APN105: Applying Nursing Practice - Palliative Care Case Study Hong

This case study focuses on Mrs. Hong, a 70-year-old Chinese woman with stage 3C breast cancer who has opted for palliative care. As an enrolled nurse, the student is tasked with providing holistic care, addressing her physical, psychological, emotional, and spiritual needs. The assignment requires defining holistic care, identifying relevant documents outlining Mrs. Hong's wishes, reflecting on personal values related to death and dying, and understanding the scope of practice for an enrolled nurse in end-of-life care. Furthermore, it involves recognizing physiological changes in a dying client, identifying members of the multidisciplinary team and their roles, addressing swallowing and breathing difficulties, managing malignant wounds, and supporting Mrs. Hong's daughter during her mother's deterioration. The solution provides detailed responses to each question, incorporating relevant references and demonstrating an understanding of palliative care principles and nursing standards.

Student Name
Date
Course
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: Adjusted according to PC mapping
HLTENN013 – 1.8, 1.9, 2.1, 3.3, 4.3, 4.4, 4.5, 4.6.
HLTENN010 – 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 2.1, 2.2, 2.3, 2.4, 3.1, 3.2,
3.3, 3.4, 3.5,3.6, 4.1, 4.2, 4.3, 4.4, 4.5, 5.1, 5.2
PE: Adjusted according to module mapping
HLTENN013 – 1, 2,
HLTENN010 – 3, 4 , 5
KE: Adjusted according to question mapping
HLTENN013 – 2, 4, 5, 10, 13, 15, 17
HLTENN010 – 1, 2, 3, 4, , 10, 11, 12, 14, 15, 16, 17
Title of Assessment Task Case Study
Type of Assessment Task Case study with short answer questions
Length 19 questions

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.
References are required in every answer box where indicated. In-text referencing can
also be used.
Reference bibliography is not required.
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
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
Question 1 Define the term ‘holistic care’
Provide examples of how you would provide holistic palliative care to Mrs Hong and her
family in each of the following 10 aspects. (word limit – 100 Words)

Response:
CATEGORY
EXAMPLES
Definition of Holistic care This is defined as the provision of care to the number of patient which is
based on the mutual understanding of their physical, psychological
emotional and spiritual pattern which is based on various dimension.
Pain relief - pharmacological Codeine, fentanyl and so on.
Pain relief – non- pharmacological Regular exercise and yoga.
Physical care Exercise
Nutritional support In this, Mrs Hong used to eat take Asian food in which this is the major
step which is taken in the care of palliative. So, as per this, diet must be
provided in appropriate way which is helpful for the Mrs Hong
Elimination support Essential to build the positive thought for the future which is helpful for the
development of positive outcome from the complication of health.
Social support Focus on the relationship make surrounding well and enjoy the life in such
a way which used to create the situation of resilience, this is also a part of
palliative care where the wellbeing is explored.
Social support This is helpful to share the complication and consequence which may arise
the issue for the health, the interaction and communication with healthcare
staff is important.
Cultural support This is kind of meditation which is helpful for the Mrs Hong to visualise
the vibes of the spiritual term and create the positive aura. This is kind of
holistic care which is appropriate and show the effect of proper palliative
care.
Religious support Use to take proper approach towards the religious aspect.
Emotional support In this, they used to take support from the loves ones or with their friend
and relative.
Reference Essential Component 5 | Palliative Care Blueprint, 2021

