Palliative Care Essay

1. What is Palliative C atomic number 18? (150 talking to)Palliative C be is a accusation proposed when some angiotensin converting enzyme is living with, and dying from a fatal chronic condition where the primary goal is maintaining quality of vivification. It provides special supportive grapple for any(prenominal) wizard who is suffering a life-threatening condition approaching the cease of life. Palliative c ar is for any age, those with ratcer or any other terminal diagnosis, people of any ethnic or cultural background, whether they may put out in the country place or the city. Palliative explosive charge maintains quality of life, provides comfort although it does not cure, It relieves distressingness and distress for long-sufferings who are on a terminal condition. Palliative care also offers support for the affected roles family members supporting them in bereavement2. What is meant by a life constraining illness (50 words)A life limiting illness is the term ro led to describe the illnesses where death is expected to be the foresee fitting future of that specified illness. This tooshie be both malignant and non-malignant illness. such illness may include cancer, renal disease, dementia, heart disease chronic liver disease and chronic obstructive pulmonary disease.3. Identify five members of a Palliative care multi -disciplinary health care team and briefly state what association and skills each discipline contributes to the team .1) Nurses Nurses are the front liners in unhurried of care and directly deals with the forbearing. Registered Nurses plan, direct, and coordinate care. License practical nurses works with RNs and other health professionals to provide direct care. 2) Pharmacists The pharmacist can educate the patient and the family on how to take and manage side effects of the medications give the doctor advice on how to administer the medication, prepare the medication, help set a schedule of taking medication, and provid e ongoing monitoring of all medications. 3) Chaplains Chaplains addresses the spiritual needs of patients like praying and answering theological questions.The help with the search for meaning in the persons life and in the reflection of matters of faith such as prayer and rituals 4)Physician/Family Doctor The physician is the one in charge of a persons medical care and works closely with the patient, patients family, and the palliative home care. The family doctor can refer the patient for palliative care consult. 5) fond Workers Social workers help the patient and family in dealing with personal and social problems of illness. They assist in making referrals to confederation services, planning discharge to home or to a hospice, and completing advance directives in case a person loses the ability to accost for himself.4. Describe how nurses could facilitate a in force(p) death by following the palliative care approach (75 words) Nurses are the one that provide direct care t o the patients. They are the one who assess the patient and the first one to see any improvements or any abnormalities on patients condition. Nurses are the one who manage the agony and any innervation of the patient. They are the one whom the patient talks to active their feeling and nurses moldiness use their therapeutic and non-therapeutic communicatings when handling palliative patients. Nurses must also provide a serious and comfort adapted environment to the patients and removing any stimuli.5. Describe how respiratory and cardiovascular factors in terminal illnesses affect the clients ADLS ADLs are greatly affected by respiratory and cardiovascular factors because they are unable to do things they used to do. In a simple walk they can be easily exhausted, fatigued and feeling weak. sometimes they need assistance to do their daily routine because they cannot handle it by themselves. This is all because of the respiratory and cardiovascular factors that affected them, there im incision be cliff in circulation and oxygenation making them feel weak on doing simple tasks. In serious cases, patient might deliver other complications due to lack of employment and immobility like pneumonia and pressure areas.6. Research and summarise the practices of Aboriginal people in relation to death and dying (100 words ) Indigenous Australians squander analogous practices to the general Australian population the main differences that when they gather for the purpose to share their grief and sorrow they testament never again speak the name of the dead soul as they believe this may stop their spiritfrom moving onto the next stage of life. At the wake they paint themselves with ochre body paint and sing, dance pray assisting the soul of their loved one to move along and return to their birthplace to be re born. Their belief is that all things may posses a soul and that the soul of the deceased may return in any form evening that of a rock. These ways are very traditional and differ even between tribal areas and current beliefs of the individuals.7. What is an Advanced wellness Directive and describe the advantages of having a directive in place? A written document stating ones wishes for care, chiefly life sustaining measures when he or she is no longer capable to behave him/herself/8. What is meant by life sustaining measures? Put simply is when your bodies system fails and will not ascertain leaving the only outcome of death a machine is used to replace the function9. What happens if a client has no AHD and cash in ones chipss too ill to express their care wishes? (30 words) When a client has no AHD they are treated as normal under the health teams objective to preserve life meaning they will be resuscitated and all attempts will be made to maintain life. Alternatively this is where the decision-making can become that of the families or a member of family.10. Can instruction manual be written for doctors to assist the client to d ie? and how (30 words ) Advance health directives are used by patients for their future treatment when they cannot be able to speak by themselves. Doctors cannot assist the patient to die unless it is the will of the patient. There cannot be