Assessment 1B: Applying Nursing Practice - Mrs. Hong Case Study

This case study presents the scenario of Mrs. Hong, a 70-year-old woman with stage 3C breast cancer and early dementia residing in a residential facility. The assignment requires an enrolled nurse to address various aspects of palliative care, including holistic care provision, documentation of patient wishes, personal values related to death and dying, scope of practice, physiological changes in a dying client, and the role of the multidisciplinary team. The questions delve into managing swallowing and breathing difficulties, caring for a malignant wound, identifying signs of deterioration, and providing comfort to an unconscious patient experiencing distress. The case study emphasizes the importance of providing emotional, spiritual, and practical support to both the patient and her family, considering the patient's cultural background and preferences. The assignment addresses the implementation of nursing interventions, pain management strategies, and the ethical considerations involved in end-of-life care, aligning with the NMBA Enrolled Nurse standards for practice and code of conduct.

ASSESSMENT 1B response template
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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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
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
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 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
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 is a philosophy which is useful in guiding care to the patients which emerges as
a concept of holism and humanism (Waks and Winer, 2019). It helps in providing wholesome nurture
and respect the need of patients.
1. Physical care: Mrs Hong must engage in physical exercise activity which helps in improving her
health conditions.
2. Emotional care: This is useful in connecting with the family and patient to get access to
additional resources with proper counselling, referrals and social group connection.
3. Cultural support: Mrs Hong must also deepen their spirituality with spiritual support and
guidance.
4. Logistical support: Providing necessary support associated with legal, financial and
employment support at the time of palliative care.
5. Social support: It helps in providing them support with instrumental and emotional support to
the Mrs Hong.
6. Pain relief: taking appropriate medication like pregabalin and Gabapentin helps in easing the
pain with breast cancer.
7. Educational support: Giving appropriate information to take informed decision.
8. Specific therapies: Mrs Hong must be given therapies like chiropractic care, massage therapy,
acupuncture, homeopathy, naturopathy, chemotherapy, and radiation therapy, hormonal and
biological therapy.
9. Surgical procedures: Lumpectomy, mastectomy are the key surgical options for Mrs Hong.
10. Psychotherapy: It is useful in providing behavioural and psychotherapeutic intervention to the
patient.
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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 still finds it challenging to effectively interact with other residential staff and can also
become quite upset and distressful, especially in case when her daughter is late with food. She has early
dementia. Mrs Hong had a deformity in her right breast which means she needs immediate care.
TASK Assessment Criteria
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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: Negative attitude towards death and dying is fear of death and avoidance of death.
Attitude towards death is most crucial factor which tends to influence the key behaviour related with
the care professionals. Providing significant care to the person is of utmost importance. Caring for
people who has died is highly challenging emotionally. I believe that, it is of crucial importance to
build relationship. It also affects my provision of care because I undergo range of emotions like guilt,
sadness, shock, and anger.
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: NMBA Enrolled Nurse standards for practice and code of conduct is the scope of practice
for the registered nurse when caring for a dying client. The nurse must always function in compliance
with the policies, laws and procedures (Waks and Winer, 2019). At the time of caring for a dying the
nurse must comply with the confidentiality, right, respect and complete dignity. The nurse must be
responsible and accountable for its own action. Proper support to the family is given and also engage
in collaborative practice to educate them.
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TASK Assessment Criteria
Question 5 Identify 4 possible physiological changes that you may observe in a client who is
dying
Response:
Below are the key psychological changes faced which has been observed within the patient:
1. Decrease in the thirst and appetite of the person who is dying.
2. Change in the person’s body temperature and appetite who is dying.
3. Irregular breathing patterns in the person who is dying.
4. Secretion of mucus and saliva in back of person’s throat tends to cause distress within the
person who is dying.
TASK Assessment Criteria
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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:
Breast surgeons: they are the surgeon who has skills in providing best possible treatment for breast
cancer treatment.
Medical and clinical oncologists: They are the ones who perform chemotherapy and radiotherapy in
managing and treating patients who has cancer.
Breast care nurse specialist: It is useful in providing support to the patient who has breast cancer.
They focuses on providing quality of care treatment to the patient and also facilitate recommended
treatment. They also focus on providing guidance and emotional support.
TASK Assessment Criteria
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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:
The key signs associated with the swallowing and breathing difficulties mainly includes cough,
excessive drool, pain when swallowing food, runny nose at time of swallowing,
Liquid of food coming out of nose, lung congestion and chronic respiratory infection, etc. are the key
signs. The key management strategies to manage breathing and swallowing difficulties are to maintain
oral hygiene and comply with choking response protocol (Rugo and et.al. 2016). Oral care is
considered to be of utmost importance for the person who is not able to drink or eat. Saliva tends to
have anti- bacterial properties and tends to act as the body defence against the infection.
TASK Assessment Criteria
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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: Malignant fun gating wound tends to largely affect sexuality, femininity and also affect the
daily life of the Mrs. Hong. This mainly occurs when the breast tumour filtrates into lymph vessels,
skin and blood capillaries. This also causes loss within the vascularity which leads to tissue death. The
multidisciplinary team must care for the Mrs Hong to treat the malignant wound with the
help of chemotherapy, radiation and surgery.
