3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

Assessment Type: Case Study
Assignment Title:35817/01 Apply a palliative approach to nursing practice
Instructions to the student:You are required to read the case study background information on Rosiane Mabweni and use this information to answer the 23 questions relating to her care. The answers you provide should be related to the patient information provided and all rationales of care should relate to her specific needs.
You are to:
 Answer the questions from the perspective of a qualified Enrolled Nurse.
 Use correct anatomical and medical terminology in your answers.
 Reference your answers using the APA 6 th Edition referencing standard.
During this assessment, you are required to analyse Rosiane’s health information and clinical presentation. You are to demonstrate essential knowledge required to provide nursing care and nursing interventions using a palliative approach to care from the perspective of a qualified Enrolled Nurse.
3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

Deliverables for this assessment:
To gain a satisfactory result for this assessment, you will need to upload all the following documents into Open Space in one submission.

Your Open Space assessment submission is to include:

 You completed assessment cover sheet
 Your responses to the 23 questions relating to the case study on Rosiane Mabweni.

Once you have uploaded your assessment into Open Space, your educator will assess your assessment submission and provide feedback to you on the Assessment Evidence Checklist attached to this assessment.

You will be given either a Satisfactory or Not Yet Satisfactory result. If your result is Not Yet Satisfactory, you will be given a due date for re submission and feedback indicating what areas need addressing to gain a satisfactory result.

Case study background information – Rosiane Mabweni

Rosiane is a 50-year-old Rwandan woman (born in the month of May) who arrived in Australia 18 years ago as refugee.  She arrived with her husband (Lonji) and their 3 daughters (aged 12, 10 and 8 years) as refugees from Cogo where they had fled following The Rwandan crisis in 1994.

They have settled well into Australian life; their family has been very important to them and has now grown to include 2 grandchildren with another grandchild due in 6 months’ time

Rosiane and Lonji are practising Muslim’s (Sunni) and are both very active in the local African community. Rosiane is currently working 4 days per week in Lonji’s Home Cleaning business to help meet their financial needs however this has become increasingly challenging for her as she has recently become unwell.

She presented to her GP, Dr White, 2 months ago with increasing fatigue, shortness of breath, mild confusion and hardening of the Right Breast with ‘peau d’orange’ (orange dimpling) causing pain and discomfort in her breast.

Dr White referred Rosiane to Mr Sheal, a Surgical Oncologist who completed a full physical examination and undertook the following investigations:

 R) Breast ultrasound
 R breast fine needle biopsy
 Sentinel lymph node biopsy          
 CBC, LFT, GFR, HBV, HCV                     
 IHC test (Immuno Histo Chemistry) for HER 2 Gene
 MRI L) and R) Breast, Chest and Head
 Chest X-ray

On review of all the findings Mr Sheal confirms that Rosiane has stage 4 Advanced R) Breast Cancer with lymph, lung + brain metastases.  Mr Sheal discusses the diagnosis with Rosiane and Lonji and explains that approaches to treatment were now not curable but rather palliative in intent.

You are the GP Practice nurse assisting Rosiane through these early stages of diagnosis and follow-up tests.

Case study questions

1.Discuss four (4) key elements of a ‘palliative approach to care’ in relation to Rosiane.

2.Describe how you would complete a holistic assessment on Rosiane?

3.Describe the pathophysiological changes associated with Rosiane’ s life-limiting diagnosis.

3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

4.Outline two (2) nursing diagnosis and interventions for Rosiane at this current time immediately post-diagnosis.

5.Identify and discuss one aspect specific to Rosiane’s care around the following lifestyle, cultural, spiritual and psychosocial perspectives.  Discuss how these will influence her personal choices towards end of life care and inform your care planning?

6.As part of a Palliative Care approach to care discuss two (2) legal and ethical implications of implementing advanced care planning and advanced care directives.

7.Discuss the state legislation, that you reside in, relevant to Advanced Care Planning.

8.Discuss the state legislation, that you reside in, relevant to Advanced Care Directives.

9.As part of a Palliative Care approach to care discuss two (2) legal and ethical issues related to “organ donation”.

10.As part of a Palliative Care approach to care discuss two (2) legal and ethical issues related to “request for autopsy”.

