Palliative and / or End of Life care Reflection
Weight: 35 %
Format: Palliative and /or End of Life Care Reflection
Word Count: 1200 words
Word count: There is a word limit of 1200 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word limit by more than 10% the marker will stop marking at 1200 words plus 10%, ie 1320 words.
Aim of assessment
Palliative care is a holistic approach addressing symptoms beyond the physical needs of the person. To improve the overall comfort of a person receiving palliative care, their physical, spiritual, social, cultural and psychological needs should be addressed.
Case Study Mrs Brown, a 62-year-old retiree lives with her husband, who works part time, she now finds difficult to leave the house - or even move around - due to her acute breathlessness. She feels trapped. Mrs Brown sees her GP whenever her condition deteriorates and has attended her local hospital since diagnosis. She has been admitted to hospital three times in the past year with exacerbations of her COPD. Her family take care of her physical and domestic needs, but she feels as her health deteriorates she will be too much of a burden on her family. Mrs Brown hasn't planned for her future care; she was waiting for her GP to tell her what to do. The GP has mentioned moving towards a palliative approach, but she is a little confused what this means. Mrs Brown has been previously diagnosed with depression by her GP. At the time, she was poorly nourished and was experiencing panic attacks.
Mrs Brown has called an ambulance due to feeling short of breath and coughing for several days. Her symptoms began 3 days ago with rhinorrhoea. She reports a chronic morning cough productive of white sputum, which has increased over the past 2 days.
Criteria Using a palliative approach discuss two high priority nursing strategies to manage Mrs Brown and provide evidence to justify these strategies.
Of the two strategies you choose to discuss in your essay, only one of these may be for a physical symptom.)
Resources: - Examples may be available on the vUWS site. - There are a number of textbooks and resources available through the Western Sydney University Library that may assist you. Please refer to the unit's VUWS site for specific unit resources
Palliative care strategies
The paper introduces palliative care that provides relief from the pain of a particular illness and other distressing symptoms. It is an approach in order to improve the quality of life of the patients as well as their families facing the association of the problem with the life-threatening illness, through the means of identification in early stages and assessment of the disease. The paper provides two palliative care approaches suitable to address the high priority nursing and management of Mrs. Brown. Additionally, the justification of the application for the strategies is also provided.
Palliative care strategies
Relieving breathlessness is a vital nursing strategy and is a high priority. Breathlessness is a frequent symptom of Common Obstructive Pulmonary Disease or COPD. There are two types of COPD; emphysema and chronic bronchitis. Both these diseases can cause shortness of breath. The symptom is generally referred to as "dyspnoea." The experience of patients suffering from COPD can describe breathlessness in the number of ways such as ‘suffocation,' ‘feeling a tightening of the chest,' ‘could not get enough air in' and ‘not able to breathe in' among others (Lewthwaite et al., 2018). Breathlessness can be caused by difficulties in airways, biochemical factors, cardiac problems, and psychological factors.
The nursing strategy in these types of situations includes assessment of the patient and asking specific questions about their breathlessness. The problems may consist of "what makes their breathing worse or easier?" (Woo, 2016). The strategy also includes questions about their past medical records and current as well as previous medications. Patients must also be asked about their history of smoking. The assessment will provide information and based on the information proper nursing care plan is applied. Patient must be observed, and their breathing pattern must be recorded.
With regards to Mrs. Brown, her breathing pattern must be observed and recorded. Her symptoms of breathlessness and coughing began three days ago with rhinorrhea. The GP must address her report of producing white sputum in the morning coughs and its increment over the past two days. The discolourations in the mucous membrane and the skin must be observed (Southwell et al., 2018). There can be blue coloured deposits around the mouth, lips, fingers, and earlobes. This blue discolouration can indicate that Mrs. Brown is not getting enough oxygen in her lungs. Patient's position must also be observed; in this case, if Mrs. Brown is sitting upright with her shoulders rounded up, then it will suggest that she is working hard to breathe.
A visual analogue scale is a tool which is useful in accessing patient's experience with breathlessness, and it will also provide information if any intervention thus far has been successful or not (Andreasen, Soendergaard, & Holst, 2018). It is also necessary to observe the scale accurately and record Mrs. Brown's breathing record in the nursing records and the observations chart. Any abnormalities should be astutely reported to her General Practice.
Other respiratory assessments which can be used to observe Mrs. Brown regarding her breathlessness includes the peak expiratory flow rate and pulse oximetry. Pulse oximetry is used to measure the oxyhaemoglobin percentage present in the heart capillaries. The instrument helps to regulate the maximum rate of flow of air which can be expelled from the lungs, based on the data of the oximetry it is indicated if the airway is obstructed or not (Dury, 2016).
Providing a physical assessment of Mrs. Brown will help medical professionals to treat her based on accurate and recorded observation. The treatment will also be accurate, and she might not need to revisit her GP since the comments will provide a precise diagnosis of her.
Breathlessness in COPD patients can be very frightening and may cause unnecessary anxiety and panic which will result in more breathlessness. Since COPD exacerbations significantly contribute to the mortality and morbidity of the patients, therefore, it induces high levels of stress and anxiety in the minds of the patients. The length of the stay in hospitals and the reduction in the quality of life can push the patient towards depression (Guo et al., 2018). Sometimes with frequent COPD attacks, patients tend to develop suicidal tendencies due to depression. The feeling of breathlessness can last from 3 minutes to even weeks and months if untreated. In most cases, patients lose interest in their daily work.
Since breathlessness is scary for the patients suffering from COPD, which may result in increased stress and feeling of restlessness; however, proper nursing intervention can break the undesired cycle. The most critical psychological strategy to calm the patient includes talking calmly and slowly to them and also instructing them to inhale slowly and exhale rapidly. Breathing along with them and guiding them to follow the breathing of the nurse can imitate deep breaths in patients helping them to calm and relax. It is also needed to make sure that the room is well ventilated which can benefit some patients. Some patients also find relief when the air is being blown by fans on their faces. Distraction can also provide patients with breathing problems to take their mind off.
By talking calmly and slowly patients tend to get calm and catch their normal breath. Breathing along with them gets the patient focus on the nurse's breathing, and they tend to imitate the nurse's breathing pattern instead of focusing on their own breathlessness. A well-ventilated room creates an atmospheric circulation in the space and patient's psychology dictates them that they can breathe in that open space. Some patients also get claustrophobic along with their COPD illness (Hussain & Williams, 2017). Claustrophobia is the fear of closed space. Blowing air on the face of the patients tend to make them relax and feel the presence of air around them.
With regards to Mrs. Brown, the shortness in breath or breathlessness has deteriorated her mental condition along with her physical health. Due to her condition, she gets a feeling of being trapped and also feels that her care will gradually become a burden to the family. She was already once diagnosed with depression by her General Practice due to being poorly nourished at that time. During that time she also had panic attacks. Her lengthy stay in hospital and treatment for the exacerbations is also affecting her mental health as well (Maddocks et al., 2017). If this continues then she can once again suffer from depressive symptoms and can develop suicidal; tendencies in the absence of her family and friends.
The paper concludes that acute breathlessness is a significant problem of COPD patients. To address the issue of breathlessness among the patients, nurses should provide an intricate assessment of the issues to the GP. Visual scaling tool can be utilised in this regards to examine the pattern of breathing among individuals. Breathlessness in COPD patients can also be very frightening and may cause unnecessary anxiety and panic which will result in more breathlessness and other mental health problems. From the given case physical and psychological strategies can be chosen as the suitable strategies to provide Mrs. Brown's the necessary care for her bodily needs and also her emotional needs.