APN105: Applying Nursing Practice (A) Assessment 1B Response Template

This is a response template for Assessment 1B of APN105: Applying Nursing Practice (A) course. It includes questions and answers related to holistic care, palliative care, patient wishes, values and beliefs towards death and dying, scope of practice for an Enrolled nurse, physiological changes in a dying client, members of the MDT, swallowing and breathing difficulties, and the importance of oral care.

APN105: Applying Nursing Practice (A)
Assessment 1B response template
ASSESSMENT 1B response template
Student Name
Date
Course HLT54115 Diploma of Nursing
Subject Code and Title APN105: Applying nursing practice (A)
Unit(s) of Competency HLTENN010 Apply a palliative approach in nursing practice
HLTENN013 Implement and monitor care of the older person
Performance criteria,
Knowledge evidence and
Performance assessed
PC:
HLTENN013 – 1.8, 1.9, 2.1, 2.4, 2.6, 2.7, 3.2, 3.3, 4.2 – 4.6.
HLTENN010 – 1.2, 1.2, 1.4 – 1.6, 2.1 – 2.4, 3.1 – 3.6, 4.1 – 4.5, 5.2,
5.2
PE:
HLTENN013 – 1, 2
HLTENN010 – 1, 2, 5
KE:
HLTENN013 – 2, 4, 5, 10, 16
HLTENN010 – 1, 2, 3, 4, 5, 6, 9, 10, 11
Title of Assessment Task Case Study
Type of Assessment Task Case study with short answer questions
Length 17 questions
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Task Instructions
To complete the assessment, you must respond to a number of questions, which are based on the case
study. These questions must be answered in full. When responding to the questions, please pay attention
to the entire question being asked, as well as the prescribed word count, if provided. Use the correct
medical terminology when answering all questions.
Case Scenario:
You are an Enrolled Nurse working in a residential facility. Mrs Hong has been a resident at your facility for
10 months. After the initial settling in period, which Mrs Hong found difficult due to her limited English and
early dementia, she is now settled and has a good routine that she and her daughter are happy with. Mrs
Hong’s daughter, Yu Yang, visits her mother daily and assists with bringing in Asian food for Mrs Hong. At
times however, Mrs Hong still finds it challenging to interact with other residents and staff and can become
quite upset and distressed, especially if her daughter is late with her food.
Five months ago, it was noted that Mrs Hong had a deformity in her right breast. On examination it was
determined that Mrs Hong had stage 3C breast cancer. Mrs Hong and her daughter, Yu Yang, were
provided with information relating to the condition and the options available. They have decided to opt for
palliative care. Mrs Hong does not want any active treatment and an advanced care directive has been
completed with her instructions. In the last 2 days, Mrs Hong has shown signs of deterioration with her
condition, is unable to eat or drink, and is confined to bed. She remains conscious at present and her
daughter, Yu Yang, is with her for most of the day.
As part of your role, you are working with a Registered nurse to provide care for Mrs Hong considering her
choices for palliative care.
Character Briefs reviewed:
Mrs Fei Hong:
Mrs Hong is a 70 year old lady of Chinese origin.
Mrs Hong’s background includes;
 Comes from one child family, Chinese background
 Speaks little English
 Has no extended family
 Came to Australia to help her daughter, Yu Yang, raise her son 19 years ago.
 Is beginning to demonstrate signs of dementia
 Interferes in parenting of twins
 Dictates cooking must be Asian
 Has hearing and sight impairment
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Mrs Yu Yang McFarlane:
Mrs McFarlane is Mrs Hong’s daughter. She is 38 years old and married to George McFarlane. She has a
son, Jason, and 3 year old twins.
Mrs McFarlane’s background includes;
 Came to Australian as a University student
 Fell pregnant at the age of 19 – did not marry
 Married George 5 years ago
 Has 3-year old twins at home
 One twin has developmental disorder
 English language is good
 Was/Is isolated with no extended family
 Her issues will be those of isolated immigrant
 Prefers to cook Asian food
 Needed help with raising child and invited Chinese mother to Australia to help out
Mr George McFarlane:
Mr McFarlane has been married to Yu Yang for 5 years. He is 53 years old. Mr McFarlane is reliant on Yu
Yang to complete all domestic duties as he is not self-sufficient. He is a long haul truck driver and is often
away for work. He earns good money.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 1
Describe the term ‘holistic care’
Provide 10 examples of how you would provide holistic palliative care to Mrs Hong and
her family.
