Nursing Assignment: Palliative Care and Nursing Interventions

This nursing assignment discusses the case scenario of Mrs. Brown and identifies two care priorities for palliative care. It also provides nursing interventions to manage shortness of breath and address symptoms of depression and panic attacks.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
According to Hudson and Aranda (2014), palliative care can be defined as the
specialized medical care that is provided to patients with chronic illness with the aim of
improving their quality of life. Palliative care typically focuses on the provision of relief from
the stress and symptoms of a serious illness (Hudson et al., 2015). The central aim of
providing palliative care is to alleviate the quality of life for both the patient as well as the
family members. This essay intends to discuss the case scenario of Mrs. Brown and identify
two care priorities and accordingly make use of the evidence base to apply appropriate
nursing intervention so as to acquire positive patient outcome.
Discussion:
Upon closely analysing the provided case study, it can be mentioned that the primary
complaint of the client is acute shortness of the breath and increased coughing which has
resulted in limiting her ability to perform physical activities. In addition to this, it has also
been reported that Mrs. Brown had been previously diagnosed with depression and also
experienced panic attacks. Further, she feels that because of her deteriorating health condition
she would become a burden for her family. With the discussed medical history of the patient,
the care strategies would be planned in the subsequent paragraphs.
Identification of care priorities and application of appropriate nursing interventions:
The first care priority for Mrs. Brown would be to manage her shortness of breath. As
has already been mentioned that due to the increased shortness of breath, Mrs. Brown is
finding it extremely difficult to cope with her activities of daily living. In order to manage the
symptom, the nursing goal would be to promote a clear and effective airway. In addition to
this, the nursing goal would also comprise of maintaining an effective breathing pattern for
the patient which would be within the normal established respiratory limits. The nursing

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intervention would comprise of placing the patient in a proper body alignment so as to
promote maximum breathing. Research studies suggest that a sitting posture with rested back
permits maximum lung excursion which subsequently promotes maximum chest expansion
(Cabral et al., 2015). In addition to this, the nurse would encourage the patient to sustain deep
breaths. This would be done by demonstrating effective breathing exercises. The nurse would
effectively highlight slow inhalation followed by holding in the breath for a few seconds and
then passively exhaling. In addition to this, the nurse would effectively demonstrate the use
of incentive spirometer and encourage the patient to yawn. Research studies indicate that
these breathing exercises promote deep inspiration which subsequently increases the
oxygenation level and prevents atelectasis (Cabral et al., 2015; Cancelliero-Gaiad et al.,
2014). In addition to this, controlled breathing methods have also been reported to promote
slow respirations in patients who are experiencing breathing abnormalities. As stated by
Sanduzzi et al. (2014), prolonged expiration prevents the possibility of air trapping. Also, a
consultation with the physician would be arranged and the patient would be administered
respiratory medication and antihistamines. Beta-adrenergic agonist medications help in
relaxing the airway smooth muscles. Also, the beta-adrenergic medications cause broncho-
dilation which helps in opening the air passages (Sanduzzi et al., 2014). This facilitates
effective breathing. In addition to this, antihistamines have been reported to clear allergic
congestion within the nasal cavity, a condition, also known as rhinorrhea.
The evaluation of the applied nursing interventions would be measure by conducting a
vital assessment of the patient. The success rate of the applied nursing intervention would be
measured by the ability of the patient to demonstrate maximum lung expansion with adequate
ventilation and the respiratory rate would be expected to remain within the permissible
respiratory range.

