of alcohol abuse until his admission to hospital on 26/01/2013.

Medical History

Care Plan Case Study

· Mr Smith has a past history of a primary Ca lung with liver and bone metastases.

· He also has a past history of COPD as he was a heavy smoker ( > 20 cigs a day for 45 years).

Physical Assessment on admission

· Mr Smith has dyspnoea, ascites, pruritus and bone pain (moderate to severe at times).

· He is very thin as he has been anorexic for several weeks. According to a neighbour, he lived on beer and baked beans with an occasional meal at the club when he could be taken there by a friend.

· His skin is stretched over his distended abdomen and bony prominences.

· He is not able to walk unaided further than from the bed to the bedside chair.

· He requires oxygen at all times.

Care Plan Case Study

29/01/2013 – Palliative Care Unit Admission Assessment

· Mr Smith is receiving regular analgesia for pain.

· He had not been ordered an aperient for several days and has not had his bowels opened since admission to hospital on 26/01/2013 and he is feeling very uncomfortable.

· He refuses to eat much as he doesn’t like the food in hospital. His fluid intake is low and he is showing signs of possible dehydration. His urine output needs to be monitored.

· Mr Smith is also complaining of stomatitis – he has poorly fitting dentures and evidence of mouth ulcers.

· He also suffers from hiccups which can last for 20 minutes at a time.

· He is complaining of nausea and vomiting. His weight loss is marked (5kg since admission 26/01/2013).

· Mr Smith can be incontinent of urine at night.

· Mr Smith is finding it very hard to sleep at night and falls asleep for long periods during the day.

· He has been talking a little about his children and speaks about his former behaviour towards his wife and children with regret. He often asks if his children are going to visit him.

Care Plan Case Study

06/02/2013

Mr Smith has now been on the Palliative Care ward for a week. He has deteriorated in the past few days and is now bed bound.

· He is able to roll from side to side for PAC.

· His skin is intact apart from a small pressure ulcer (0.2 x 0.1cm) on his sacrum.

· He is extremely sensitive to soap because of an increase in ascites and consequent pruritus.

· He needs assistance with personal hygiene (sponge in bed).

· He refuses to wear his dentures now as his mouth is extremely painful. He has been ordered Nilstat and Bonjela (anaesthetic mouth gel) with limited effect as he doesn’t like the taste.

· His breathlessness has increased and he is having 4/24 Ventolin nebs.

· He is ordered soft diet, encourage fluids. Mr Smith likes ginger beer which he says helps his hiccups (next-door neighbour brought some in)

· BNO for several days. Microlax enema and Agarol 10ml given with effect.

· Can be incontinent of urine at times – pad in situ.

· Current analgesia is oral (Oxycontin 100mg bd and Tramadol 50mg bd) – Mr Smith states this regime is “holding pain at present”. Pain score 2 -3/10.

· He can be confused and agitated at times.

· Mr Smith has requested a visit from the Social Worker to try to organise a visit with his children. He is very depressed about the current situation.

· Daily TPR and BP and girth measurement.

PART A: Analyse the information given in the case study and answer the following questions. NUMBER EACH QUESTION IN YOUR SUBMISSION

Review the following document to assist your responses to questions 1 – 2:

Queensland Health (2011) Sad News, Sorry Business: Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying

http://www.health.qld.gov.au/atsihealth/documents/sorry_business.pdf

.

1. Could Mr Smith’s culture influence his pain assessment? Why? What strategies could you employ to ensure that you are adequately addressing Mr Smith’s pain?

2 Consider Mr Smith’s social and medical history.

a. Reflect on any judgements and prejudices that you may have when caring for Mr Smith.

b. Review the following professional Australian nursing standards:

http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx

Code of Ethics for Nurses

Code of Professional Conduct for Nurses

EN Competency Standards

Outline the standards / codes that relate to non-judgemental nursing care in this situation.

3. Compile a list of questions you would ask Mr Smith as part of an holistic health assessment. These questions should be framed to enable collection of information on:

a. physical health status including pain assessment

b. mental and emotional status

c. social and cultural issues

4. Mr Smith asks you about planning for his future. He states that he does not want to be resuscitated. Provide Mr Smith with a brief description (with APA referencing) of the following and apply it to this scenario:

a. Advanced Health Directive

b. Enduring Power of Attorney

c. Organ Donation

5: Suggest alternative strategies (complimentary therapies) other than pharmaceutical pain management that could help Mr. Smith’s pain.

6.List appropriate referrals for Mr Smith to other members of the multi-disciplinary team. Provide a rationale and a description of the service for each referral.

7: What support / referral could be offered to Mr Smith’s family?

8. Outline the pathophysiology of the following conditions ensuring you relate back to Mr Smith and his clinical presentation and diagnosis. Include within your answer the possible management strategies and rationale for these symptoms:

a. Anorexia related to cancer (NOT Anorexia Nervosa)

b. Ascites

c. Dyspnoea

d. Hiccups

Note: Pathophysiology is not signs and symptoms. Pathophysiology explains the processes within the body that result in the signs and symptoms of a disease.

9. Consider Mr Smith’s deterioration. What data provided about Mr Smith’s condition on 06/02/2013 would assist in determining if Mr Smith is at end of life?

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.