11. Rosiane was referred to an Oncologist to explore palliative options of
chemotherapy. She completed a course of IV Trastuzumab which she has been having weekly however she says to you that she feels ‘worse not better’.  She tells you she is not going to accept further chemotherapy treatment and she wants to talk to you about Palliative Care.

Describe what Palliative Care is and state four (4) members of the Multidisciplinary Palliative Care Team.

12. Lonji is quite distressed at the level of Rosiane’s deterioration and complains to you in front of Rosiane that she doesn’t “make an effort to eat and drink to help her stay well”.  He thinks she needs to go to “hospital for a drip”…

How would you explain to Lonji’s Rosiane’s hydration and nutrition needs in line with a palliative approach to care and her ACD?

Case study update on Rosiane

Rosiane begins to deteriorate…
Rosiane is finding it increasingly difficult to manage at home and she is becoming increasingly distressed that her R) Breast wound as it is not healing and “seems to be getting bigger”.  She is visited by her GP at home, at 1000, and he recommends that Rosiane is transported to “Care Shore Tertiary Hospital” for review by the Surgical Oncologist and the Palliative Care Team.

1400: On arrival to the Oncology ward, Rosiane presents with the following signs and symptoms:

 Increasing fatigue (unable to get out of bed over the past 3 days)
 Leg weakness and inability to weight bear
 Shortness of breath has worsened and now affecting her at rest (8/10)
 Increased pain, now a persistent dull throb (Pain Score 4/10) with occasional sharp sensations (Pain Score 10/10) experienced on movement
 Increased muddled thought patterns
 Anorexia hasn’t eaten for 3 days as she has no appetite
 Difficulty swallowing all fluids
 Constipation – BNO 5 days
 Nausea which “is there all the time” (10/10)
 Insomnia which is causing her moderate distress (5/10)

13.Using the updated case study information on Rosiane Mabweni complete the attached Palliative Assessment and Clinical Response Form PCOC Assessment below using the Symptom Assessment Scale to determine Rosiane’s symptom management and subsequent nursing interventions.

The “Patient Rated Score” will be simulated from the information presented
in the Rosiane’s case study.

The “Clinician Rated Score” will be completed by the student from the perspective of a qualified Enrolled Nurse from the clinical information provided in Rosiane’s case study.

Q 14. Discuss why these signs and symptoms have occurred. (hint – describe the physiology of dying) .

15.Outline two (2) Nursing Diagnoses, Interventions and evaluation arising from completing the “Palliative Assessment Clinical Response Form”. (Hint review the scores for Rosiane’s symptom assessment scale, problem severity score or her ability to attend to ADL’s.

16.Outline how you would consult with the Registered Nurse to implement the nursing interventions you have outlined in Question 15. (Hint -ensure you also discuss your role and scope of practice as an Enrolled Nurse.)

Rosiane has returned home and you have had a phone call from Lonji re Rosiane’s R) breast wound.  You arrive at Rosiane and Lonji’s home and find Rosiane’s malignant breast wound (non-healing: see attached) has now significantly extended its growth across the external surface of the breast and involves deeper subcutaneous levels of tissues.

The exudate level is increasing and is malodorous and there are areas of slough on the wound bed.

The wound itself is not painful but rather uncomfortable to dress and difficult to keep secure when she is dressed.

3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

3581701 Apply A Palliative Approach To Nursing Practice Assignment-Open College School Of Health Australia.

Rosiane is feeling very self-conscious about the wound and is quite distressed about the o dour.

17.Identify four (4) key aspects of managing a non-healing malignant wound?

18. Rosiane’s daughters express to you that they feel their Mum is in a lot of pain during the wound dressing and they would like you to assess her pain.  Describe the process you would undertake and the tool you would use to complete a pain assessment on Rosiane.

19.Outline two (2) non-pharmaceutical and two (2) complementary care pain management strategies.

20.Discuss the impact of grief and loss on Rosiane.

21.Discuss the impact of grief and loss on Lonji and his daughters.

22.Discuss the impact of grief and loss on staff caring for Rosiane.

23.List four (4) grief and loss support services for Rosiane and her family?

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