Response:
Holistic care can be defined as the process of treatment to whole person: mind, body and souls or in other
word combination of traditional and allopathic treatment which is prescribed by doctors in the form of
complementary medicines. Holistic treatment generally gives to life threatening disease like cancer patient
whereas treats patient through chemotherapy and acupuncture. Palliative care is a type of approach that
enhance quality of life of patients and their families who faces problem from life threatening illness and
prevent it’s negative impacts and provides relief suffered person by determining disease.
 At the post of nurse, I will provide holistic palliative care to Mrs Hong and her families such as I will
provide her moral supports because she was lack behind English language.
 Mrs Hong unable to communicate with other people and specially her daughter due to dementia, so I
will help her to remind her families and daughter time to time which keeps her happy and satisfied
instead of upsetting.
 She has high craving of Asian food so I will provide her Asian food which keeps her emotionally and
spiritually happy.
 Mrs Hong has sign of hear impairment so I will support her to understand things through writing paper
or facial expression then she will not feel socially isolated herself.
 She is suffering from dementia and hear impairment so I will provide her formulary compliance time to
time which support to keep her memory sharp.
 She had 3C breast cancer due to right breast deformity so I will do constant testing as per doctor order
and gives value-based care services. it will reduce her pain which occurs in breast.
 I will provide consolation to her family as well to assure them I will take care her like my family, thus I
will provide them emotional support.
 Mr Hong has Chinese background and comes to Australia to help her daughter because she has
miscarriage. So, I will try to create such environment which keeps her close to religion and make her
feel like her life is valuable for her and family so that she wishes to get well soon.
 At the post of registered nurse, I will set her food schedule that supports to manage medicine time
schedule so that she does not face any medicine interaction in her body. So, I will take care of this thing
more effectively.
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Assessment 1B response template
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
TASK Assessment Criteria
Question 2
What document would outline Mrs Hong’s wishes for her care if she was unable to tell you?
What details might this document include?
Response:
Mrs Hong was suffering from dementia and hearing impairment, so in that situation she wanted such care like
nurse helps her to understand things while interacting with other staff and her family members. Due to
dementia she was unable to recall her family and others which made her distressed and upset. In this state she
requires her caregiver helps her to recall things before meeting to other so that she can interact with her family
and others effectively. Apart from this, when she was suffering from third stage breast cancer that time, she
was unable to take food and drink as well. in that situation, Mrs Hong’s would expect from caregivers that they
insist their family to spend long time with her. Overall, she was facing challenges to interact with resident and
staff that time she wanted to communicate with them more effectively but she was unable, in that state she
wanted such care which made her feel efficient to communicate with other people effectively.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 3 Discuss your values, beliefs and attitude towards death and dying. Include your
reflection on how these may affect your provision of care to the client
Response:
Whenever I listen about life-threatening illness like cancer, tumour and others I become restless and more
emotional because these diseases are called life threatening because there has no treatment on last stage. S far
as I think there is a big task to treat such patients who are already on last stage and have limited days or
months to live their life that makes mind more sensitive and too much pathetic for them. Whenever I deal with
such clients that directly affect my provision care because I want to give best to best care services in different
terms like socially, physically, physiologically, spiritually, emotionally and others so that such clients does not
feel themselves socially isolated and lives their limited days or months with happy moments. Apart from this, I
take care of their food and medicine schedules, medical testing, exercise and others because it keeps them
healthy and away from undesirable medicinal side effect which occurs through acupuncture and chemotherapy
treatments.
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
TASK Assessment Criteria
Question 4 What is the scope of practice for an Enrolled nurse when caring for a dying client? (Refer
to the NMBA Enrolled Nurse standards for practice and code of conduct)
Response:
There is large scope of practice for an Enrolled nurse while offering care services to a dying client such as
 It is mandatory for registered nurse to practices all professional obligation under the national law and
keeps their practice safely, effectively and collaborative as well which leads productive result on life
threating illness client.
 Enrolled Nurses must posses’ cultural practices and respectful relationships. For example, nurse should
engage with such client who suffers from life-threatening disease to keep them culturally safe and
treats them respectably while making with them open and honest professional relationship. So, it is
primary duty of enrolled nurse to follow all obligation related to their privacy and confidentiality.
 Enrolled Nurse must practice to keep professional behaviour while offering care services to such dying
client.
