NRSG374 Unit Outline Assessment Task 2 Particulars
College students are to supply an 1800 word critique of the offered case examine utilizing solely ONE CPG.
To finish this job you will want to debate and critique related parts of the CPG and case examine while upholding the Nationwide Palliative Care Requirements at the very least one in all:
• NSQHS
• NMBA requirements and/or
FAQ’s
Do we have to use all of those requirements to do effectively?
• Because the rubric states when you present -Excellent data of themes and ideas related to palliative care- it will display an impressive utility of your data to observe subsequently utilizing requirements from greater than one of many above and relating them collectively to uphold your critique of the affected person care and help the medical observe guideline chosen will display wonderful data and understanding. Utilizing one commonplace from one of many above is not going to present robust utility of data. Nevertheless, a comparability of a number of requirements that as registered nurses we’re required to uphold will completely display very robust data and understanding, when you hyperlink them collectively effectively with proof primarily based observe (EBP)
The place do I discover all of those requirements?
You ought to be conscious of all the requirements above as they’ve been mentioned in lots of items all through your diploma, so now it’s time to display your data and produce them collectively. to help you We’ve got offered hyperlinks under to every of the requirements we want you to utilise in your critique.
NSQHS
Eight Nationwide security and High quality Well being Service Requirements to supply a nationally constant degree of care that may be anticipated by all customers from all well being organisations
https://www.safetyandquality.gov.au/requirements/nsqhs-standards
NMBA
Seven Requirements that every one Registered nurses should uphold to make sure that they preserve their registration and supply particular person centred and proof primarily based preventative, healing, supportive, formative and palliative parts to their observe
https://www.nursingmidwiferyboard.gov.au/Codes-Tips-Statements/Skilled-standards/registered-nurse-standards-for-practice.aspx
Nationwide Palliative Care Requirements
9 Nationwide palliative Care requirements that you realize effectively as they’ve fashioned the framework of NRSG374 and have been elementary for Assessment job 1
https://palliativecare.org.au/requirements
How do I relate these requirements to the case examine?
That is the place your essential pondering and utility of principle to observe is required, we can not let you know how to do that, as a closing yr nursing unit it’s important that you’re conscious of how all of those requirements, uphold and preserve, affected person centred care, dignity, affected person Assessment and security to call a number of. Spend a while reviewing these and map out those that you just consider are necessary to your critique.
Objective
College students are required to display an understanding of how principle interprets into sensible nursing care and the way proof underpins finest observe. Every pupil will evaluate and critique the care given within the Case Research offered in line with their selection of ONLY ONE of the offered Scientific Follow Tips (CPG’s) finest suited to the highlighted dialogue.
The place will I discover the CPG’s that you really want me to make use of?
You’re supplied with CPG’s for this job, on this booklet .
It is advisable to select one in all these solely to display the world of care that you’re offering a critique of. You aren’t anticipated to search for different CPG’s to help your work, nonetheless proof primarily based observe of peer reviewed journal publications are anticipated to additional reinforce the critique.
Studying outcomes assessed: LO1, LO5, LO7
submit: Digital Submission by way of Turnitin
Return of project: The Assessment suggestions and grade might be returned by way of Turnitin.
Assessment standards: The Assessment might be marked utilizing the criteria-based rubric. Please notice that in-text citations are included within the word depend while the reference record shouldn’t be included within the word depend. Phrases which can be greater than 10% over the word depend is not going to be thought-about.
CASE STUDY
AETIOLOGY OF MOTOR NEURON DISEASE
Motor neuron illness (MND) is a progressive neurological dysfunction characterised by lack of motor neurons (Brown, Edwards, Buckley & Aitken, 2017). There are four major forms of MND, relying of the extent of motor neurone involvement and the place signs start. These embody:
· Amyotrophic lateral sclerosis (ALS)
· Progressive bulbar palsy (PBP)
· Progressive muscular atrophy (PMA)
· Main lateral sclerosis (PLS)
MND normally results in dying 20-48 months after signs start, nonetheless 5%- 10% of sufferers could survive for greater than 10 years (MND New Zealand, 2018). The onset of MND is normally between 40 and 70 years of age and is extra widespread in males than girls by a ratio of 2:1 (MND Australia, 2018). The prevalence is roughly eight.7 in 100 000 in Australia (MND Australia, 2018).
