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Principles of Palliative Care PDF

   

Added on  2020-12-18

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COURSE TITLE: PRINCIPLES OF PALLIATIVE CARE

INTRODUCTIONThis assignment will be evaluating the outcome of the holistic assessment given to a patienton frailty older adult hospital setting, taking into consideration the bio-psychosocial needs of thepatient. The impact of government policies and initiatives in the development of palliative careservices will be explained. The palliative and end of life care would be defined, its relevance to myclinical area will be discussed. A brief account of my clinical case study will be given. The strategiesutilized in the assessment process from a bio-psychosocial perspective will be analyzed. The impactof the holistic assessment process on the care planning process will be discussed taking intoconsideration what would have happened if the assessment had not taken place and how theassessment interrelate. The ethical issues arising in the implementation of care plans will bediscussed. RATIONAL FOR PALLIATIVE AND END OF LIFE CARE.In the year of 1900, ways in which people died in their own home has labelled death as ataboo instead of a natural existence of life (Leadership Alliance, 2014). Therefore, delivery of care inlast few days of life was supported by the use of Liverpool Care pathways (LCP) (Department Health,(DOH) 2013). However, an Independent review made by LCP, 'More Care, Less Pathway' (DOH,2013) has found that strategy was not adequately supporting care and it did not given right servicesto vulnerable and found great variation in quality and practice across both acute and communitysettings. Thus, it was recommended that the LCP should be phased out and replaced withindividualized end of life care plans to aid an improved symptoms management. With the help ofthis, patients who were in need of palliative and end of life care could get right services. At this juncture, it is paramount to define palliative and End of life care. Palliative care is anapproach that improves the quality of life of patients and their families facing problems that wereconnected to life-threatening illness, through prevention and relief of suffering by means of earlyidentification. On the other hand, impeccable assessment and treatment of pain and other problemsrelated to physical, psychosocial and spiritual (WHO, 2002). While, end of life care is the aid whichbasically helps all those with advanced, progressive, incurable illness to live as well as possible till themoment they die ( National End of Life Care Strategy, 2008). THE CASE STUDY I work in an elderly frailty post acute ward. Mrs. Jane, aged 85 years for confidentiallypurpose will be used for the present case (Nursing and Midwifery Council, (NMC), 2015). She got

admitted in the hospital due to falls treatment given for urinary tract infection (UTI) secondary todehydration. As given by NICE, (2004), over 230,000 people in England and Wales gets cancer eachyear, and this chronic disease could be considered as one quartered reason of all deaths (NICE,2004). In addition to being frail, Mrs Jane, has been recently diagnosed of advanced, progressivecervical cancer, with choice of no further treatment (The General Medical Council, (2010) and Goldstandard Framework, 2011). Therefore, she was identified as nearing the end of life. After sometime, she was referred to the palliative team who advised the nurses to complete an individualisedcare plan. Other co-morbidities are osteoporosis, hypothyroidism, poor appetite, recurrent UTI andright hip replacement. She has been bed-bound due to complaints of lower back and left with hippain as well. Away with this, an X-ray was performed to rule out a fracture. It was discovered thatMrs. Jane has severe compression to her spine. She used to have 5mg of morphine sulphate tabletstwice daily prior to admission. Mrs. Jane is psychologically distressed as she have the fear of inabilityto walk again or go back to her sheltered accommodation where she had lived more than 5 years.PHYSICAL ASSESSMENTOn getting to Mrs. Jane, I introduced myself, drew the curtain for privacy, explained to herwhat I intend to do and asked her if it is fine and she accepted and understood perfectly. In presentcase, Mrs. Jane has been immobile due to pain and investigation revealed severe spinal cordcompression (SCC). On the given point of view of Ropper and et. al., (2017), complications fromspinal cord injury will depend on the site of compression and severity of associated neurologicaldysfunction. Paniagua-Collado and Omar (2018) mentioned that, SCC is being considered as complexand challenging condition that greatly affects the quality of life. Also, pressure ulcer is a cause of painand physical debilitation and patient in a supine or semi-recumbent because of immobility are moreat risk (NICE, 2014). Considering the fact that Mrs Jane has been bedbound and barely move in bed,has been identified that Mrs Jane will be at risk of pressure ulceration. As mentioned by NICE, (2001), identifies the use of Waterlow Pressure damage scale inconjunction with clinical judgement to determine the risk of developing pressure ulcer in an adult.The Waterlow scale is divided into different segments; the skin assessment, age, gender, nutritionalstatus, medication and neurological deficit. There are several specific risk factors that place patientsat increased risk of pressure ulceration (Rajpaul and Acton, 2016). Also, Davies (2018) added thatconsiderations must be given to other conditions like dehydration, urinary and faecal incontinence.In addition, NICE, (2014) points out that patients at risk of pressure ulcer will have multiple riskfactors. Some of the risk factors observed and that will put Mrs Jane at risk of pressure damage are;

redness to her heels and sacral areas, poor nutrition, on immuno-suppresant drug, female isaccorded higher score than male, she is doubly incontinent, frail and advanced in age. How my biological assessment informed my patient careDougherty and Lister (2015) express that pressure ulcer occurred due to unrelieved pressureor pressure with shear or friction and it is more common in patients above 65 years of age. Pain ordiscomfort at a potential pressure ulcer site may be a precursor to pressure damage and could beconsidered as a risk factor (Davies, 2018). Also, Tidy (2017) recommend that a careful and frequentturning of the patient is essential. Hence, care plan was designed to assess pain regularly and tochange the position of Mrs Jane's body every 2 hourly in bed. The National Pressure Ulcer AdvisoryPanel (NPUAP) ( 2014) recommends the use of specially designed mattresses to help reduce the riskof pressure ulceration. Mrs. Jane was put on pressure relieving mattress and prevalon boots wasapplied to each foot to offload the heels. NPUAP et al also advised to consider the use of slidesheets when repositioning at risk patient to reduce the risk of shear and frictions. She wasrepositioned adopting the appropriate manual handling technique. she was encouraged andsupported to sit out daily, chair cushion was also ordered for her sit on. Plan was also implementedto improve her nutritional status, she was put on food chart and was encouraged with snacks inbetween meals. Though, Mrs Jane on assessment was at high risk of developing pressure ulcer wasable to go home with her skin intact.Psychological AssessmentAs given by De Souza and Pettifer (2013), pain as one of the most prevalence symptomsexperienced by cancer patients. Rosser and Walsh (2014) view pain as the primary symptoms ofspinal cord compression. One of the complications of spinal cord compression is depressionassociated with restriction of activities of daily living due to immobility (NICE, 2008). The psychologydistress expressed by Mrs Jane was that of institutionalisation due to immobility caused by severelower back and hip pain. Therefore, my psychological assessment of Mrs Jane would be focusing onpain management. It has been argued that nurses have a pivotal role in undertaking pain assessment ( thechronic Pain Policy Coalition (2007). Mrs Jane's pain was assessed using the numerical rating scalewhich helped her to express the intensity of her pain on a scale of 0-10. 0 being no pain, 1-3 beingmild pain, 4-6 being moderate pain and 7-10 severe pain (Moller, (2012) and Parson and Preece,

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