Complete the palliative nursing care plan for a person who requires the maintenance of oral health

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1. Complete the palliative nursing care plan for a person who requires the maintenance of oral health.

The maintenance of oral health is related to the changes in the hydration and nutritional requirements of a person during palliative care and at end-of-life.

Refer to specific instruction listed above to clarify what information is expected in each column

Nursing Assessment and Identification of Actual or Potential issue	Planning	Implementation	Evaluation – assessment of the desired outcome
Actual problem – oral health Nursing assessment: Patient can experience a dry mouth due to dehydration or side effects of medication.	Specific ? Measurable ? Achievable ? Realistic ? Time-bound ?	Ensure the patient is having adequate amounts of water to stay hydrated and make sure to Maintain the use of lubricating ointment on the lips to prevent drying and cracking.	After these interventions have been put into place, the patient will be hydrated and the risk of developing infection will be reduced.

1. Complete the palliative nursing care plan for personal care who has the potential problem of cachexia in relation to changes to their hydration and nutrition requirement during palliative care and end of life

Refer to specific instruction to clarify what information is expected in each column

Nursing Assessment and Identification of Actual or Potential issue	Planning	Implementation	Evaluation – assessment of the desired outcome
Potential problem – Cachexia Nursing assessment: Patient experiencing extreme weight loss and muscle wasting.	Specific ? Measurable ? Achievable ? Realistic ? Time-bound ?	Ensure the patient is having a high intake of food and fluids to be getting the adequate amount of nutrition. Refer the Pt to a dietician. Weigh the Pt daily to see if there’s a decrease or increase in weight.	After these interventions have been put into place, the patient will start to get the right amount of nutrition in the body to slowly start gaining weight.

1. Complete a palliative nursing care plan for pain management including common non-pharmaceutical and complementary care for a person requiring a palliative approach to care

Refer to specific instruction to clarify what information is expected in each column

Nursing Assessment and Identification of Actual or Potential issue	Planning	Implementation	Evaluation – assessment of the desired outcome
Pain Management – Non pharmaceutical and complementary care Nursing assessment: The patient may be experiencing pain due to developing pressure sores.	Specific ? Measurable ? Achievable ? Realistic ? Time-bound ?	Ensure to reposition the patient every 2 hours and provide support such as a pillow. Also provide pressure area care and ensure the patient is maintaining good nutrition + keep the skin clean and dry.	After these interventions have been put into place, the patient will have a reduction in pain and pressure sores. Reduced risk of further impairment of skin integrity.

 

1. Complete a nursing care plan of pain management including medication administered using a syringe driver or intima sub cut lines for a person requiring a palliative approach to care

2. Refer to specific instruction to clarify what information is expected in each column

   Nursing Assessment and Identification of Actual or Potential issue	Planning	Implementation	Evaluation – assessment of the desired outcome
   Maintenance and usage of sub cut line pain relief, anti-nausea, and steroid injection	Specific ? Measurable ? Achievable ? Realistic ? Time-bound ?	Name four indications for the use of sub cut lines: Severe nausea and/or vomiting.   Dysphagia.   Unconscious or sedated patient.   Non-absorption of oral drugs.	With the implementation of a sub cut line, the patient will be able to receive adequate pain relief and the risk of infection will be decreased.

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4. In reference to the relevant organisational procedure “Administration of subcutaneous medications in Palliative Care: a) Intermittent b) Via a syringe driver” https://www.seslhd.health.nsw.gov.au/sites/default/files/migration/Policies_Procedures_Guidelines/Clinical/Cancer_Services/documents/SESLHDPR175AdministrationofsubcutaneousmedicationsinPalliativeC.pdf

5. Complete a nursing care plan for the management of syringe drivers to administer pain relief, antinausea and steroid injections.