Motor neurons within the brainstem and the spinal twine regularly degenerate. Useless motor neurons can not produce or transport alerts to muscle groups. Consequently, electrical and chemical messages originating within the mind don’t attain the muscle groups to activate them. The everyday signs for prognosis of MND are limb weak point, dysarthria and dysphagia (Brown et al., 2017). Muscle losing and fasciculations outcomes from the denervation of the muscle groups and lack of stimulation and use. Different signs embody ache, sleep issues, spasticity, drooling, emotional legal responsibility, despair, constipation and oesophageal reflux (Brown et al., 2017). Demise normally outcomes from respiratory tract an infection secondary to comprised respiratory operate.
All through the sickness trajectory for MND, the affected person stays cognitively intact whereas bodily declining. The affected person needs to be inspired to partake in reasonable depth, endurance-type train for the truck and limbs as this may occasionally Help cut back MND spasticity.
Nursing interventions embody however should not restricted to (Brown et al., 2017):
· Facilitating communication
· Lowering the chance of aspiration
· Facilitating early identification of respiratory insufficiency
· Lowering ache secondary to muscle weak point
· Lowering danger of harm associated to falls
· Offering diversional actions resembling studying and companionship
CONSIDERING THE PATIENT’S SITUTION
the Affected person:
Tyler Morton is a 40-year-old man who spent is childhood and teenage years in Brisbane. Tyler, while rising up excelled in all sports activities and represented QLD within the state Cricket Workforce. Upon finishing highschool, Tyler graduated from the College of Queensland with a Bachelor of Enterprise Administration earlier than becoming a member of the Royal Australian Airforce as a Pilot in 2004. While coaching to change into a Pilot, Tyler met is future spouse Catherine in Newcastle and that is the place the couple settled to begin their household. Tyler and Catherine have Three Youngsters. Catherine is a keep at house Mum to:
· Andrea (eight Years)
· Jessica (5 years)
· Erin (2 Years)
Being from Newcastle, Catherine’s Household may be very near Tyler and Catherine and spend plenty of time collectively. Tyler’s Household is in Brisbane and has solely minimal contact with Tyler and his younger Household. Sadly, Catherine and Tyler’s mom Joyce don’t get alongside and this causes plenty of battle within the marriage.
18 months in the past
Tyler skilled some weak point in his left hand. His grip power was not a robust as his proper hand and he discovered he could be dropping something that he picked up. Tyler additionally famous he was getting in need of breath with out exertion. Contemplating his common health is kind of good, this was extremely irregular. Tyler made an appointment with the GP on the Airforce base to debate this concern.
After a number of MRI’s and blood assessments and lumbar punctures (over a Three-month interval), Tyler was recognized with Amyotrophic lateral sclerosis (ALS). On the time of prognosis, Tyler’s weak point in his left hand had progressed to his proper hand and he had developed a foot drop in his left ankle.
Upon prognosis, Catherine was adamant that the youngsters weren’t going to be informed the explanation that Dad is not working. Tyler’s prognosis additionally prompted extra stress and stress with the connection between Catherine and Joyce. Joyce wished to go to and be there along with her son, nonetheless Catherine was not supportive of Joyce and Tyler’s brothers visiting.
12 months in the past
Round 6 months after preliminary signs and three months after prognosis, Tyler’s situation had deteriorated. Tyler now required a strolling body to mobilise. His dyspnoea has elevated, he was affected by complications and was usually fatigued. Tyler was being assessed by a respiratory specialist for the requirement of Non-invasive air flow (NIV) particularly at night time. Tyler now suffers from dysphagia and was being assessed in session with the respiratory specialist and dietician for the necessity for a gastrostomy.
