NRSG374 Unit Outline Analysis Exercise 2 Particulars
School college students are to provide an 1800 phrase critique of the provided case analysis using solely ONE CPG.
To complete this course of you may must debate and critique associated components of the CPG and case analysis whereas upholding:
• NSQHS and/or
• NMBA necessities and/or
• Nationwide Palliative Care necessities
FAQ’s
Do we have now to make use of all of these necessities to do properly?
• As a result of the rubric states do you have to current -Wonderful data of themes and concepts associated to palliative care- it would present a formidable utility of your data to look at because of this reality using necessities from better than one in all many above and relating them collectively to uphold your critique of the affected particular person care and help the scientific observe guideline chosen will present wonderful data and understanding. Using one customary from one in all many above will not current sturdy utility of knowledge. Nonetheless, a comparability of quite a lot of necessities that as registered nurses we’re required to uphold will fully present very sturdy data and understanding, do you have to hyperlink them collectively properly with proof based observe (EBP)
The place do I uncover all of these necessities?
It’s good to take heed to the whole necessities above as they have been talked about in plenty of objects all by way of your diploma, so now it is time to present your data and convey them collectively. that will help you We now have provided hyperlinks beneath to each of the necessities we would like you to utilise in your critique.
NSQHS
Eight Nationwide safety and Top quality Effectively being Service Necessities to provide a nationally fixed diploma of care that could be anticipated by all consumers from all nicely being organisations
https://www.safetyandquality.gov.au/necessities/nsqhs-standards
NMBA
Seven Necessities that every one Registered nurses ought to uphold to guarantee that they protect their registration and provide particular person centred and proof based preventative, therapeutic, supportive, formative and palliative components to their observe
https://www.nursingmidwiferyboard.gov.au/Codes-Suggestions-Statements/Expert-standards/registered-nurse-standards-for-practice.aspx
Nationwide Palliative Care Necessities
9 Nationwide palliative Care necessities that you just understand properly as they’ve common the framework of NRSG374 and have been elementary for analysis course of 1
https://palliativecare.org.au/necessities
How do I relate these necessities to Frank’s experiences as a affected particular person?
That’s the place your necessary pondering and utility of precept to look at is required, we can’t inform you the way to try this, as a remaining yr nursing unit is essential that you just’re aware of how all of these necessities, uphold and protect, affected particular person centred care, dignity, affected particular person analysis and safety to name a few. Spend some time reviewing these and map out those who you simply think about are very important to your critique.
Due date: 14/10/2020 1600 hours
Weighting: 50%
Measurement and/or format: 1800 phrases +/- 10%
Perform: School college students are required to indicate an understanding of how precept interprets into smart nursing care and the best way proof underpins biggest observe. Each scholar will consider and critique the care given throughout the Case Analysis provided in step with their various of ONLY ONE of the provided Medical Apply Suggestions (CPG’s) biggest suited to the highlighted dialogue.
The place will I uncover the CPG’s that you just actually need me to utilize?
You is likely to be provided with CPG’s for this course of, it is best to choose one in all these solely to indicate the realm of care that you just’re providing a critique of. You do NOT should seek for completely different CPG’s to help your work, nonetheless proof based observe of peer reviewed journal publications are anticipated to further reinforce your critique.
Finding out outcomes assessed: LO1, LO5, LO7
Straightforward strategies to submit: Digital Submission by the use of Turnitin
Return of challenge: The analysis strategies and grade shall be returned by the use of Turnitin.