6. Refer to specific instruction to clarify what information is expected in each column

   Nursing Assessment and Identification of Actual or Potential issue	Planning	Implementation	Evaluation – assessment of the desired outcome
   Care and use of syringe driver	Keep the skin around the tube dry and ensure to check the site every 4 hours.	According to the above procedure document, what are the indication and contraindication for use of a syringe driver: Patient is NBM due to nausea/vomiting. Poor absorption of oral medicines. Patient is in and out of consciousness.	With the implementation of the syringe driver, the patient will be comfortable because plasma drug concentrations are maintained without peaks and troughs, giving constant therapeutic drug levels over a 24-hour period. ("Safe practice in syringe pump management", 2015)

7. PLEASE READ THROUGH Part 2: Palliative Nursing Care Plans
8. Specific Instructions

9. Completing Palliative Nursing Care plans will assist you to identify the needs of the person, family, and carers during the palliative approach to health care. In this task you will need to complete the Nursing Care Plans based on the knowledge you have obtained during this unit of study and your own personal research

1. Nursing assessment and identification of actual or potential problems – In this column, you should document how you would gather the information needed to identify the features of the actual or potential issue. The information may be obtained: -

• directly from the client or from significant others

• by physical examination using the techniques of inspection, palpation, percussion or auscultation

• by assessment tools

• from information, assessment and collaborative care from another member of the palliative interdisciplinary healthcare team

1. Planning – In this column you start planning by documenting and identifying the patient’s goals and what nursing care needs to be implemented to achieve these goals. In order to ensure goals are practical and reasonable applying the acronym SMART is helpful:

• Specific. Be clear about what the goal is — include specifics such as ‘who, where, when, why and what’.

• Measurable. Set goals that are measurable. The goal should include a quantity of ‘how much’ or ‘how many’, ‘how long’

• Achievable. Set goals that are reasonable. Setting a harder goal might lead to a better outcome, but only as long as it achievable.

• Realistic. Set goals that are practical for the person requiring a palliative approach to care, the environment, and the healthcare team.

• Time-related. Set a timeframe and have an endpoint.

1. Implementation – in this column you are expected to outline the nursing actions and interventions needed to help the person achieve the goal that has been set. These interventions benefit patients in a predictable and expected way. These interventions may be independent nursing interventions or collaborative interventions with a member of the interdisciplinary palliative healthcare team; a nursing colleague; a carer; the person requiring a palliative approach to care or a family member

2. Evaluation is the final stage – in this stage, you need to determine if the intervention has been effective. As this is an assessment task only, you will need to identify and document the process or processes you would use to determine the extent to which the set goal has been achieved.

1. ******TEACHER FEEDBACK AND WHAT NEEDS TO BE FIXED/ADDED TO WHAT I’VE ALREADY WRITTEN ******

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• Planning column to be completed- What are you planning to do documented in SMART format.

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2. All sections - Require further research and detail in answer. Expand on how you communicate in implementation column. Include the patient and family observations in evaluation column

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4. Q. 22. Oral care- Assessment- include assessment - what do you do to assess. Planning include the plan what strategies are you using Implementation expand how do you do oral care and explain. Evaluation what will you see if outcome satisfactory.  Include the patient and family observations in evaluation column, focus on care of mouth. 

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6. Q. 23. Cachexia Assessment- include assessment - what do you do to assess. Planning include the plan what strategies are you using 

7. Implementation do you know what the patient likes, otherwise great . Evaluation what would the patient, family and yourself observe if a good outcome. 

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9. Q. 24. Pain management- Assessment- include assessment - Relate to pain not pressure sores. how do you assess pain. Planning relates to non-pharmaceutical and complementary care. Include the plan what strategies are you using Implementation relates to non-pharmacological and complementary therapies  not pressure area prevention. Give examples here.

10. Evaluation. How would the patient appear if pain minimised- could they do more,? quality of life  Include what pain score would you aim to keep pain under.

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12. Q. 25. Include plan. Expand evaluation with key points

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14. Q. 26. expand plan to include all key points in the plan. Expand evaluation 

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