6 months in the past
Tyler’s situation has continued to deteriorate. Attributable to inadequate dietary consumption secondary to dysphagia, Tyler had a gastrostomy inserted. Since insertion, he has had quite a few infections on the insertion website. Tyler additionally requires help of NIV primarily at night time, nonetheless the demand has elevated considerably during the last couple of weeks. Tyler’s mobility is proscribed. He walks intermittently with using an Help and one particular person. His mobility is proscribed attributable to progressive foot drop and elevated dyspnoea. Together with his situation worsening, Tyler initiated the tough dialog with Catherine about his mortality. Catherine continues to be not accepting of Tyler’s situation neither is she wanting the Youngsters to know the extent of Tyler’s situation. Tyler accomplished an Superior Well being Care Directive and he ensured each Catherine and his mom Joyce had a replica. Tyler is at the moment visited weekly by the Neighborhood Palliative Care Workforce and he has every day help from Neighborhood nurse to help together with his actions of every day residing.
Regardless of Tyler’s progressive bodily deterioration and the continuing tensions with Catherine’s incapacity to simply accept his situation, Tyler values the time he will get to spend together with his Three ladies. Watching them play collectively and their interactions are invaluable to Tyler. Tyler has insisted that his mom and brothers are in a position to go to month-to-month. When his household go to, Catherine usually takes the ladies and leaves Tyler at house. Though this a super scenario, Tyler has come to simply accept the battle between Catherine and Joyce. Tyler can also be nonetheless in touch together with his colleagues from the Airforce who go to him often.
COLLECTING CUES AND INFORMATION
Previous Medical Hx
• # R) Wrist as a toddler
• Bronchial asthma
Present Historical past
• Weak point in left and proper palms
• Improve in dysponea on exertion and at relaxation
• Restlessness/ sleeplessness nocte
• Complications
• Dysphagia
• Low temper
• Constipation
• Foot drop left foot
• Improve demand for NIV
• 02 Remedy
• Peg Feeds
• Intermittent infections Peg website
Gathering new Data
Thursday 19th March
Tyler’s very important indicators 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 levels
1300 hrs
RR: 24
HR: 70
BP: 120/70
SaO2: 92% on 2Lmin NP
GCS: 14/15
Temp: 38.6 levels
1900 hrs
RR: 26
HR: 88
BP: 120/70
SaO2: 92% on 2Lmin NP
GCS: 14/15
Temp: 39.2 levels
Affected person Notes from Neighborhood Nurses over 24-hour Interval:
“Affected person’s mobility has decreased. He’s now spending extra time in mattress secondary to weak point in legs and arms. Elevated requirement of care from 1 particular person to 2 folks to switch affected person. Affected person seems extra SOB. O2 remedy and NIV continues. Peg feeds persevering with as per routine. Affected person’s temper seems low. Mates in attendance throughout go to. Affected person speaking in brief bursts.”
“Affected person RIB throughout go to. Affected person’s place altered. Affected person sleeping for many of nursing go to. Affected person seems extra fatigued. Further analgesia administered as per sufferers request. Peg feeds proceed as per routine. Spouse and youngest baby in attendance throughout go to. Affected person seems heat to the touch. Fan utilized to help with local weather management.”
“Affected person seems very drowsy all through go to. Affected person seems flushed within the face and stays heat to the touch. Peg feed disconnected as per routine. Peg website seems purple and infected. Swab taken from Peg website for pathology. Affected person seems in discomfort. Paracetamol 1gram given by way of peg. Oramorph 5mg given by way of PEG. NIV related. Affected person repositioned in mattress. Affected person’s spouse was attending to kids throughout nursing go to. Spouse experiences spending extra time sleeping all through the day. Voice message left for physician evaluate mane.”
