Palliative Assessment and Clinical Response
Palliative Assessment and Clinical Response
(Please complete or affix Label here)
UPI: 9823693642
Surname Kngwarreye
First name: Ngarla
DOB: 01/01/62
UTAS
Assess on admission, daily, at phase change and on discharge
Year 20 Date Time Patient Rated Score Symptom Assessment Scale (0-10) Rate experience of symptom distress over a 24hr period 0 = absent 10 = worst possible
0 = Continue care 1 -3 = Monitor and record 4-7 = Review/change plan of care; referral, intervention as required 8-10 = Urgent action
Distress from difficulty sleeping 3 Distress from Appetite 3 Distress from Nausea 2 Distress from Bowels 4 Distress from Breathing 6 Distress from Fatigue 3 Distress from Pain 3 Other Rated by Patient, Fam/Carer or Clinician
Use codes = Pt, FC, Cl Clinician Rated Score Problem Severity Score Actions (0-3) Refer to complete definition and rate each domain
0 = Continue care 1 = Monitor and record 2 = Review/change plan of care; referral, intervention as required 3 = Urgent action
Pain 1 Other Symptoms 1 Psychological / Spiritual 1 Family / Carer 2 Australia-modified Karnofsky Performance Status Scale (10-100) Refer to complete definition
Consider MDT review at score of 50 or below
AKPS 40 RUG-ADL Refer to complete definition4 - 5 = Monitor6 - 10 = assist x 110+ = assist x 1, consider equipment, staff requirements, falls risk, referral 15+ = as above, pressure area risk, consider carer burden and MDT review 18 = as above, full care assistance x 2
Bed mobility 3 Toileting 4 Transfers 4 Eating 2 Total RUG-ADL (4-18): 13 Palliative Care Phase (1-4 Died or D/C) Refer to complete definitionStable = Monitor Unstable = Urgent action required Deteriorating = Review plan of care Terminal = Provide EOL care
Died = record date, no further assessment required Discharge (D/C) = assess at discharge
Palliative Care Phase 3 Staff Initials Symptom Assessment Scale
Complete Definition
Patient Rated distress relating to symptoms over a 24hr period
The Symptom Assessment Scale describes the patients level of distress relating to individual physical symptoms. The symptoms and problems in the scale are the seven most common.
Usage:
Best practice is for the patient to rate distress either independent or with the assistance of a clinician or family/carer using a visual of the scale such as the Symptom Assessment Scale Form for Patients.
Symptom distress may be rated by proxy. This only occurs when the patient is unable to participate in conversation relating to symptom distress i.e. Terminal phase. Proxy: a family / carer or clinician who rates symptom distress on behalf of the patient though observational assessment. Use the following codes to describe Patient = Pt, Fam/Carer= FC or Clinician =Cl
Instructions: patient to consider their experience of the individual symptom or problem over the last 24 hours and rate distress according to
A score of 0: means distress from the symptom absent
A score of 1: means the symptom is causing minimal distress.
A score of 10: means the symptom is causing the worst possible distress.
SAS translations available on the PCOC website www.pcoc.org.au
Problem Severity Score
Complete Definition
Clinician rated assessment of problems over a 24hr period
Global assessment of four palliative care domains to summarise palliative care needs and plan care.
The severity of problems are rated and responded to following using the scale:
0 = Absent; 1 = Mild; 2 = Moderate; 3 = Severe
Pain: overall severity of pain problems for the patient
Other Symptoms: overall severity of problems relating to one or more symptoms other than pain
Psychological / Spiritual: severity of problems relating to the patients psychological or spiritual wellbeing. May be one or more issues.
Family / Carer: problems associated with a patients condition or palliative care needs. Family / Carer do not need to be present to asses needs as written, verbal or observational information may be used.
Australia-modified Karnofsky Performance Status
Complete Definition
Clinician rated assessment of performance relating to work, activity and self-care over a 24hr period
Normal, no complaints or evidence of disease
Able to carry on normal activity, minor signs or symptoms of disease
Normal activity with effort, some signs or symptoms of disease
Care for self, unable to carry on normal activity or to do active work
Occasional assistance but is able to care for most needs
Requires considerable assistance and frequent medical care
In bed more that 50% of the time
Almost completely bedfast
Totally bedfast & requiring nursing care by professionals and/or family
Comatose or barely rousable
Resource Utilisation Group Activities of Daily Living
Abbreviated Definition
Clinician rated assessment of dependency over 24hr period Palliative Care Phase
Abbreviated Definition
Clinician rated assessment
Stable Symptoms and problems are adequately controlled by established management. Monitor, review, anticipate & respond.
Unstable An urgent change in the plan of care or emergency treatment is required due to development of a new problem &/or a rapid increase in the severity of existing problems &/or family/carer problems. Urgent response required.
