Palliative care case scenario
Handover report to Ward 5B Oncology Palliative care unit
Patient name: Andrew Brian
MRN: 968 644
DOB: 27.05.1953
Weight: 53kg
Height: 170cm
BMI: 18.3 kg/m2 (underweight)
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.
Assessment
Observations taken at 10am this morning:
BP: 105 / 72 mmHg
HR: 64 beats per minute
SpO2: 94% R/A
RR: 12 breaths per minute
On Auscultation: Fine crackles–bilateral lower lung fields
Cool lower limbs
Temp: 36.4
OC (oral)
Glasgo Coma Scale (GCS): 10/15 (Eye = 2, Verbal = 3, Motor = 5)
Pain score: 8/10
BGL: 4.8 mmol/L
Recommendations
Continue with end of life care and PRN subcutaneous morphine and hyoscine medications.
Pain assessment and management
Colostomy care
Patient comfort measures for palliative care
QUESTION:
Identify a total of three patient health issues from the case scenario that
nurses can address within their scope of practice
. You can choose actual or potential health issues.
Rank the
three patient health issues
that were selected in part 1 in order of priority. Provide a rationale for the order of the rankings. The rationale must be supported with current literature.