TASK Assessment Criteria
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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 has shown some signs of deterioration with her condition. She is unable
to eat and drink. Mrs Hong is also confined to bed (Rockson, 2018).
This would further reported to the medical oncologists who perform chemotherapy and
radiotherapy in managing and treating patients who has cancer.
Emotional and spiritual support to the Mrs Hong’s daughter has been given where she
witnesses that the condition of the mother is deteriorating.
TASK Assessment Criteria
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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: non- verbal cues of pain and distress demonstrated by Mrs. Hong is associated with
groaning. Pain management by using injection is a prominent way to reduce Mrs Hong distress.
Pharmacological treatment like Fulvestrant injection is useful in effectively treating breast cancer in
Mrs. Hong. This helps in reducing pain and also reducing spread to other parts of the body.
Non-pharmacological treatment for pain management because of breast cancer in Mrs. Hong is mainly
managed by practicing relaxation, superficial massage, spiritual practices etc. is useful in effectively
managing pain.
TASK Assessment Criteria
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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:
Physical comfort, providing emotional and mental support is considered to be one of the key
intervention which is useful for Mrs. Hong. Family centred intervention is considered to be of utmost
importance because Mrs. Hong cannot meet her own self care needs (Greenlee and et.al. 2017).
Activities like going to the washroom, eating food, changing clothes, walking, comfortable sleep, etc,
are the key activities of daily living that Mrs Hong can no longer do for herself.
TASK Assessment Criteria
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:
Nursing and Midwifery Board of Australia law will be complied and code of conduct has been used.
As a registered nurse I will comply with the collaborative and professional practice within the scope of
the enrolled nurse. I will inform the family members and other members within the multi- disciplinary
team who were associated with the patient who has died. Emotional and collaborative support to the
members has been given.
TASK Assessment Criteria
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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:
Privacy, dignity and respect of the person who has died has been effectively maintained. Complete
respect to the wishes of the person is respected and provide emotional and mental support to the
family members of the deceased person is given (Maass and et.al. 2015). The deceased person is
properly cleaned and well dressed. Complete respect and dignity of the person who has died is to be
maintained. This is usually done by respecting their cultural and religious practices. Keeping a positive
attitude and protecting physical privacy and personal information and assisting with grooming helps in
maintaining dignity and respect for the client at the time of preparing person’s body after death.
TASK Assessment Criteria
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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:
For autopsy proper written requirement must be complied with and is carried out by the pathologist.
The National Code of Ethical Autopsy Practice is one of the relevant legislation within which the
hospital must comply when autopsy is required for patient.
Organ donation teds to take place in the acute hospital where they are properly equipped to manage the
organ donation. Australian organ donation is an effective end of life law within Australia which must
be complied with at the time patient wants to donate organ.
TASK Assessment Criteria
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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:
Emotional and mental support to Mrs Hong’s daughter has been given after her death. The registered
nurse must educate them and also address all the concerns and questions they might have (Rugo and
et.al. 2016).
Provide 3 community services you could refer Mrs McFarlane to, to assist her with grief and loss.
1. Bereavement intervention program must be used by Mrs McFarlane to assist her with grief and
loss.
2. Connecting with the families and providing emotional support is used by Mrs McFarlane to
assist her with grief and loss.
3. Creating a positive environment and building strong will power is used by Mrs McFarlane to
assist her with grief and loss.
TASK Assessment Criteria
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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:
3 examples of ways we have taken care of my own wellbeing
1. Engaging in relaxing trip: yoga, meditation, etc. is considered to be useful in practicing self-
care after taking care of a long term client who has died.
2. Engaging in spiritual activity: Connect with the spiritual god which helps in gaining soothing
experience is considered to be useful in practicing self- care after taking care of a long term
client who has died.
3. Communicating with family members: Sharing you feeling with the family members helps in
gaining emotional support.
TASK Assessment Criteria
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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:
Surgery: It is useful in taking out the breast tumour.
Radiation therapy: It tends to have high degree of radiation or energy waves which helps in killing
cancer cells (Waks and Winer, 2019).
Chemotherapy: It is relevant in killing fast growing cancer cells into the body using powerful
chemicals.
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REFERENCES
Books and Journals
Greenlee, H & et.al. (2017). Clinical practice guidelines on the evidence‐based use of integrative
therapies during and after breast cancer treatment. CA: a cancer journal for clinicians. 67(3). 194-
232.
Maass, S. W & et.al. (2015). The prevalence of long-term symptoms of depression and anxiety after
breast cancer treatment: a systematic review. Maturitas. 82(1). 100-108.
Rockson, S. G. (2018). Lymphedema after breast cancer treatment. New England Journal of
Medicine, 379(20), 1937-1944.
Rugo, H. S & et.al. (2016). Adaptive randomization of veliparib–carboplatin treatment in breast
cancer. New England Journal of Medicine. 375(1). 23-34.
Waks, A. G., & Winer, E. P. (2019). Breast cancer treatment: a review. Jama. 321(3). 288-300.
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