written any instruction to assist the patient to die as currently this is illegal and the health practitioner that does perform such duties with be trialled for murder.11 . Can a client change or revoke an AHD ?. (30 words )Patient can change their advance health directive at any time, provided that they will still have the decision making capacity. Patient can also revoke their AHD having their signature witnessed.12. .A family is in conflict over the treatment of their family member who is dying .The patient is in a terrible amount of pain ,yet some members want less pain relief as they dont want him to be too drowsy .Should the patient be able to die with dignity with controlled pain relief or live longer in pain ? Explain your rationale and reflect your thoughts on this .Also how would you support the family with this plight ? (100 words)The aim of palliative care is to maintain integrity and quality of clients life while he/she is battling an incurable illness. Quality of life includes ensuring that the patient is comfortable and pain free. In this situation, providing education to the patients family is important by trying to make them understand the advantages as well as disadvantages of providing pain relief to the client. Providing terminally ill patients adequate pain relief is vital in the outcome of palliative care.13. The care plan states that your patient is to have a shower any day at the familys request .You are helping to crap out of bed and she states I dont recollect I can shower today You also note that she is short of breath. What is the appropriate response to this situation? What actions would you take? (50 words) I will assist the patient back in bed and elevate the head of bed to 45 degrees o r higher indeed check her vital signs. In short, I will grant the patients wish of lenifying in bed and let the patient rest.If she prefers a bed bath because shes not feeling well, then bed bath should be rendered. I will also assess her vital signs and neurological observations then inform the RN and the tending physician. How would you communicate these events to the patients family when they pull through ? Once the family arrives, we could inform them that the patient is not feeling well and is short of breath so she refused to be given a bath. Explain to them that vital signs were checked, attending physician has been informed of the situation, and appropriate intervention was already given.14Consider the following symptoms and list strategies you could use to implement to assist the client (150 words)Abdominal bloating and discomfortMoist gurgling respirationsReddened sacrumDysphagiaOpioid induced constipationStrategies includeInstruct client or family to avoid carbonated drinks and gas forming food such as breadstuff and beans.Advise to chew slowly and not to eat too much food at onceInform the doctor about the condition for a medication to be ordered if not alleviated Maximising the clients oxygenation through positioning the client upright Providing supplemental oxygen and maintaining obvious airway through deep breathing exercises Suctioning if requiredPhysiotherapy15. Describe how you would respond to the following questions /request for informationWhy is he continuing to have pain when he is barely conscious? Although the client is barely conscious, it doesnt mean that he is not in pain. The manifestations of pain could not only be appreciated through verbal or physical gestures but also through vital signs. Pain could cause the blood pressure to shoot up as well as the respiration and pulse rate.Why does her breathing sound so bad?The breathing is due to the decrease in oxygenation that causes the respirations to be rapid or slow, shallow an d irregular. Breath sounds may become wet and noisy, which are due to the accumulation of mucus in the airways and the patients unfitness to expectorate their secretions due to muscle weakness and decreased gag reflex. How much longer will this go on for? (50 words)This kind of breathing will go on until the vital organs and systems stopfunctioning. Generally, respiration ceases first.16 . Palliative care can be challenging environment to work in. Discuss ways in which you could ensure you care for yourself and why this is so important It is important to maintain a healthy body & mind if you are to be workings in such an environment as you are a key element of care to both the patient and their family. Ways to maintain your own health are to maintain a journal and to actively seek out and debrief or find a professional to discuss your personal concerns with. fittingness and physical activities or simple stretches and/or yoga or pilates sessions can also be just as beneficial as mu ch as it is about your physical benefits it can also assist in relinquishing any built up stressors.17Mr J ones care plan states that he must have a blood transfusion if his HB falls below 8.0 .Hi test today shows 6.5 .He is short of breath and fatigued .As the RN leaves the room later on informing Mr Jones that he is to have a transfusion he says that he does not want the transfusion and that he has had enough and just wants to die .What are your actions and response to this situation ? (50 words)As it is already established why he does not wish to receive the treatment I would simply discuss why the transfusion is done and how non invasive the process is and its benefits. However in saying this the situation presented is one where the patient is obviously in emotional distress. I would can the RN, MO &/or Doctor. Depending upon the end resolve next of kin may also be notified should treatment cease so as they can be prepared for any outcome. In my scope I would notify & document .Provide education where needed and support the patient making referral to social services or identified individuals who have already had dealings with the patient on a faith or belief basis it may also be beneficial. The MO/Doctor will deem if the patient is of sound mind to make such decisions and/or discuss with the patients substitute decision maker/s.18. .Access a local group or organization in your lodge and identify what resources the organization offers to