Analysis requirements: The analysis shall be marked using the criteria-based rubric. Please discover that in-text citations are included throughout the phrase rely whereas the reference itemizing is simply not included throughout the phrase rely. Phrases which is likely to be better than 10% over the phrase rely will not be thought-about
Rubric – could also be found throughout the unit outline in Appendix B
Hyperlink to the unit outline beneath (ought to be logged in to LEO entry this)
https://leo.acu.edu.au/pluginfile.php/4187239/mod_resource/content material materials/11/NRSG374%20Unit%20Outline%20.pdf
Keep in mind the Affected particular person State of affairs
(Levett-Jones, 2018)
Fortunato (Frank) Rossi, is a 60 yr earlier male who was born in Italy and Migrated to Australia collectively along with his partner in 1952, every he and his 58 yr earlier partner Sofia have twin citizenship in Italy and Australia. Frank and his partner observe a strong catholic faith. Frank has labored as a Secondary School Science and Arithmetic coach at a neighborhood Catholic Secondary School for over 20 years and loves his job. He is properly revered by his colleagues and school college students collectively along with his very -quick wit and sharp ideas with draw back solving- that he prides himself on
Sofia has been a maintain at dwelling mother and carer for his or her 2 daughters:
• Eldest Daughter: Anna married Phillip have 2 daughters Bella (6) and Emily (three months)
• Youngest Daughter: Gabriella married Michael have 1 son (18 months earlier)
Collectively they’ve had a good looking life, with supportive family visiting from Italy and the Rossi family themselves with the flexibility to go over to Italy for lots of family holidays. Every Frank and Sofia are very excited and having enjoyable with being grandparents, they’re wanting forward to Frank’s dedication for an early ‘self funded retirement’ to take pleasure in additional time with the family. Frank has organized collectively along with his college to have the flexibility to undertake a small amount of casual instructing if he and his family require some small earnings as quickly as he has retired, although he is very desirous to work in his yard and spend time serving to to raise the grandchildren and profit from the just a few years of arduous work that he and Sofia put in to help their family and the -good life- they’ve created in Australia.
Three months prior to now
Frank expert some confusion at work and a seizure -of unknown origin- that was witnessed by his partner and grandchildren. Sofia immediately known as 000 and Frank was transported urgently beneath the care of paramedics to the emergency division (ED) of a big metropolitan hospital as they lived close to the city.
Purchase Cues and Information
(Levett-Jones 2018)
Earlier Medical Hx
• Tonsillectomy as a child
• Ex smoker (hand over smoking 25 years prior to now was a packet a day smoker)
• Meals plan Managed kind 2 Diabetes
Current Historic previous
• Seizures of unknown origin
• Confusion
• Headache
• Blurred imaginative and prescient
• Difficulties with draw back fixing and dedication making
• Gradual onset of speech disturbance
• Muscle Weak level
• Behaviour Modifications
• Vomiting
• Sleepiness
• sluggish pupil response to light
Gathering new Information
Frank’s necessary indicators upon admission to medical ward
RR : 18
HR: 84 bpm
BP: 185/95
SaO2: 96% on 3Lmin by the use of N/P (For Comfort measures)
Raised Intracranial Stress (ICP) – fastened headache
GCS – 9/15 (eyes open to painful stimuli 2 / confused and disorientated verbal response 4 / Irregular Flexion from painful stimuli three)
Intermittent Affected particular person Notes
-Affected particular person transferred to medical ward following observed seizure of unknown origin by partner and grandchildren who known as 000 for paramedic help. In ED affected particular person’s acutely conscious state was altered with confusion and incapability to recognise wife-
-Pupil measurement of every eyes was equal nonetheless pupillary light reflex is sluggish, constructive babinski sign response bilaterally, renal function common, affected particular person experiencing double incontinence, common FBE and U&E-
-Preliminary MRI clearly confirmed abnormalities throughout the frontal and temporal areas, with a differential Assessment of metastatic tumors throughout the thoughts from an unknown primary-
Frank was experiencing Elevated Intracranial Stress seemingly from thoughts lesions and doable Assessment of a Glioblastoma Multiforme (GBM)
Differential Diagnoses had not however been dominated out
-Affected particular person was administered mannitol every 12/24 over 16 days to chop again Intra Cranial Stress (ICP,) Lyrica 150mg BD for seizure train, and Diazepam 10mg PRN….. 5 days publish preliminary seizure pt woke with common cognitive responses and recognition of family members as quickly as ICP had begun to chop again. Progressively pt’s potential to walk with out deficit returned. Pt was completely continent, had good long term memory recollection, nonetheless fast time interval memory was impacted-
-Pt’s oral mucosa had quite a lot of abrasions and thrush evident from doable harm all through seizure, affected particular person complained of mouth and throat ache, normally refusing to eat and drink-
-Differential Diagnoses of ?An an infection, ?metastaic cerebral tumors have been talked about nonetheless following lumbar puncture for assortment of cerebro-spinal fluid (CSF) specimen, and extra MRI outcomes displaying quick tumor progress notably in Frank’s frontal lobe merely 18 days after his preliminary ED presentation, the Assessment was extraordinarily indicative of a GBM-
-Affected particular person and partner agreed to surgical tumor resection as a palliative measure with the knowledge that this was not a treatment. Histopathology publish surgical resection clearly acknowledged a shortly rising GBM with temporal lobe metastases as a result of the definitive Assessment. A family meeting was organized with the neurosurgeon, oncologist, palliative information, social worker, nurse unit supervisor, Frank and his family to debate options-
Confirmed Assessment, medical imaging and histopathology outcomes
Following CT Thoughts and MRI it was concluded that Frank had a Glioblastoma Multiforme (GBM) in his frontal lobe which had seemingly metastasized in every temporal lobes, thus his prognosis was devastatingly a Stage IV GBM with a possible survival of two – three months with out surgical resection and/or palliative radiation treatment.