Common Medicines Dose Indication
Diazepam 5mg Nocte Anxiousness
MS Contin Suspension Managed Launch 20mg BD Ache
Movicol 1 Sachet BD Constipation
Amitriptyline 25mg Nocte Sialorrhea
Multivitamin Suspension 20mls OD
Paracetamol 1g QID Ache
PRN Medicines
Oramorph 5mg four/24 Ache/ Discomfort
Clonidine zero.1mg Nocte Sialorrhea
Microlax Enema 1 tube Constipation
PROCESSING INFORMATION
Evaluate of Medical Officer from Palliative Care Neighborhood Service
Friday 20th March
The medical officer (MO) reviewed Tyler after considerations raised by Registered Nurse. Tyler had developed one other peg website an infection. It was mentioned with Tyler the necessity for IV antibiotics. The MO instructed admission to hospital for therapy, nonetheless Tyler was not eager on this suggestion. After discussing hospital admission with each Tyler and Catherine collectively, it was determined that this was not an choice. The Neighborhood Palliative Care Workforce would offer additional care to Tyler with provision of IVAB’s within the house. It was organized for Tyler to have a day go to to the native hospital for insertion of a PICC line attributable to anticipated lengthy period of antibiotics.
Put up evaluate of Medical Officer from Palliative Care Neighborhood Providers:
Common Medicines Dose Indication
Diazepam 5mg Nocte Anxiousness
MS Contin Suspension Managed Launch 20mg BD Ache
Movicol 1 Sachet BD Constipation
Amitriptyline 25mg Nocte Sialorrhea
Multivitamin Suspension 20mls OD
Paracetamol 1g QID IV Ache/ Febrile
Cephalothin 2g BD IV An infection
Metronidazole 2g BD IV An infection
PRN Medicines
Oramorph 5mg four/24 Ache/ Discomfort
Clonidine zero.1mg Nocte Sialorrhea
Microlax Enema 1 tube Constipation
Notes made by MO following evaluate of Tyler:
-Total decline in affected person’s situation on remark. Bodily dependent for all actions of every day residing.-
-Affected person seems to be oriented to particular person, place and time. Some confusion at instances, most definitely attributable to an infection current.-
-Affected person’s spouse seems to be supportive of affected person and his selections. It’s my observations that the affected person’s spouse is anticipating a full restoration from present an infection. It’s unsure of her understanding of the sufferers situation.-
Palliative Care Section – Unstable
IDENTIFYING PROBLEMS AND ISSUESS
Concerns for the Neighborhood Palliative Care Setting
Many of those are constantly being assessed and monitored:
• Falls Threat Assessment
• Braden Stress Threat Assessment
• Ache Assessment
• NOK contact particulars
• Superior Well being Care Directive
• Modified Karnofsky Rating of 30-40
• RUG- ADL 17
• SAS Software Accomplished
What is likely to be some issues I would like to think about as an RN caring for Tyler and his household ?
• Nationwide Palliative Care Requirements ?
• NSQHS Requirements?
• NMBA Requirements?
• What do I do know concerning the sickness trajectory of motor neurone illness?
• How will I recall info beforehand learnt and understood about this sickness?
• The place are a few of the finest places to entry EBP and present requirements of care?
• What’s my function in supporting the affected person and their household?
• What’s a SAS Software?
• What’s the Issues Severity Rating/ (PSS)
• What’s a Modified karnofsky Rating?
• What’s a RUG-ADL Rating?
• How do I decide the Palliative Care Section that the affected person is in?
• Do I would like to start out having some tough conversations and ask the affected person and their helps what they perceive about his prognosis?
• What are a few of the issues that the affected person and household could face?
• Are there any particular signs that I needs to be in search of when growing a care plan?
• What’s the pathophysiological response when somebody dies from the particular sickness of this affected person?
• What ought to I count on?
• Am I able to take care of this?
• The place do I get help as an RN if I really feel overwhelmed?