patients and their families forbereavement counselling ,education and support .How can clients access the information (50 words)? A good provider of a full range of services is the Salvation Army as being already well established they have an extensive knowledge base and well thought processes being implemented. Counseling and education is available over the telephony 24/7 and can be useful for any circumstance from distress & grief to suicidal moments.They also offer face to face counceling and can cover a full topic r ange, along with those already mentioned they can also discuss and assist with finance, drug abuse, domestic violence, homelessness, youth issues and even hostel and aged care assistance. The salvation armies care line phone number nationally is 1300 36 36 22 19Care of the body after death is a vital aspect of palliative care and is based on cultural and religious beliefs, which includes issues of organ donation ,post mortem and autopsy .Briefly provide some information on the above in regards to The Jewish community ( 40 words )From the time of death to the funeral the body is to always be accompanied and never alone. Jewish religious law also preserves the rate for the dead. These rites may includeClosing of eyes and mouthApplying clay over the eyelidsFacing the body toward the doorPlacing the body on the floor for 20 transactionsPlacing the arms alongside the body rather than folded over the chestPurification of the bodyWrapping the body in a white shroud and (for men) in a pr ayer shawl Customarily, only members of the same sex are permitted to touch the corpse These rituals may be facilitated by family members, the funeral home, and/or the Chevrah Kadish (burial society)Keeping with the Jewish laws of not mutilating a body autopsies and organ donations can also be prohibited but it has been known on occasion for organs to be donated to family members. The Muslim community (40 words )For those of Islam the process is quiet simple the body is to be bathed andshrouded (3 pieces of cloth for men and 5 for women) and buried as soon as possible. In the stave prays will be made and loved ones begin grieving and the mourning process over 3 days. The main points of avocation is that the grave is to be line up perpendicular to Mecca as for other burial traditions they vary between regions. Cremation is forbidden and organ donation is permissible generally as long as it is to moreover life. Autopsies are a grey area in that there is no religious decry but many would prefer not to as a quick burial is preferred however if it where for legal reasons it has been allowed.20. Discuss three legal and ethical issues that are related to Palliative. Briefly discuss (80 words) http//www.adelaidenow.com.au/archive/ intelligence operation/giving-my-dad-final-dignity/story-e6freah3-1111118720637?nk=5be06e19d7df58d1a484641fb445fb30Legal Issues Currently under law and a part of all practitioners industry acts is to do no harm as I have discussed previously any practitioner under current legislation to participate in mercy killing would be tried for murder. I dont agree with this in person and even more so that should the individual perform the duties themselves it would be considered suicide negating any legacy or insurances taken to look after their families as part of their comfort in knowing the family will be cared for. Ethically I agree with the article (link above) in that humans do play god in most aspects of the anatomy and health care we pro vide interventions that would cease the immanent course of any ailment, we preserve the life of those inflicted with chronic illnesses, we intervene in every aspect even without knowing the full course or purpose of the health issue in the first place.The results of intervention are starting to become clear in our society, reduced immunity, fragile and susceptible bodies I believe may only be the beginning what happens after a couple generations of this. all the same we will sit on our hands when the individual is left with no dignity, pride or human rights and wait for what could now almost be looked as The Miracle of Death.Did the gather hunters have it right back in the beginning? I think if I where void of all senses and only had very basic neurological activity and being kept alive for the sole purpose of viewing and an observation tool I think if I could speak I would speak of cruelty and probably win a court case for it.Dont get me wrong though, I am not pro euthanasia eith er however if we are to take a debate on that topic then why stop intervening in nature and playing god when it comes to end.21. List some of the ways that you can manage the hydration and nutritional requirements of the client during the end of life stage (80 words ) A fluid eternal rest chart, cardiovascular and visual observations of throw together turgor, lips and mucousal linings would be a good indication for both hydration and nutrition. Depending how long the client has been in your care you may also be able to view changes in nails, hair and eyes these may also be good diagnostic tools and also ensure regular visits from the dietician and hamper to the plan.22. Pain care is an important aspect of palliative care. Discuss six ways that pain symptoms can be managed without medication (50 words ) Any confusion can assist in removing the focus from pain. Massage can assist in relieving muscles, has a diversion and therapeutic effect also. Hot & cold packs, sleep, exercise , music, inborn oils and simple stretches all can contribute in alleviating or reducing pain.23 . List five barriers to effective pain management (30 words ) A barrier is as defined is anything that can restrict the patient from achieving an outcome. Given this as a starting point and making the target to be effective pain management or free of then the barriers are dateless. They can range from family members to low medication supply through to increased resilience to medications or organ failure. Not to mention the individuals psyche emotion and physical state, they may manifest pain that doesnt exist or they may be besides stressed causing pain to increase they may also be in blatant refusal of