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: In this, Mrs Hong is used to show the condition which is outline some of the important document
which used to provide the information which is associated with the client. In this, the patient used to state that
she loves to walk and other activities which is helpful for care. Moreover, they use to eat Asian food.
REFERENCE: End-of-life care | Australian Commission on Safety and Quality in Health Care, 2019
TASK Assessment Criteria
Question 3
Reflect on and outline your values, beliefs and attitude towards death and dying – give an
example.
State how your beliefs and values may affect your provision of care to the client- give 2
examples.
Response: On the basis of belief and value, as nurse the main factor is providing quality of care which may
helpful for the patient to provide the resilience and care while providing quality of care and providing quality of
life.
PART A: Reflect on and outline your values, beliefs and attitude towards death and dying
In term of this, the value, belief and attitude which is associated with death and dying must be neutral and
provide support with emotional aspect to people.
PART B: State how your beliefs and values may affect your provision of care to the client
In this, the value and support used to create obstacle for the number of time. In terms of client there are various
aspect which used to create the diabolical view and bases which maintain the factor which filled with emotion
and pain to loose someone.
EXAMPLE- sometime while providing support the emotional breaches are occur.
EXAMPLE- used to take the emotional factor and related the situation with himself which can cause
overthinking.
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 –especially Code Conduct

3.6- End of Life Care).
Describe how these standards and codes dictate the care ENs provide – give 4 points
from the STANDARDS FOR PRACTICE and Codes of Conduct. (Word limit – 30
Words per point)
References: review mapping
Standard 3
Code of Conduct
The main purpose of the standard is to provide the better and quality based care to the Mrs Hong which is helpful
for the development of resilience and other which essential for the dying client. Moreover, the standard is used to
provide direct and maintain the safe and clinical competent for the nursing practice.
reference
Standard 3: set out the legal requirement which help to show the professional behaviour and conduct expectation
for the nurse while any death is occur in the practice should be managed.
TASK Assessment Criteria
Question 5
Identify physiological changes by body system that you may observe in a client who is
dying- List two per system
Response:
Cardio- vascular Heart beat become slow.
Symptoms of the hypertension is observed
Respiratory Respiration rate become slow
Rate of bronchiole fraction is observed.
Neurological Excitatory neurotransmitter become slow
Inhibitory neurotransmitter become slow.
Urinary/Renal Pain during urination
Yellow colour observed during urination
GIT Pain
Congestion is also observed in some of the condition
Integumentary Pain
Cause of reshuffle
Metabolism Become slow and diverse

Have consequence with formation of slow energy rate.
Psychological Have tendency to being ill.
Can create complication with the though and feeling.
REFERENCE: Home - Palliative Care, 2021
TASK Assessment Criteria
Question 6
Provide examples of 3 members of the Multidisciplinary Team (MDT) and how each one
will assist in providing holistic care to Mrs Hong and her family
NB. If including nurses please include specialist nurses – state their specialty).
Response:
MDT member 1: Psychiatrist
Role: They used to provide positive outcome by taking proper interaction with the client and provide effective
and important scope for life.
MDT member 2: Specialist nurse
Role: They focus on the client complication and their recovery
MDT member 3: Medicine counsellor
Role: Provide medicine as per the need and requirement of patient as per taking concern which is part of holistic
care.
REFERENCE: Stories Archive - Palliative Care, 2021
TASK Assessment Criteria
Question 7
Identify signs of swallowing and breathing difficulties. Which nursing management
strategies could you use in each case?
b) Why is oral care important to consider in a client who is unable to eat or drink?
Response:
a) Swallowing difficulty
 unable to eat and drink.
 Do not take food.
 Avoid eating and follow the liquid diet which is easily disintegrate.
Nursing management strategies x 2 (Word limit 15 words)
 Used to provide care based on the complication

 Take proper step for the care by analysing the condition of patient.
Breathing Difficulties
 During the diagnose of cancer.
 During the treatment of breast cancer.
 On the advance care of sign which is associated with cancer and dementia.
Nursing Management strategies x 2 (word limit 15 words)
Oral Care
REFERENCE: Palliative Care NSW – Leading voice for Palliative Care in NSW, 2020
TASK Assessment Criteria
Question 8
Mrs Hong’s breast tumour has developed into a malignant wound.
Explain what malignant means and describe how you would care for the wound.
Response:
The malignant wound is cancerous. As per this, they develop when the cell grows uncontrollably. If the cell
continues to grow and spread, the disease which is become life threatening
REFERENCE: Palliative Care Victoria, Palliative Care Services Resources, 2020
TASK Assessment Criteria
Question 9
What signs/ changes may you observe in Mrs Hong that may indicate that she has
deteriorated further?
Who would you report these changes to?
Explain how would you support Mrs Hong’s daughter as she witnesses her mother
deteriorating?
She is avoided to take the treatment which is show the indication of deterioration. Because it can care barrier for
the care. By providing information in the positive sense and providing quality of care to the Mrs Hong.