 Enrolled Nurse must have extensive knowledge regarding research in health that supports to aware
about quality of healthcare and policy development. When they have massive knowledge then they can
support to take effective decision to keep life-threatening patients risk free.
These are important practices of Enrolled nurses when providing care services to the patient.
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
TASK Assessment Criteria
Question 5 Identify 4 possible physiological changes that you may observe in a client who is dying
Response:
There are various physiological changes that can observe in a client who suffers from last stage of life-
threatening illness or on dying situation such as difficulties to eat and drink, inability to take breathing own,
restlessness, changes in urination and decreases response of mind on particular fact.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 6 Provide examples of 3 other members of the MDT and how they can assist in providing
holistic care to Mrs Hong and her family.
Response:
Clinical nurses, social workers and occupational therapists etc. are major member of multidisciplinary team
who can support in offering holistic care to Mrs Hong and her family.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 7
Identify signs of swallowing and breathing difficulties. What management strategies
could you use in these cases?
Why is oral care important to consider in a client who is unable to eat or drink?
Response:
There are number of signs to determine swallowing and breathing difficulties such as:
Swallowing signs
 Food or medicines are sticking in mouth, throat or chest that denotes swallowing
 Coughing and chocking is also the sign of swallowing
Breathing difficulties signs
 When nasal and chest congestion situation take place that creates difficulties in breathing.
 Wheezing is also sign that denotes client finds difficulties in breathing.
Management strategies
For swallowing
There are various management strategies which could use to deal with swallowing and
breathing difficulties:
Swallowing therapy is the best approach that will improve this muscle to response and
learns client how to response on them.
For breathing difficulties
If a person finds difficulties to take breath then make them sleep in relaxed position, otherwise could sit the
person forwards while providing support with table etc. are first aid which could provide at home. otherwise
CPR (Cardiopulmonary resuscitation) is the best management emergency care strategy that could support to
manage circulation and breathing of person till then emergency medical services does not arrive.
Significance of oral care
The person who does not able to eat and drink then oral care plays significant role to keep patient alive. For
example, oral care keeps person’s lips and mucosa soft, clean, moist and highly intact. To prevent food debris
and dental plague requires to keep cleaning mouth and teeth effectively as well as it improves oral intake.
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 8 Mrs Hong’s breast tumour has developed into a malignant wound. What does this mean
and how would you care for it?
Response:
Mrs Hong was suffering from breast tumour initially but she did not take any medical treatment due to
unawareness. Initially breast tumour dysfunctional fewer cells and tissue of breast but later on it transformed
into maligned wound means cancer has grown under the skin and breaks functionals cells as result develops a
wound, While testing of Mrs Hong found out that she was suffering from last stage breast cancer because in
report identified a big wound in her right breast that denotes her breast tumour has taken place of malignant
wound. However, breast cancer is considered advanced skin cancer because it develops fungating wound which
causes patient potent distress and resist themselves to live at home. As Enrolled Nurse I would provide
comfortable living environment to Mrs Hong whereas she can live peaceful. Radiation therapy gives such
patients who suffers from last stage. As same case with Mrs Hong, I would take care her medication and food
so that she would not have face any discomforts. I would give first priority to such patient and provides all type
cares like social, emotional and physical which they need in such situation.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 9
What signs/ changes may you observe in Mrs Hong that may indicate that she
deteriorating further?
Who would you report these changes to?
How would you support Mrs Hong’s daughter as she witnesses her mother
deteriorating?
Response:
Mrs Hong was too much distress and upset and she had more thickening in her right breast etc. Apart from this,
she had dementia and hearing impairment etc. were observed by me as enrolled nurse then I would report to
doctor who has taken charge of Mrs Hong then he tested her through some medical techniques. Then doctor
reported that Mrs Hong is suffered from third stage breast cancer. I would give consolation and encourage Mrs
Hong’s daughter who knows that her mother deteriorating to be stayed with her mother more time which
would make her feel happy and mentally strong as well. I would assure Mrs Hong’s daughter that I would take
care like my family that would make her more comfortable.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 10
Mrs Hong is no longer conscious, but is demonstrating signs of distress by groaning like she
is in pain. Consider how you can assist in decreasing Mrs Hong’s distress. (Consider
nonverbal cues of pain and distress.
What options for pain relief would you consider if Mrs Hong cannot take oral medications?
