7490765203NUR353: NSP2 2024: AT3: Part A: Care Plan
7490765203NUR353: NSP2 2024: AT3: Part A: Care Plan
654055935900 Patient situation
IDENTIFICATION
Jo Smith, DOB 21/01/1931, Nil known allergies.
SITUATION
For discharge home on care of the dying pathway with community nursing and other supports.
BACKGROUND
Jo lives at home with his daughter. Jo has a history of Alzheimers Disease, NIDDM, AF, GORD, CCF, mild depression, and previous hernia and AAA repair. Two weeks ago, Jo was bought into ED by his daughter with a history of new confusion, fevers, and rash, refusing diet and fluids for the previous two days and was jaundiced in colour. Jo deteriorated with sepsis. He experienced a cardiac arrest in ED. Following resuscitation, Jo was transferred to intensive care. He underwent further investigations and was diagnosed with advanced CA of the liver with metastases in the pancreas, lungs, and brain. He was transferred to the medical ward and Jos family requested no further active treatment and have asked that he be discharged home with appropriate supports.
ASSESSMENT
Palliative care phase 3: Deteriorating. Symptom Assessment Scale (SAS): Pain 5; Nausea 2.
Problem Severity Score (PSS): Pain 2; Other symptoms 1; Psychological/Spiritual 1; Family/carer 1.
RUG-ADL: 18 AKPS: 20
Airway, breathing, circulation intact. Jo is no longer mobile. He remains confused. He requires full assistance with activities of daily living, nutrition, and toileting. Jo is lethargic, has generalised body pain and nausea.
Jo is 50 kgs and is 163 cm tall. Jo has a stage 2 pressure injury on his sacrum
Jo does not identify with any particular religious denomination however his daughter advises that he is strongly spiritual, and this will need to be considered in planning his care.
RECOMMENDATIONS
Jo needs an assessment and a care of the dying plan developed.
584207205900 Interpret: In the following table, list the cues of concern from the scenario above
Cues of concern (Subjective & Objective)
Subjective
Objective
Process Information. Interpret, analyse, discriminate, relate, infer, match, and predict.
Are there recognisable patterns when the cues are clustered?
Are there comparisons which can be drawn with previously observed clinical presentations?
Consider thinking ahead: What could happen if you took no action?
498346667500
From the cues/information above identify and prioritise 3 nursing problems.
Nursing problem 1
Nursing problem 2
Nursing problem 3
622305811600
Goals, Actions and Evaluation
For each of your 3 chosen nursing problems:
Establish a minimum 2 goals for each nursing problem that include all 5 elements of the SMART acronym (Specific, Measurable, Achievable, Realistic, Timebound).
List a minimum 2 actionsto achieve each goal in your chosen order of priority.
For each action provide a rationale that evidences the relevant pathophysiological and palliative care principles. This section must be appropriately referenced.
For each action describe how you would evaluate the effectiveness of the care provided (i.e. how will you know that your action/s were beneficial to the patient). This section must also be referenced. You must include at least 1 evaluation measure for each action.
SMART goal(s) Actions (2 per goal) Rationale (for each action) Evaluation measure (for each action)
Nursing problem 1 Goal 1
Goal 1 Action 1
Goal 1 Action 1 rationale
Action 1 evaluation measure
Goal 1 Action 2 Goal 1 Action 2 rationale
Action 2 evaluation measure
Nursing problem 1 Goal 2 Goal 2 Action 1 Goal 2 Action 1 rationale
Action 2 evaluation measure
Goal 2 Action 2
Goal 2 Action 2 rationale
Action 2 evaluation measure
Nursing problem 2 Goal 1 Goal 1 Action 1
Goal 1 Action 1 rationale
Action 1 evaluation measure
Goal 2 Action 2 Goal 2 Action 2 rationale Action 2 evaluation measure
Nursing problem 2 Goal 2
Goal 1 Action 1
Goal 1 Action 1 rationale
Action 1 evaluation measure
Goal 2 Action 2 Goal 2 Action 2 rationale
Action 2 evaluation measure
Nursing problem 3 Goal 1
Goal 1 Action 1
Goal 1 Action 1 rationale
Action 1 evaluation measure
Goal 1 Action 2 Goal 1 Action 2 rationale
Action 2 evaluation measure
Nursing problem 3 Goal 2 Goal 2 Action 1 Goal 2 Action 1 rationale
Action 2 evaluation measure
Goal 2 Action 2
Goal 2 Action 2 rationale
Action 2 evaluation measure
Part B: Family discussion
Watch the video titled:" Jo Smith discharge planning conversation"(available in the MyLO Assessment Resources Tab)
The video captures the conversation between the consultant caring for Jo and his family. Jo is not present as he is too unwell.
Following the meeting, Jos family relocates to the family room. You are the nurse assigned to care for Jo. You approach the family, and they ask you the following questions.