• Have I assumed sufficient about my very own effectively being and resilience for this skilled specialty?
• How do I take care of a deceased particular person?
• How will I do know what to say?
ESTABLISHING GOALS AND TAKING ACTIONS
• Wednesday 24th March (Afternoon)
• Tyler’s peg website seems to be much less infected and redness has subsided a little bit. Tyler stays heat to the touch. RN administered PRN oramorph to help with Tyler misery and discomfort. Tyler has developed a wheeze. Repositioned to the semi- recumbent place to help with respiratory. Tyler appeared barely confused, though was oriented place, particular person, and time. Tyler’s temper seems low. He places a courageous face on when his daughters are round, nonetheless Catherine is noticing a major distinction in his manner.
• Thursday 25th March (Morning)
• Tyler is visited by the Palliative Care Registered Nurse. Catherine is out dropping the youngsters at college. Tyler seems to be extraordinarily in need of breath and struggling to breathe. O2 2L by way of NP was insitu. The RN utilized NIV to help Tyler together with his respiratory.
• Thursday 25th March (Afternoon)
• When attending to Tyler’s private cares, Tyler made some requests to the RN. He requested for the CPAP machine to be eliminated, extra analgesia for his elevated ache and discomfort, he requested for preparations to be made for a mattress within the hospice and requested for his mom and brothers to be contacted. The RN spoke with Catherine concerning contacting Tyler’s prolonged household. Time was spent with Catherine speaking about Tyler’s situation at current. Tyler was oriented to particular person, place and time.
• Catherine didn’t wish to share this time with Joyce and Tyler’s brothers and subsequently she didn’t contact them.
EVALUATING AND IDENTIFYING NEW PROBLEMS
Friday 26th March (Morning) – Sunday 28th March (Morning)
Tyler was visited Three instances per day by the palliative care crew. At completely different instances nurses and social employees visited.
Symptom administration included:
• Break via intermittent ache aid
• Stress space care
• Dyspnoea aid – intermittent use of CPAP mixed with 02 remedy
• Mouth cares
• Peg feeds continued
• Help and counselling given to Catherine
Sunday 28th March (Afternoon)
When the palliative care nurse visited Tyler, she discovered him to be stressed and agitated. Tyler acknowledged he was in ache, and he simply wished all of it to be over. Tyler requested once more after his mom and brothers and the possibility of being transferred to the hospice. After an intensive Assessment, speaking to Tyler and Catherine extensively, the nurse applied the next:
• Subcutaneous butterfly (ready for the order for steady analgesia infusion)
• Referred to as the hospice and organized a mattress for the next morning
• Peg feeds discontinued
• Referred to as Joyce to tell her of Tyler’s situation
A syringe driver containing morphine, haloperidol and ondansetron was commenced after an order was obtained from the MO.
A hospice mattress was organized for switch Monday afternoon.
Joyce and Tyler’s brothers have been making flight preparations to be there asap.
Modified Karnofsky Rating – 30
RUG-ADL – 17
Tyler is now within the Terminal Palliative Care Section
Monday 29th March (Morning)
Upon arrival of the palliative care nurse, Tyler appeared nonetheless and cozy. His respiratory was quick, shallow and laboured with a respiration charge of 5. Catherine was sitting by Tyler’s bedside. Tyler’s ladies have been visiting neighbours. Joyce and Tyler’s brothers have been attributable to arrive at 1pm.
At 1025 hrs, Tyler’s respiration charge decreased additional. Upon inspection, Tyler’s peripheral extremities have been cyanosed. Tyler’s pupils have been mounted and dilated, and he took is final breath with Catherine by his aspect within the household house.
REFLECTION
High quality of Life Concerns
Think about a few of the following as you choose one of many medical observe tips provided within the assessments folder to help you with working via the prognosis, and journey to the palliative care setting:
• Fast prognosis and illness development leaves little time to consolidate and put together for dying – religious, social and cultural wants have to be thought-about
• Was an ample ache scale used?