care, have fears, language & cultural differences, communication the barriers are endless and should I have a full education in multiple fields and endless time to study and read random information Im sure there would be many others to add to the list.24. List the five stages of dying a ccording to Dr Kubler -Ross ( 10 words) The five stages of dying areDenial- this is natural and defence mechanism where people may not accept the fact that they are dying or will die. Anger- Upon realisation of the situation to they may get frustrated and angry about their predicament, how and why it has happened. Bargaining- in this stage they realise that they are dying soon and pray for more time. Such phrases like Ill be a better person, father or Partner would be commonly heard. Depression- The person has accepted the fact and is sad about the fact they are dying. They have realised the ultimatum and may have regret over past choices or behaviours and can do nothing about it. Acceptance- People realise that they are dying and finally accept it and have come to a kind of peace with the situation.CASE STUDY 2Using this case study summary some nursing interventions that demonstrate applying a palliative care approach using the following headings (150 words) Spiritual Patient in a palliative care often spend their time praying and they become closer to God as they get old. evermore respect the patients beliefs and values. If the patient is praying do no interrupt him and to the procedures when he is finished praying. Ask him if he want a priest to visit him and give him some prays. Always know the patients religion and his beliefs to avoid conflict on giving care Comfort The main goal of the palliative care is to give provide comfort to the patient. Always ask the patient how they are feeling or if they need some help. Simple chat with the patient makes them comfort, a simple questions like How are you? can make them feel special and they might think there is still someone who cares to them. Giving what patients need and attend to those needs makes the patient feels comfortable. Legal Patient at this stage have their Advance Health Directives, it is a legal document for that the patient did for his future treatment and must be implemented. Always provide pa tients autonomy. We as EEN must always maintain confidentiality and privacy of the patient. Pain management Pain assessment is important for management of the pain. We must always assess the patients pain and must have intervention to the pain not only in a pharmacological way but also in a non-pharmacological way because some of the patient cannot take too much medicines. Always ask the patient how are they and report to us if they feel any pain. Elimination bowel and urinary At this time patients elimination changed unlike before, some of the patient are incontinent of urine and faeces due to deterioration of the body. Make sure to educate the patient about normal aging that incontinence is a normal process of aging. We must monitor their Input and Output and document it on a Fluid Balance Chart if necessary. If the patient is constipated push them to increase fibre in diet and have some exercise. Assist the patient always in the toilet early in the morning and use toilet chair i f necessary. Skin Integrity As the patient goes old, their skin becomes dry and fragile. Encourage the patient to use lotion or moisturiser on their skin so that their skin will not be dry. Prevent the patient to have pressure areas by repositioning the patient to different sides every 4 hours. Assess the skin for pressure areas and put some cream on those areas. Document any abnormalities to patients skin such as fervor and bruise. Mobility Provide patient independence on their care to promote range of motion. Refer patient to physiotherapist if necessary. Encourage the patient to exercise daily. If the patient have mobility aids educate the patient on how to use it properly. Mental health physiological support Patients at this point becomes depressed and feels alone. Always provide communication to the patient using therapeutic and non- therapeutic approach. Always talk to the patient or ask the family to visit the patient.Describe how you could improve the room and environment f or black lovage (100 words) Ask the children to bring pictures of themselves and the parents tobring in any items they think would make the room more comfortable but allow Alexander to decide if they stay Greenery never hurts and/or a fresh breeze through the window and perhaps a couple science orientated magazines on the side table to peak his curiosity as if you do a trade long enough you will always have a professional interest whether you want it or not.ReferenceCrisp, J, Taylor, C, Douglas, C & Rebeiro, G 2013, Potter and Perrys Fundamentals of Nursing 4th Ed. Elsevier Mosby, Sydney.Brown, D., & Edwards, H. (2012). Lewiss Medical Surgical Nursing (3rd ed.). Sydney, Australia Mosby, Elsevier department of Attorney General 2014, Advance Health Directives, viewed 10 phratry 2014, http//www.publicadvocate.wa.gov.au/A/advance_health_directives.aspxEnd of life Care Network, Life limiting illness, 2011, Viewed on 09 September 2014 http//www.endoflifecumbriaandlancashire.org.uk/info_ patients_carers/life_limiting_illness.phpHibbert C 2014, Dealing with griefThe 5 Stages of Grief, viewed 10 September 2014, http//www.drchristinahibbert.com/dealing-with-grief/5-stages-of-grief/OConnor, M & Aranda, S 2003, Palliative Care Nursing A Guide to Practice second Ed. Ausmed Publications, Melbourne.NSW Board of Jewish Education 2012, Autopsy, Transplantation, Insemination and abortion, viewed 10 September 2014, http//www.bje.org.au/learning/judaism/ethics/bioethics/autopsy.htmlPalliative Care Council, What is Palliative Care, 2012, Viewed on 09 September 2014 http//www.pallcare.asn.au/about/what-is-palliative-careTasmania Department of Health and Human Services 2013, Palliative Care Team, viewed 10 September 2014, http//www.dhhs.tas.gov.au/palliativecare/about/teamWorld Health Organisation 2014, WHO definition of Palliative Care, viewed 10 September 2014, http//www.who.int/cancer/palliative/definition/en/