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The second care priority for Mrs. Brown would be to adapt a palliative care approach
and effectively address the symptoms of depression and panic attacks. In addition to this,
health literacy as well as counselling would be imparted to Mrs. Brown as well as her family
members so as to foster holistic wellness. The nursing intervention for addressing the
depression and panic attack symptoms of the patient would be managed by reinforcing a safe
environment. In addition to this, a thorough nursing assessment would be conducted to
identify the psychological stressors that elicit a negative impact on the mental wellness of the
patient. Upon identification of the life stressors, the family of the patient would be contacted
and a referral would be made for psychological counselling. In addition to this, the patient
would be notified about different self-help groups within the community. The supporting
rationale for the referral can be explained by making a network of support resources available
to the patient so as to diminish negative feelings pertaining to worthlessness, hopelessness
and being a burden to the family (Hudson et al., 2015). Research studies mention that
psychological counselling help in fostering optimism and elevated self-esteem in patients that
accelerated the process of recovery (Rumbold & Aoun, 2014). In addition to this, the nurse
would educate and empower the patient as well as the family members so as to present an
overview about the patient’s health condition. In addition to this referral of family
counselling would help in disseminating awareness about the mental state of the patient and
at the same time would also help in taking care of the psychological stress of the family
members on account of the patient’s chronic illness. According to Fox (2014), adapting a
family centred practice helps in promoting positive outcome for the patient as well as the
family members. This accounts for the reason why the referral to psychological counselling
has been made for the patient as the family members. In addition to this, the family members
of Mrs. Brown would be informed about financial support services available so as to alleviate
the financial expenses incurred on account of the medical expenses of the patient. The

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psychological needs of the family members of the patient would be treated at par with the
patient and accordingly psychological and psychosocial support referrals would be made.
Further, the family members would also be involved in a one-on-one session where they
would be imparted psychological education which would support them to interact and support
Mrs. Brown to cope with her illness (Rumbold & Aoun, 2014). Studies suggest that that the
primary objective of palliative care is to put the patient and the family members at the heart
of the care process and accordingly address psychological, emotional, social as well as
financial concerns (Hudson & Aranda, 2014; Hudson et al., 2015). Also, at each step of the
care process, the patient and the family members would be actively involved in the decision
making process so as to devise a care plan in the best interest of the patient and promote
holistic wellness so as to improve the cumulative health outcome.
Conclusion:
Therefore, to conclude it can be mentioned that the care priorities for Mrs. Brown
would be to provide relief from the symptom of shortness of breath and to administer
psychological counselling to the patient as well as the family members to alleviate them from
psychological distress. In addition to this, psychological education would also be provided to
the family members so that they can support Mrs. Brown to cope with her chronic illness.
Also, appropriate referrals would be discussed with the family members about social and
financial support services so as to achieve holistic wellness for the patient and the associated
family members.

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References:
Cabral, L. F., D'Elia, T. C., Marins, D. S., Zin, W. A., & Guimaraes, F. S. (2015). Pursed lip
breathing improves exercise tolerance in COPD: a randomized crossover study. Eur J
Phys Rehabil Med, 51(1), 79-88.
Cancelliero-Gaiad, K. M., Ike, D., Pantoni, C. B., Borghi-Silva, A., & Costa, D. (2014).
Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD
subjects. Brazilian journal of physical therapy, 18(4), 291-299.
Fox, M. Y. (2014). Improving communication with patients and families in the intensive care
unit: palliative care strategies for the intensive care unit nurse. Journal of Hospice &
Palliative Nursing, 16(2), 93-98.
Hudson, P., & Aranda, S. (2014). The Melbourne Family Support Program: evidence-based
strategies that prepare family caregivers for supporting palliative care patients. BMJ
supportive & palliative care, 4(3), 231-237.
Hudson, P., Trauer, T., Kelly, B., O'connor, M., Thomas, K., Zordan, R., & Summers, M.
(2015). Reducing the psychological distress of family caregivers of home based
palliative care patients: longer term effects from a randomised controlled
trial. Psycho‐Oncology, 24(1), 19-24.
Rumbold, B., & Aoun, S. (2014). Bereavement and palliative care: A public health
perspective. Progress in Palliative Care, 22(3), 131-135.
Sanduzzi, A., Balbo, P., Candoli, P., Catapano, G. A., Contini, P., Mattei, A., ... & Stanziola,
A. A. (2014). COPD: adherence to therapy. Multidisciplinary respiratory
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