Palliative Care: Nursing Priorities and Interventions

Running head: PALLIATIVE CARE
Palliative Care
Name of the Student
Name of the University
Author Note

1
PALLIATIVE CARE
Introduction
Palliative or end-of life care requires a holistic approach for addressing the symptoms
that are beyond physical needs like spiritual, cultural and psychological needs of the patient.
While giving care to terminally ill patients, nurses are required to identify the clinical
priorities in order to satisfy the patient needs. The following essay of palliative care is based
on the case study of Mrs. Brown, a 62-year old lady who is suffering from breathless and has
previous reported history of COPD. The essay will analyse the nursing care needs of Mrs
Brown followed by framing of nursing interventions to satisfy those needs. Patient-centred
palliative will maximise emotional and psychological well-being of service users.
Nursing Priority 1: Improving Shortness of Breath
As per the case study, Mrs Brown has called an ambulance as she was experiencing
shortness of breath and coughing for several days. These symptoms began 3-day ago with
rhinorrhoea. She has also reported chronic morning cough productive of white sputum that
has increases during the past two days. Effective management of breathless is the main
physical care need for Mrs Brown. This is because; Mrs. Brown has exacerbations of COPD
in the past year for which she was admitted to hospital thrice. Moreover, she also has acute
breathlessness. According to Steindal et al. (2018), patients’ with COPD report high
symptom burden of breathlessness. Breathless affects numerous aspects of patients' live.
Kyngäs et al. (2017) reported that COPD patients with breathlessness have significant
negative impact in their life starting from frustrating lack of mobility along with consequent
difficulties in accomplishing daily living activities and maintaining proper social contacts.
Breathless also reduces overall physical activity like ability to climb stairs. The case study
highlights that the Mrs. Brown family members take care of her domestic and physical needs.
Breathlessness is also accompanied with fear, anxiety and pain followed by generation of

2
PALLIATIVE CARE
depression and cough (Steindal et al., 2018). The case study highlights that Mrs Brown has
previously been diagnosed with depression along with panic attacks. Thus taking care of her
breathless will help to improve her comprehensive well-being. The nursing intervention from
the management of cough while ensuring proper breathing will be breathing exercise and
coughing and sleeping in Fowler’s position. Breathing exercise and coughing will help to
promote the clearance of the cough or white sputum from the lungs and thereby helping to
ease the process of involuntary breathing (Westerdahl, 2015). Ünver, Kıvanç and Alptekin
(2018) highlighted that deep breathing exercises help to decrease the chances of pulmonary
complications and thus reducing the chance of generating hypoxia among COPD patients. It
is the duty of the nursing professional to educate the patient and at the same time demonstrate
how to conduct deep breathing exercise. The breathing exercise will start with deep, slow
breath followed by slow exhaling, three to five times after every one to two hours. Deep
breathing exercise will help to reduce the respiratory rate while increasing the rate of the
alveolar ventilation Patients’ education in deep breathing helps to promote increased exercise
participation and thus generating improve outcome (Ünver, Kıvanç & Alptekin, 2018).
Breathless among COPD patients reduces the level of oxygen saturation in the body (Kyngäs
et al., 2017). In order to improve the oxygen saturation Mrs Brown must be positioned in
Fowler’s position. In this position, the head of the patient is kept raised at an angle of 45
degree from the waistline. This raised positioning of the body helps to increase the surface
area of the diaphragm of the lungs. Diaphragmatic descent leads to maximum inhalation
leading to increase in the flow of the oxygen in the lungs while decreases laboured breathing
(Ceylan et al., 2016). The evaluation of the outcome will be done by measuring the level of
oxygen saturation within the body along with decrease in the sense of laboured breathing and
cough with white sputum.