• How can the household be supplied with help and persevering with bereavement follow-up ?
• Think about the ample and detailed use of the SAS device.
• What can nursing workers present households and the deceased affected person to help them of their grief, loss and must say goodbye?
• Are the Nationwide palliative Care requirements thought-about within the CPG?
• Had been the NMBA and NQHS requirements thought-about within the CPG?
• What’s your duty as an RN to grasp the illness trajectory of your affected person’s, plan their care and the care of their cherished one’s via the data of nursing requirements?
• Was the Superior Well being Care Plan adopted within the care that was offered?
Think about these factors and the various others that you could have additionally considered you mirrored on the case examine.
Scientific Follow Tips
CPG’s and Case Research
Please select ONE of the next CPG’s to evaluate the case examine and talk about in your Assessment job, :
Care of the dying affected person CPG
OR
Finish of Life Care CPG
A PDF of every CPG is offered on the Assessment tile of the NRSG374 LEO by clicking on the hyperlinks above.
Now that you’ve learn the case examine and chosen ONE of the CPG’s offered you might be required to:
• Evaluate and critique the care given to the affected person in opposition to the CPG you might have chosen and supply proof to help your critique via further analysis that you’ll undertake
• Spotlight the significance of the Nationwide Palliative Care Requirements and at the very least one of many NSQHSS and/or the NMBA Requirements and the way they affect our observe
• Reveal data on the sickness trajectory of Motor Neurone Illness (MND) in step with Palliative Care Rules
• Present hyperlinks between the case examine and your chosen CPG to determine highlights or limitations in care
• Be sure that your sources are all up to date (throughout the final 5 years) and from proof primarily based sources)
• Learn all directions and the rubric very rigorously
• PLEASE NOTE, YOU DO NOT NEED TO INCLUDE ALL OF THE POINTS ABOVE IN YOUR ESSAY. THESE ARE GIVEN TO YOU TO EVOKE THOUGHT PROCESS.
The record of references utilised on this case examine can be utilized as a few of the references to your personal critique, nonetheless additionally display depth and breadth of analysis by utilizing different sources of EBP additionally.
ACU Follow guideline. (2018). Care of the Dying Affected person. https://leo.acu.edu.au/pluginfile.php/4991074/mod_resource/content material/1/Care%20of%20the%20Dying%20Affected person%20CPG.pdf
ACU Follow guideline. (2021). Finish of Life Care.
https://leo.acu.edu.au/pluginfile.php/4991076/mod_resource/content material/1/Finish%20of%20Life%20Care%20CPG.pdf
ACU. (2021). Tyler Morton Advance Well being Directive. https://leo.acu.edu.au/pluginfile.php/4990157/mod_resource/content material/Three/Tyler%20Morton%20AHCD.pdf
ACU. (2021). Tyler Morton Case Research. https://leo.acu.edu.au/mod/guide/view.php?id=4317892
Australian Fee on security and High quality in Well being Care. (2020). Nationwide Security and High quality Well being Service (NSQHS). Retrieved from: https://www.safetyandquality.gov.au/requirements/nsqhs-standards
Brown, D., Edwards, H., Thomas, B., & Aitken, R. L. (2017). Lewis’s Medical-surgical Nursing E-book: Assessment and Administration of Scientific Issues. Elsevier.
Borbasi, S., Jackson, D., & East, L. (2019). Navigating the maze of analysis?: enhancing nursing and midwifery observe (Fifth version.). Elsevier Australia.
Levett-Jones, T. (2018). Studying to Suppose Like a Nurse (2nd Ed). Pearson. 2018
Nursing Midwifery Board of Australia. (2016). Registered Nurse Requirements For Follow. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Tips-Statements/Skilled-standards/registered-nurse-standards-for-practice.aspx
Palliative Care Australia. (2018). Nationwide Palliative Care Requirements (fifth Ed.). Retrieved from https://palliativecare.org.au/requirements

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