(consider pharmacological and non-pharmacological treatment options)
Response:
At the post of Enrolled nurse, I will read her facial expression and eye contacts to understand her level of
distress which occurs due to pain. To reduce her pain will give pharmaceutical compliance that will not only
reduce her pain but also creates sedation that keep her away from distress phase. If Mrs Hong unable to take
oral medication then I would give her pain relief medicine through penetration methods like injection that give
her instant relief from her distress level. I would give her massage therapy as well that will support to reduce
pain of Mrs Hong. Massage therapy considers non-pharmacological treatment which does not posses any side-
effect.
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
TASK Assessment Criteria
Question 11
Consider what nursing interventions may be required for Mrs Hong now that she is
unconscious and no longer able to provide for her own self care needs. (consider
activities of daily living that Mrs Hong can no longer do for herself)
Response:
When Mrs Hong unable to take decision herself for her daily living activities in that situation only nurse can give
actual treatment and performance to help her. The primary duty of nurse is that nurse must use own
knowledge, critical thinking skills and experience to decide that which intervention can support patient the
most. For example, Mrs Hong like to interact with people specially her daughter then nurse influence her family
or daughter to meet her mother on regular basis. Mrs Hong was distressed and upset due to pain so nurses
must have such critical thinking skills so that they can understand needs and pain of Mrs Hong.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 12
You assess Mrs Hong and believe she has died. What is the legislation for the
notification of a death in a healthcare facility in your state? What action should you take
within your scope of an Enrolled Nurse?
Response:
Dying law is the legislation for denoting of death in a healthcare facility in Australia. With this law I will inform
all healthcare professionals and close eyes of Mrs Hong after death. As enrolled nurse I will inform to my senior
professionals to about her death.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 13
What care activities are undertaken once a person dies?
How would you maintain respect and dignity for a client when preparing their body
after death?
Response:
When person is died then provides personal care such as washing and dressing the body. Provides supports and
consolation to the died person’s family and friends and request them to signpost for taking person’s body. At
the post of Enrolled Nurse, I would give extensive condolences and take respectful name while preparing
client’s body after death and lay him flat and straight their hand and legs as much as possible. Thus I would
maintain dignity and respect of client.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 14
How does the care requirements change for a patient who dies who:
 Requires an autopsy
 Wants to be an organ donor
(consider the legislative requirements for the care of a person after death who requires
an autopsy or chooses organ donation)
Response:
The legislative requirement changes in two cases such as for first instance when patient commit suicide or
killed by someone through poison or any objects. In that situation legislative requires an autopsy to determine
reason behind of death. Autopsy supports to identify specific reason of death like death is occurred naturally or
intentionally. Organa donation requirement situation occurs by legislative when patient or client is died
naturally and from life-threatening disease, in that state doctors are allowed to take some good organs for the
care of person after death.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 15
How would you provide support to Mrs Hong’s daughter after her death?
Provide 3 community services you could refer Mrs McFarlane to, to assist her with grief
and loss?
Response:
At the post of nurse, I would give condolence to Mrs Hong’s daughter after her death and tell her that she love
to interact with u more and more and would say her to keep control on her emotions. I would suggest Mrs
McFarlane to meet with psychological therapist that would assist to overcome with grief and loss. I could refer
her to interact wither her family and finds more and more that would assist to overcome sadness and grief. To
listen free mental wellbeing audio is also best option that would keep away from loss. So I would refer this type
care service to Mrs McFarlane as well.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 16 How would you support your own self-care after caring for a long term client who has
died? Provide 3 examples of ways you could take care of your own wellbeing
Response:
I would take few days off to keep my mind cool and spends with my family and friends that would keep my
mind stress free. I would take proper diet, exercise and sleep that would keep me healthy and away from
negative aspects which comes from patients who has died. I would take support of psychological therapies to
keep my soul and mind peaceful. Such ways could support me keep own self-care effectively.
TASK Assessment Criteria
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APN105: Applying Nursing Practice (A)
Assessment 1B response template
Question 17
What services are available in your area which can assist you and your healthcare
colleagues to debrief after a death in your workplace? (Provide 2 – 3 examples of
services available and how they can assist with debriefing and supporting healthcare
professionals)
Response:
To organize training program is the best option that will support me and heath care professionals to become
more trained to deal with such situations. With this program we can learn how to take effective decision to give
best care services to the person who is no longer conscious. To practices value-based framework is another
service in resident facilities that can support me and healthcare professionals to give such service to the life-
threatening patients which improves their quality of life. To lead high availability of medical emergencies and
equipment’s service will support me and healthcare professionals to treat such patient more effectively.
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