-Family instructed to debate and full an Superior Care Directive whereas Frank was competent with the knowledge that his ICP was extra more likely to improve as soon as extra, and a name on strategies to proceed with interventions was wished. Palliative radiotherapy was provided to Frank, he and his partner refused and decided to be transferred to an inpatient palliative care unit nearer to their family the place he might go dwelling on day visits and likewise spend additional time collectively along with his family on the palliative care unit, comparatively than in a busy medical ward-
Whereas on Day go away Frank had one different seizure and was transferred once more to the Primary Ward for consider …..Frank has now spent some time in a standard medical ward on the Tertiary Stage Metropolis Hospital that he was initially transferred to by ambulance 2 weeks prior to now following one different seizure whereas he was at dwelling all through a go to there from the palliative care unit. All through his re-admission the following cues and data have been collected and a Assessment made. Earlier to his change and re- admission once more to the palliative care unit in an outer metropolis hospital nearer to his family dwelling
Processing Information
Arrival and Admission to the Palliative Care Unit
Frank expressed some personal family historic previous and wishes for his sickness improvement
-Frank educated medical and nursing workers that his father had died from a GBM, pressured, undignified crawling on the bottom from terminal restlessness and his solely want was to not die like his father had-
-Nil Superior Care Directive had been completed with Frank and Sofia as they thought they nonetheless had a great deal of time when educated about an ACD on the Medical Ward. Nonetheless, with Frank’s fluctuating ICP and disorientation he is now deemed incompetent for any approved selections or changes to his Will-
-Sofia was Frank’s medical Power of Authorized skilled, presenting paperwork to help this to the admitting palliative Care Workers-
-Sofia stayed with Frank all through his admission and collectively they communicated that they wanted him to be comfortable and dignified-
Medicines Commenced as quickly as reviewed by Palliative Care Workers
• Dexamethasone: 8mg BD oral or S/C (0800 and 1400) – To Help in low cost of ICP and Ache Help from headache (Keep in mind unintended results and behavioural changes from dexamethasone – How can these be managed?)
• Lyrica : 75mg BD Oral (0800 and 2000) – To deal with seizure train (keep in mind unintended results of Lyrica, are there completely different selections that is likely to be thought-about for Frank?)
• MS Contin 10mg BD Oral (0800 and 2000hrs) – Analgesia
PRN Medicines
• Morphine 5-10mg S/C
• Midazolam 2.5-5mg s/c
• Ondansetron 8mg wafer (most dose of 16mg in 24 hours ) for nausea and vomiting
Upon arrival and admission to the palliative care unit the following referrals have been made
• Physiotherapist consider for analysis of strolling Helpance on account of rising parasethsia and weak spot in Frank’s legs
• OT dwelling analysis and kit for dwelling visits
• Dietician to guage lack of urge for meals, cachexia and anorexia
• Pastoral care
• Catholic Priest visits and need to be anointed ASAP
Determining points/factors
Points for the Palliative Care Setting
Frank arrived on the Palliative Care unit late on a Sunday afternoon at 2pm, he was welcomed by his RN who undertook the following assessments and discussions between him, his partner and two daughters:
• Welcome and orientation to the ward
• Falls Hazard Analysis
• Braden Stress Hazard Analysis
• Ache Analysis
• Allied Effectively being Referrals made
• NOK contact particulars
• Modified Karnofsky Score of 40-50
• RUG- ADL 10+
• SAS Machine Partially Completed 5 of the 7 indicators solely (consider to debate fatigue and bowel factors tomorrow as affected particular person was sleepy and Sofia had gone dwelling to get clothes and can be found once more to sleep the night on the palliative care unit
• Palliative Care Half – -Deteriorating-
What could also be some points I need to ponder as an RN caring for Frank and his family ?
• Nationwide Palliative Care Necessities ?
• NSQHS Necessities?
• NMBA Necessities?
• What do I study GBM illness Trajectory?
• How will I recall information on GBM?
