Introduction Andrew Brian a 69 year old male presented to the Oncology ward three days ago following deterioration over the last week. Patient is in the terminal phase of cancer and is experiencing...

Introduction

Andrew Brian a 69 year old male presented to the Oncology ward three days ago following deterioration over the last week. Patient is in the terminal phase of cancer and is experiencing severe pain. Andrew and his family are not comfortable attending to end-of-life requirements at home. The patient wife and two children have accompanied the patient to the hospital for end of life care. The patient wife informs the nurse that the patient has not been sleeping well for the past week due to experiencing severe pain.

Situation

The patient is becoming less conscious and is no longer verbalising but opens eyes to pain. Vital signs prn have remained stable for the past three days. The patient is receiving regular subcutaneous morphine and hyoscine via an abdominal subcutaneous butterfly. The patient is NBM. Mouth care has been attended and Colostomy has minimal output.

Background

Andrew has a four year history of Colorectal Cancer and has a Colostomy insitu following bowel resection surgery four years ago. Andrew developed terminal metastases in his lungs and brain three months ago. The patient medical notes contain the required documentation for an Advanced Care Directive (ACD) which includes a
do-not-resuscitate order and no other acute medical response or treatment.
Medical staff discussed advanced care planning with the patient and family during a previous medical admission for radiotherapy six weeks ago. Andrew lives with his wife and has two children with families of their own.

QUESTION:

Identify a total of three patient health issues from the case scenarios that

nurses can address within their scope of practice
.
Outline the nurse’s role in addressing the

top three priority patient health issues

in relation to patient assessment, coordination of care and delivery of care. Relate the discussion to nursing and healthcare standards and health department policies. e.g. RN Standards for Practice, NSW health policy, National Safety and Quality Health Service (NSQHS) standards etc.