Western Sydney University: Palliative Care Strategies for Mrs. Brown

This essay critically analyzes two high-priority nursing strategies essential in palliative care, focusing on the case of Mrs. Brown. The first strategy discussed is the administration of supplemental oxygen to manage acute breathlessness, a common symptom of COPD, emphasizing the importance of monitoring and adjusting oxygen therapy based on the patient's condition. The second strategy explores cognitive behavioral therapy (CBT) as a method to address Mrs. Brown's depression, including panic attacks and feelings of being a burden, highlighting how CBT helps in identifying and modifying negative thoughts and behaviors. The essay underscores the importance of integrating both strategies, alongside other treatments, to provide comprehensive and effective palliative care, ultimately improving the patient's quality of life and managing both physical and psychological symptoms associated with serious illness.

Running head: MANAGEMENT STRATEGIES 1
Management Strategies for Mrs. Brown
Student’s Name
Professor’s Name
Institution Affiliation
Date

MANAGEMENT STRATEGIES 2
Introduction
Palliative care is an essential approach especially when caring for conditions connected
with life threatening diseases. Palliative care involves specialized medical care that is delivered
by a highly trained and specialized team of nurses, doctors and other specialists who provide
extra support to a patient and family through working collaboratively. Palliative care mainly
focuses on providing a reprieve from pain, mental stress, symptoms and physical stress at any
stage of a serious disease. Suitable palliative care help in promoting quality care by managing the
social, emotional, practical and spiritual concerns of people with life threatening conditions.
This essay aims to critically analyse two high priority nursing strategies that are essential in
palliative care.
Administrating supplemental oxygen
Administration of supplemental oxygen should be the highest priority strategy for
managing breathlessness. Mrs. Brown is suffering from acute breathlessness which has led to
exacerbations of COPD, and hence this means that there is no adequate saturation of oxygen in
her body. Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with
worsening health condition, deterioration in the way lungs function and increase in mortality.
Oxygen therapy involves the oxygen that is given at concentrations that are higher than that
found in the environmental air (Wickerson, 2018). Since Mrs. Brown has been diagnosed with
COPD when administering supplemental oxygen one should ensure that she is monitored
closely. It is because administering a large amount of oxygen in her body may cause a blunt in
her respiratory drive and also she has a potential danger of oxygen toxicity if she receives a
fraction of 0.5 to 0.6 of inspired oxygen concentration for a prolonged period.

MANAGEMENT STRATEGIES 3
Nevertheless, the benefits of administering supplemental oxygen to a patient with acute
breathlessness will outweigh the risks (Mellor &Beausoleil, 2017). After administering
supplemental oxygen therapy, one should ensure that the patient is closely reassessed and
observed. As presented in the case scenario, Mrs. Brown condition is changing very quickly, and
hence close monitoring is important. The regular assessment of a patient with breathlessness
should not only focus on their physiological measurements, oxygen saturation, and respiratory
rate but should also focus on the patient conscious level (Holm et al, 2016).
The initiation of oxygen therapy can be through the use of nasal cannula that helps in
delivering low or moderate oxygen, the use of standard face mask that can administer a high
level of oxygen than the nasal cannulas and the use of Venturi system that allows for constant
concentration of oxygen to a patient (Fraser, Spooner, Dunster, Anstey & Corley, 2016). It is
essential to note that oxygen therapy should be viewed as medication and hence it should be
prescribed on the treatment chart as the way other pharmacological agents are prescribed. The
information included in the prescription should include oxygen flow rate, the delivery device and
the target concerning the range of oxygen saturation (Wickerson, 2018)
Oxygen therapy is useful in reducing symptoms associated with dyspnea through
breathing compressed air and supplemental oxygen. Mrs. Brown has been suffering from an
acute breathlessness which is deteriorating, oxygen therapy help in decreasing hyperinflation and
also decreases minute ventilation which in turn helps in reducing dyspnea. The use of
supplemental oxygen also helps in increasing the flow of oxygen which stimulates facial
receptors and upper airway which seems to be able to reduce dyspnea (Pisani et al, 2017).