• The place are quite a lot of the best areas to entry EBP on GBM and current necessities of care?
• What’s my perform in supporting Frank’s partner and family?
• What’s a SAS Machine?
• What is the Points Severity Score/ (PSS)
• What’s a Modified karnofsky Score?
• What’s a RUG-ADL Score?
• How do I resolve the Palliative Care Half that the affected particular person is in?
• Do I need to start having some powerful conversations and ask Frank and his partner what they understand about his prognosis?
• What quite a lot of the problems that Frank may face?
• Are there any explicit indicators that I should be in quest of when creating Frank’s care plan?
• What is the pathophysiological response when anyone dies from a GBM?
• What must I anticipate?
• Am I ready to deal with this?
• The place do I get help as an RN if i actually really feel overwhelmed?
• Have I assumed enough about my very personal properly being and resilience for this expert soeciality?
• How do I take care of a deceased particular person?
• How will I do know what to say?
stablishing Goals and Taking Movement
(Levett-Jones, 2018)
Monday Morning
All through handover the day after Frank was admitted to the Palliative Care Unit we’re suggested that he had a fall in a single day attempting to get to the toilet and have develop into confused as he was unable to void, telling the nursing workers that his -feet felt numb-.
Frank was reviewed by the Night Primary Medical Registrar who in session with the Urology Registrar decided to insert an IDC into Frank as on the bladder scan it confirmed that he had 800 mls in his bladder, and was in obvious discomfort from urinary retention. All through this course of the medical and nursing workers gave Frank a breakthrough of s/c morphine 5mg to Help collectively along with his discomfort. He had a full neurological analysis with lower limb weak spot evident, nonetheless nil pores and pores and skin tears, breaks or lacerations to the physique or head. Frank appeared barely confused, although was oriented to place and particular person.
Frank was despatched for added scans throughout the morning displaying spinal metastases and a shortly advancing spinal wire compression, which is likely to be thought-about unusual nonetheless seen in circumstances of GBM. Spinal wire compression in these circumstances are sometimes referred to as drop metastasis whereby cellular unfold all through the sub-arachnoid space travels all through the cerebrospinal fluid (CSF) onto the exact spine as an affect of gravity usually settling and rising throughout the lower thoracic and better lumbar spine areas (Shripad, et al, 2015).
Talking with Frank and his partner
Frank and his family are devastated by the knowledge of the quick improvement and the knowledge that he is dropping additional independence with an incapability to walk, and administration his urinary and faecal continence. Frank turns into very withdrawn and refuses to take his drugs and eat.
(Levett-Jones, 2018)
Wednesday Afternoon
The afternoon shift nurse walked in to introduce herself and situated Frank alone as his partner had left solely half an hour prior to now, his respiratory is temporary, shallow and laboured, with a respiratory cost of 6, Frank is aggitated and attempting to crawl out of bed, eradicating his clothes and pulling out is S/C breakthrough Intima’s (s/c butterfly).
The Palliative Care Workers consider Frank and recognise indicators and indicators of terminal restlessness seemingly from an inreased ICP and ongoing sickness progress. Frank’s partner is called and educated of his sudden alteration in behaviour and instructed syringe driver was required to be commenced as his refusal to take his oral drugs notably his dexamethasone might need contributed to this cerebral oedema. Sofia agrees to subcutaneous drugs being commences as she promised him when his father was dying that she would do regardless of she might to confirm he died with dignity and respect. Sofia began making her methodology once more to the Palliative Care Unit collectively together with her family.
Evaluating and Determining new points
(Levett-Jones, 2018)
Wednesday Night time
Frank has been unresponsive, and experiencing intervals of apnoea since earlier this afternoon. He has been commenced on a syringe driver containing dexamethasone, morphine and midazolam. Frank has not spoken to his family since they arrived nor has he held or squeezed Sofia’s hand.
Frank is now completely mattress sure thus his Modified Karnofsky Score is 10, with him now throughout the -Terminal- Palliaitve Care Half.
Frank is on a stress mattress, and is being turned every 2-4 hours or when exhibiting sounds or indicators of moaning or restlessness to maintain up comfort and pores and pores and skin integrity, this takes x2 nursing workers to hold out this care, along with full mouth care as he is now longer consuming or consuming.Frank’s RUG-ADL full is now 18
Wednesday Night / Early Thursday Morning
All by way of the night Frank’s family stays by his facet listening to his -rattly breathing-, nursing workers place Frank forwards and backwards normally comparatively than on his once more to guarantee that terminal secretions drain from his mouth, he is administered PRN doses of glycopyrroalate S/C as an anticholinergic agent to help in excessive secretions and try to ease his work of respiratory.