Explain how you would respond to each question.You may answer these questions in the first of third person.
How will we care for dad at home. Who will help us?
Will he be in a lot of pain? How will we manage his pain? What if it gets really bad?
What happens to dad after he dies at home? What do we do? Who do we contact?
Task Description
During the Intensives you cared for Jo Smith, a 92-year-old male with a history of Alzheimers Disease and other complex health issues. In the first intensive, he experienced an acute deterioration and was successfully resuscitated.
He was discharged for a brief period and has now been admitted due to a deterioration in his condition. The second study module and intensive provides an opportunity for you enhance your understanding of palliative careand the assessment and treatment of people with palliative care needs through the use ofspecialised assessment tools and approaches to treatment and symptom control.
Jo has now entered a stage of palliation and he and his family have had a meeting with the consultant regarding end-of-life decisions.
For this assessment task you must complete Part A and Part B anduse the Assessment Task 3 Template provided for you in the Assessment Task Resources.
Part A
You will explore the eight stages of the clinical reasoning cycle to create a plan of care for Jo.
You must support the plan with relevant frameworks, codes, standards, and evidence-informed sources.
Firstly from the ISBAR information interpret and list the subjective and objective cues of concern.
You will then process the information to identify and prioritise 3 nursing problems. In developing your care plan you must consider the holistic requirements of the patient.
For each of the 3 chosen nursing problems:
Establish a minimum 2 goals for each nursing problem that include all 5 elements of the SMART acronym (Specific, Measurable, Achievable, Realistic, Timebound).
List a minimum 2 actions to achieve each goal in your chosen order of priority.
For each action provide a rationale that evidences the relevant pathophysiological and palliative care principles. This section must be appropriately referenced.
For each action describe how you would evaluate the effectiveness of the care provided (i.e. how will you know that your action/s were beneficial to the patient). This section must also be referenced. You must include at least 1 evaluation measure for each action.
Part B
Requires you to watch the video titled: "Jo Smith discharge planning conversation" (available in the MyLo Assessment Resources Tab) which captures the conversation between the consultant caring for Jo and his family. Jo is not present at the meeting as he is too unwell.
Following the meeting, Jos family relocates to the family room. You are the nurse assigned to care for Jo. You approach the family and they ask you the following questions. Explain how you would respond to each question. You may answer these questions in the first of third person.
How will we care for my dad at home. Who will help us?
Will he be in a lot of pain? How will we manage his pain ? Who will help us?
What happens to dad after he dies at home? What do we do? Who do we contact?
The CRC care plan template is to be used for both Part A and Part B (See MyLo Assessment Resources tab)
Please Note:
Assessment Task 3 is an individual submission and although you will have the opportunity to work individually or in groups during and supported by your tutor in Intensive 2, you will not be submitting any group work.
Your submission must be made individually and follow academic integrity requirements
Assessment criteria and marking rubric
Assessment Criteria Measures IntendedLearning Outcome:
Criterion 1 Correctly interpret relevant pre-briefing diagnostic information. LO1, LO2, LO4
Criterion 2 Use critical thinking to predict possible deterioration pathways. LO1, LO2, LO4
Criterion 3 Analyse and rationalise priorities of care. LO1, LO2
Criterion 4 Develop a management plan describing actions with rationales provided and goals. LO1, LO2, LO3
Criterion 5 Reflect on intraprofessional and interprofessional communication, critical thinking and clinical reasoning. LO1, LO5
Criterion 6 Adhere to presentation conventions: legibility, spelling, punctuation, grammar and referencing. LO6
Jo Smith Case Study Notes
Background
Patient name: Jo Smith
Age: 92
Next of Kin: Marlie Smith
Diagnosis: Advanced cancer of the liver and metastases in the pancreas, lungs and brain
Patient Notes
Jo lives at home with his child Sam Smith. Jo has a history of Alzheimers Disease, NIDDM, AF, GORD, CCF, mild depression, and previous hernia and AAA repair and one week ago was diagnosed with advanced CA of the liver and metastases in the pancreas, lungs, and brain.
Two weeks ago, Jo was bought into ED by his daughter with a history of new confusion, fevers, and rash, refusing diet and fluids for the previous two days and was jaundiced in colour. Jo deteriorated with sepsis. He experienced a cardiac arrest in ED.
Following resuscitation, Jo was transferred to intensive care. He underwent further investigations and was diagnosed with advanced CA of the liver with metastases in the pancreas, lungs, and brain.
Jos family then requested no further active treatment and have asked that he be discharged home with support from the community nurses.
Regular medication
Atenolol 50 mgs daily
Metformin 1gram daily
Frusemide 40 mgs daily
Perindopril 4 mgs daily
Oxycodone 5mgs every 6 hrs PRN
Paracetamol 1 gram 4th hourly PRN
Ondansetron 4mgs 6th hrly PRN
Task length: 1700 words (50% of the final grade for this unit)
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