MANAGEMENT STRATEGIES 4
Research indicates that oxygen therapy also helps in reducing mortality for a patient with
breathlessness. The health condition of Mrs. Brown was deteriorating, and hence a long term
oxygen therapy should be initiated. Oxygen therapy can be conducted to Mrs. Brown overnight
only or continuously for a minimum of 12 months with a proper follow-up. Also, supplemental
oxygen is administered to ensure there is a high saturation of oxygen, high saturation of oxygen
in the body means saturation of 90% or more (Beasley et al, 2017). But it is of importance to
note that the supplemental oxygen therapy acts as a supportive measure during acute
breathlessness and hence it should be accompanied by other treatment options that are necessary
for breathlessness.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a high priority nursing strategy that is vital for
managing depression. Mrs. Brown has been recently diagnosed with depression. Symptoms that
precede depression as evident in the case scenario include panic attacks and poor nutrition. Also,
Mrs. Brown has presented episodes of feeling like a burden to her family which can also
influence the rate of depression. CBT is a strategy for depression which involves the nurse
helping the patient in identifying specific thoughts that may be negative and helping the patient
in getting tactics on how to respond to challenging and stressful circumstances. Cognitive
behavioral therapy involves talking about activities that influence your thoughts and feelings,
and also you open up about the way you perceive the world, other people and yourself (Meganck
et al, 2017). The therapy involves meeting with the nurse in sessions of between 30 and 60
minutes for 5 to 20 times weekly or biweekly depending on the intensity of depression. But in
case of high intense depression, CBT should be accompanied by medication treatment. During

MANAGEMENT STRATEGIES 5
the meeting, the nurse will be able to identify if you are right and contented for the treatment
(Janssen et al, 2017).
Even thou CBT focuses on the present sometimes the therapist (nurse) may consider
asking you about the past in order to understand how it is currently influencing you. You agree
on what to be discussed and also make a decision on whatever you need and want to deal with.
The nurse helps the patient in breaking down her problem into differentiated parts. For nurses to
assist the patients with breaking down a problem, they may request them to keep a diary in order
to aid them in identifying physical feelings, thoughts, patterns of actions and emotions that may
be impacting them negatively. The therapist will then work towards figuring out how to alleviate
the things that have negatives influence (McCombie, Gearry, Andrews, Mikocka-Walus&
Mulder, 2015). During every session, the patient discusses with the therapist progress since the
previous meeting. If a particular task seems not working for you, the therapist assists you in
addressing the issue. Tasks that may have negative thoughts reactions and patterns are
eliminated. Some negative reactions or patterns may include discarding the positive feelings and
thoughts, taking things personally, experiencing automatically negative habitual thoughts, and
mainly concentrating on one particular negative issue (Dikareva, Harvey, Cicchillitti, Bartlett &
Andersen, 2016).
Research indicates that Cognitive Behavioral Therapy is useful in managing depression
since it helps in challenging underlying assumptions that may be affecting the patient (Ekberg,
Barnes, Kessler, Malpass & Shaw, 2016). For instance, in the case scenario, CBT will help Mrs.
Martha in correcting her assumption that she is a burden to her family.

MANAGEMENT STRATEGIES 6
Cognitive Behavioral Therapy has also been found to be useful because it helps in
lowering the symptoms of depression since it can help in alleviating panic attacks. Panic attacks
in Martha may be caused by her feeling trapped or her inability to walk around since these
conditions may trigger stress and negative thoughts and feelings. CBT helps in replacing
negative thoughts with positive and realistic thoughts (Fava, Cosci, Guidi&Tomba, 2017). CBT
should be conducted to patients with depression problem since it takes a short period and the
results are long lasting.
Conclusion
In conclusion, nursing strategies are essential for managing patient’s conditions in
palliative care. A nurse ought to have adequate knowledge concerning effective strategies to
provide efficient care to the patient in a palliative setting. Administration of supplemental
oxygen and cognitive behavioral therapy are important management strategies. Although
supplemental oxygen is important, the nurse should also consider accompanying it with other
medication treatment. Similarly, cognitive behavioral therapy especially when treating a patient
with intense depression it should be accompanied by medication treatment in order to make it
effective.

MANAGEMENT STRATEGIES 7
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