Deteriorating The plan of care is addressing anticipated needs but requires periodic review due to gradual functional decline &/or worsening of existing symptoms &/or the development of new but expected problems &/or family/carer problems. Review & change care plan
Terminal Death likely in a matter of days. Monitor, review & respond
Complete Phase Definitions available on the PCOC website www.pcoc.org.au
For Bed Mobility, Toileting & Transfers For Eating Independent or supervision only
Limited physical assistance
Other than two person physical assist
Two or more person physical assist Independent or supervision only
Limited assistance
Extensive assistance / total dependence / tube fed Complete RUG-ADL definitions available on the PCOC website www.pcoc.org.au June 2021
Assessment Task 3: Case Study Task Description
This assessment focuses on a complex case study of an individual living with a life-limiting illness.
In this task, you will be required to develop a plan of care in your own words, for the individual following their transfer from acute care to their home in the community.
You will select two key areas on which to focus and develop your care decisions/actions using the highest level of evidence available.
You will need to incorporate selected research articles into your plan, while applying applicable pathophysiology and pharmacology into your discussion.
Assessment Criteria Measures Intended Learning Outcome:
Criterion 1 15% Identifies and utilises high level evidence to inform and support care plan actions LO4
The work clearly identifies the highest level of peerreviewed research and practice guidelines specifically addressing the persons needs to support care plan actions
All relevant available information is included in initial examination and appropriate assessments are well chosen and justified to obtain new information.
Criterion 2 30% Discuss the inter-relationship between research and quality care and identify the issues impacting translation of research into practice to support person/family centred care. LO4
The work succintly and clearly discusses the interrelationship between research and quality care and identifies the issues impacting translation of research into practice.
All information is relevant and has been correctly interpreted and analysed.
Ideas and concepts are well justified.
Criterion 3 25% Relate the pathophysiology and pharmacology/nonpharmacological to your selected actions that support person/family centred care. LO1, LO3
The work clearly links the pathophysiology and/or pharmacology to your selected actions.
The explanation expertly applies this knowledge of the pathophysiology and pharmacology to the case study
Criterion 4 15% Communicate plan of care in a cohesive and clear manner LO6
The work clearly and concisely communicates a plan of care
The plan succinctlyy addressesthe two key areas and justifies relevance to the case study.
The plan draws on the most apropriate methods for evaluating actions and outcomes.
Criterion 5 15% Adhere to presentation conventions: legibility, spelling, punctuation, grammar and Harvard referencing LO6
The work is concise, clearly written, using correct terminology, twith no spelling or grammatical errors.
The work is correctly formatted and information is presented in a logical, easy to follow fashion. Difficult concepts have been well explained and easy to understand.
Task length 1500 words (45% of total for unit) D
Ngarla Kngwarreye Case Study Notes
BackgroundPatient notesVital signsRegular medicationsPRN Medications
Patient name:Ngarla Kngwarreye
Age:62
Next of Kin:Son Gwoya and Daughter's Inala and Jenna
Consultant:Dr Parry.
Diagnosis:End Stage Chronic Obstructive Pulmonary Disease
Ngarla Kngwarreye is a 62 year old Anmatyerre woman from Urpuntia in Central Australia. 2 years ago Ngarla developed a Hospital Acquired Pneumonia during a hospital stay for exacerbation of her COPD. Since this time her lung function has continued to deteriorate until 6months ago she was admitted to hospital with respiratory failure and her conditioned was critical, at discharge her COPD was categorised as End-Stage. Three days ago Ngarala was again admitted with exacerbationof her COPD requiring extensive oxygen support, multiple antibiotics and high dose steroids to stabilise her. You are the nurse responsible for her care.
Since admission, Ngarla's condition has failed to improve, her breathing has progressively worsened and she is now in the deteriorating palliative care phase of her illness. A family meeting has been held online (facilitated by the local community health nurse) with Ngarla, her family medical and nursing staff in the hospital and the community support available at home. During this discussion decisions concerning her ongoing care were made. Ngarla has decided that she wanted to return to country with a package of care designed to enable her to die at home and to support her family.
An initial clinical assessment was conducted by the consulting palliative care nurse who visited Ngarla on the medical ward. This information is to be used in the referral to the community palliative care nursing team. The PCOC Assessment is available in your assessment resources.
His last vital signs were taken at 0800 today:
BP:114/58 mmHg
HR:90 bpm
RR:20 bpm
Temp:35.8
SpO2:84% RA 88% 2l02 NP
Regular Medications
Budesonide/formoterol (Symbicort) 2 MDI BD
Tiotropium (Spiriva)1 cap MDI OD
Prednisolone 5mg Mane
Doxcycline Hyclate 50mg BD
Coloxy and Senna 2 tablets Nocte
Morphing SR (MS Contin) 5mg BD
PRN medications
Salbutamol 2 MDI Shortness of breath 4/24
Movicol sachet 1-2 Mane PRN constipation
Morphine Elixir 1mg every 2/24 maximum dose 10mg
Task Format
Task length: 1500 words (45% of the final grade for this unit).
This is to be written in essay format. You may use headings if you wish (which are not included in the overall word count).
Refer to the unit outline for the task assessment due date.