Explain how you would support Mrs Hong’s daughter: -
In this, create a positive sense for the Mrs Hong and maintain the support with the emotional level to his
daughter while sharing memories and their behaviour.
REFERENCE: Palliative Care QLD, 2020
TASK Assessment Criteria
Question 10
Mrs Hong is no longer conscious but is demonstrating signs of distress by groaning in
pain. (Include also nonverbal cues of pain and distress).
What is the most appropriate Nursing tool to use and what else can you observe to assess
Mrs Hong’s pain?
Response: In this, the physical therapy and occupational therapy is play vital role when Mrs Hong do not take
medicine.
 Numerical rating scale
 Visual analog scale
 Adult nonverbal pain scale
REFERENCE: Palliative Care SA – Palliative Care SA, 2020
TASK Assessment Criteria
Question 11
Split into two
boxes
Mrs Hong is no longer conscious but is demonstrating signs of distress by groaning in pain-
you have assessed Mrs Hong and decided to assist in decreasing Mrs Hong’s distress.
What options for pain relief would you consider if Mrs Hong cannot take oral medications?
(non-pharmacological treatment options)
Outline 4 methods used to administer pharmaceutical pain relief to Mrs Hong now she is
unconscious and no longer able to swallow

Response: Reference:
Non -Pharmaceutical Pain relief
 Maintaining Mrs Hong airways for the better respiration.
 Maintaining fluid balance and manage the nutrition.
 Prevent the retention of urine.
B) Outline methods of pharmaceutical pain relief administration
 Topical administration
 Parental administration
 Intravenous administration
 Sublingual administration
TASK Assessment Criteria
Question 12
Discuss and recommend 3 nursing daily living activities which will 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:
1. bathing: As per this, they used to provide care for their bathing, they cannot take the bath due to the condition.
2. brushing: this is also applicable in the oral care.
3. medication: in this, they used to provide the drug and medicine at time.
REFERENCE: Palliative Care Victoria, Palliative Care Services Resources, 2020
TASK Assessment Criteria
Question 13
You assess Mrs Hong and believe she has died.
What action should you take within your scope of an Enrolled Nurse?
Identify one legislation for the notification of a death in a healthcare facility in your
state?
In what circumstances should a death be referred to the coroner?
Response: REFERENCE
A. as per this action which is performed by enrolled nurse in this condition is provide support and sympathy
which is proper aspect to develop a sense of matter. In this, they are used to take possible management behalf of

this to create the sense of empathy and sympathy to the number of way which help to maintain the resilience.
The coroners act 2009: This provide effective legislation which is imperative for the death of any patient which
is explanatory in practice, as per this, the act is initiated which is essential to cause more and more need of this
act.
B. Doctor did not treat the person during the last illness. Or the doctor did not see the patient for the situation
which is associated within the 28 day before death
TASK Assessment Criteria
Question 14
a) What care activities are undertaken once a person dies? Please list.
b) How would you maintain respect and dignity for a client when preparing their body
after death (include one cultural or religious practice)?
Response:
 In this, there are various activities which is followed under the circumstance which used to play vital role
in the development of activities. Moreover, they are used to focus on the various part which is helpful
and used to maintain the quite elongation to follow the rule and regulation before the death. In this the
autopsy is being imitated by taking various approach.
 Patient and their family have their confidentiality and self-respect which is appreciated all the time. With
this honour the people requirements for the organ and tissue contribution. Provide the well-being and
protection for the everybody who is comes into the interaction with the body. In this, some of the family
member of close to the patient might want to assist with the personal care. Moreover, record all the
personal care in the deceased care plan.
REFERENCE: Home - Palliative Care, 2021
TASK Assessment Criteria
Question 15
How does the care requirement change for a patient after death 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)
Please complete the table
Response:

An Autopsy Pt has chosen organ donation
Definition There are two type of the autopsy a
corner autopsy and hospital autopsy
and this done by the legal reason
about the case or cause of death.
Before they death they willingly
follow some the paper work to donate
organ.
Reason 1 To verify the detail which is accountable
and reason of death as per the law and act.
They use to create an understanding by
donating their organ to beneficial for
others.
Reason 2 To know the causes and time of death to
verify that it is natural or any type of
complication.
Have willingly want to donate organ for
the other who have complication with
their organ can use after the death for the
public needs.
Consent
requirement – who
from
From the regulation and law For the needy people who required organ
transplantation.
Cause of death &
signing death
certificate
Natural or due to any complication Show the significance of organ.
Chain of
notification
responsibility-
EN & RN
EN RN
Nursing care
(3 for each)
 Used to provide quality of care of
patient and provide all essential
support.
 Focus on the requirement of
patient
 Complete aspect of care and
standard quality care.
 Used to take concern with nurse
and doctor.

REFERENCE: Palliative Care QLD, 2020
TASK Assessment Criteria
Question 16 List three ethical and legal considerations for organ donation?
Response:
 Should be voluntary.
 Confidentiality and protection of donor and recipient data.
 Equitable opportunities and fairness allocation.
REFERENCE: Palliative Care SA – Palliative Care SA, 2020

TASK Assessment Criteria
Question 17
How would you provide support to Mrs Hong’s daughter (Mrs McFarlane) after her
death?
Outline 3 community services you could refer Mrs McFarlane to, to support her with
grief and loss? One service from your local/home area.
Response: REFERENCE: Palliative Care SA – Palliative Care SA, 2020).
Support for Mrs Mc Farlane
 Used to show sympathy
 In that situation be strong and brave to handle and hold the hand to provide support.
 Allow a person to talk about their concerns
Community services
1. Do not afraid and predominately ask for the help in which the grief can be isolating when a person start to feel
like that only person in the world feeling which is appropriate and show the relevance of feeling in which they
start to think.
2. Talk and ask help and show the need if the support is required, the family and friend are the basic need when
the individual is loss something due the major factor.
3. try to focus on the work and live life in the happier way which is essential and play the role of activeness and
so exercise and make a fitness streak among the body which help to provide positive core concept in body.
TASK Assessment Criteria
Question 18
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:
Supporting self- Care
By making change in the environment and distract from the thought of person.
 Used to change place.
 Busy with some activities.
 Join some of the classes which is make themselves busy for the longer.
Personal Wellbeing
1. To formulate the wellbeing, it is important to follow the concept of live healthy and eat healthy food
which is appropriate and vital role in the development of wellness. This help to provide the effective
exercise regularly and provide the good and effective drink such as juice and all. Moreover, avoid drug

and alcohol which can cause more complication and affect the wellbeing.
2. In this, try to do and manage the healthy and good hygiene which is essential and used play vital role in
development of individual resilience.
3. As per this, try to do something which helps to provide happiness and meet friend and make new friend
and engage with them and try to do activities which is interesting in order to create the wellbeing with
friend.
TASK Assessment Criteria
Question 19
What services are available which can assist you and your healthcare colleagues to
debrief after a death in your workplace? (Provide 3 examples of general services
available and how they can assist with debriefing and supporting healthcare
professionals).
Please provide one example of a service in your local area.
Response:
General services
1. In this, they are used to show the encourage worker which is all about the current need which help to
imply the worker advice, information and handout which is productive in practice and cause various
complication.
2. A critical incident is ant workplace which is show the events or the series which is show the sudden
which can create the impact threatening or the protracted which may be an assaults, threat which show
the condition which is important to know.
3. The critical incident which is associated with the stress management can cause various complication in
this, they can cause to show the aim which is show the emotional reaction which may results from the
scope of involvement in an exposure which is unusual in workplace incident.
REFERENCE End-of-life care | Australian Commission on Safety and Quality in Health Care, 2019