At 0215 hours Frank’s intervals of apnoea began to change to Cheyne-Stoking upon examination Frank’s pupils had become mounted and dilated, he was cyanosed spherical his mouth, on his fingers, toes and knees. Frank’s family was with him throughout the room when inside a few fast minutes he ceased respiratory and died. His demise was rather a lot faster than his family had anticipated leaving workers to help them and make clear the outcomes of raised ICP and thoughts herniation into the thoughts stem, that will occur with a GBM Assessment.
Reflection
(Levett-Jones, 2018)
Top quality of Life Points
Keep in mind quite a lot of the next as you select one in all many scientific observe suggestions geared up throughout the assessments folder that will help you with working by the use of Frank’s Assessment, surgical preparation and switch to the palliative care setting all in a matter of weeks from the time he was recognized with a terminal illness from being at a stage in his life that he had labored for to retire and experience his family.
• Issues are multifactorial for affected particular person’s with a GBM inflicting not solely bodily ache nonetheless social, psychological and emotional factors as they uncover their social lives being restricted related to the reminder that they’ve a life limiting illness that could be a painful psychological reminder of the poor prognosis of a GBM (Bennett, et al, 2016)
• Speedy Assessment and sickness improvement leaves little time to consolidate and put collectively for demise – spiritual needs ought to be thought-about
• Was an ample ache scale used?
• A quick decline like Frank’s would not give the affected particular person nor the family time to prepare, are there another interventions that may have been thought-about to Help Frank’s family after his demise ?
• How can Frank’s family be provided help and persevering with bereavement follow-up ?
• Keep in mind the ample and detailed use of the SAS software program
• Is there one thing that may have been accomplished to guarantee that Frank had his dexamethasone to Help collectively along with his raised ICP?
• Does Frank have a correct to refuse remedy ? Was he competent to make this dedication?
• What can nursing workers current households and the deceased affected particular person to help them of their grief, loss and should say goodbye?
• Are the Nationwide palliative Care necessities thought-about throughout the CPG?
• Have been the NMBA and NQHS necessities thought-about throughout the CPG?
• Can the CPG be improved in any choice to Help its affiliation with care planning, analysis devices and care provided throughout the palliative setting?
• What’s your accountability as an RN to know the sickness trajectory of your affected particular person’s, plan their care and the care of their cherished one’s by the use of the knowledge of nursing necessities?
Keep in mind these components and the quite a few others that you would have moreover thought of you mirrored on Frank’s fast and aggressive journey with a GBM diagnosi
Medical Apply Suggestions
CPG’s
What are they?
Why are they very important?
How do they help us to maintain up extreme ranges of care?
Will we improve our care by reflection and updating CPG’s by the use of proof Based Assessment?
Frank’s Case Analysis
As described throughout the Unit Outline you’re truly required to:
• Three CPG’s are on the LEO tile select ONE of the Medical Apply Suggestions provided on the Analysis LEO tile
• Two of these CPG’s are proper for this case analysis whereas one is NOT (Choosing the right CPG as per requirements three of the Rubric) is essential all through the workplace.
• The CPG’s to choose from are:
o Care of the Dying affected particular person
o Organ and Tissue Donation
o Managing Psychological Factors inclusive of Terminal Restlessness
• Consider and critique the care given to Frank in opposition to the CPG you’ll have chosen and providing proof to help your critique by the use of completely different additional Assessment that you will undertake
• Highlight the importance of the quite a few necessities and the best way they have an effect on our observe
o NSQHSS and/or
o NMBA necessities and/or
o Palliative Care necessities
• Reveal data on the illness trajectory of a Glioblastoma Multiforme (GBM) consistent with palliative Care concepts
• Current hyperlinks between the case analysis and your chosen CPG to find out highlights or limitations in care
• The place any areas of the CPG omitted throughout the care?
• Do you think about that the CPG requires updating? If that is the case help with trendy literature
• Make sure that your sources are all trendy (all through the ultimate 5 years) and from proof based sources)
• Study all instructions and the rubric very fastidiously
• PLEASE NOTE, YOU DO NOT NEED TO INCLUDE ALL OF THE POINTS ABOVE IN YOUR ESSAY. THESE ARE GIVEN TO YOU TO ENVOKE THOUGHT PROCESS
