NSP2 2023 Clinical Reasoning Cycle Template Assignment

Part A: Care Plan

ASSESSMENT

The client is in 3rd stage of palliative care and health is presently deteriorating. As per Problem Severity Score or PSS, pain score is 2, while rest symptoms are one. According to Symptom Assessment Scale or SAS, his nausea level is 2 and pain level is 5 Spiritual/Psychological 0, AKPS: 20, RUG-ADL: 18, Carer/Family 1.

Circulation, breathing and airway are intact. Immobility problems and stays confused. Complete assistance is required by him with toileting, nutrition and regular living activities. Nausea, lethargic and common body pain.

The patient is 163cm tall and weighs 50kgs. On his body’s sacrum, he is experiencing pressure injury at stage 2 level.

RECOMMENDATIONS

An effective care plan at the dying stage needs to be developed for Joe by the palliative care team. Normal (Subjective & Objective)

Subjective

• No pain
• No nausea
• No confusion

Objective

• Pain scale 5
• Nausea scale 2
• Confusion level present
• Abnormal (Subjective & Objective)

Subjective

• No weakness
• No appetite
• No constipation

Objective

• Lethargy signs
• Weight loss
• Pressure injury at stage 2

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?

Identify & prioritise at least 2 nursing problems.

The two key nursing issues can be identified as:

• Confusion
• Pain (Vera, 2023)

Goals, Actions and Evaluation

For the nursing problem of highest importance:

• Establish a minimum 3 goals for each nursing problem that include all 5 elements ofthe SMART acronym.
• List a minimum 6 actions (minimum 6), in order of priority that you would undertake to achieve that goal. Specify if the action is a dependant or independent nursing action. You must consider the holistic requirements of the patient. Provide a rationale that associates the pathophysiological and psychological principles with each selected nursing action. This section needs to be referenced.
• Describe how you would evaluate the effectiveness of the care provided (i.e. how will you know that your actions were beneficial to the patient?) This section needs to be referenced. A minimum 1 evaluation of the outcomes for each action.

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, Jo’s 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. 

1. What happens now to my dad?
   It can be explained that the consultant has interacted regarding the options for care that exist with the family and it has been found that the family have decided that Joy must be discharged home with assistance from the nurses who serve the community. It can also be explained that the nurses who serve the community would have the ability to offer pain relief, management of symptoms as well as emotional assistance to the patient and his family.
2. Will he be in a lot of pain?
   It can be reassured that the family of the patient that the nurses of community would have the ability to manage the pain of Jo in an effective manner. it can be explained the patient that pain medication has been prescribed already and the nurses who serves to the community would gain the ability to adjust the dose according to the requirement.
3. How will I tell my dad if he asks what is going on? What do I say?
   In this case, it can be explained that it is much significant to be honest with the patient regarding his own condition.

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