Principles of Palliative Care, Chronic and Complex Care free essay sample

Introduction Ageing and dying is a normal process and body goes through several changes in whole life. Palliative care is a kind of health care. It is offered to those whose illness cannot be cured. It helps people to live as well as possible while they manage their illness. This assignment discusses the principles of chronic, complex and palliative care. It will also looks at the assessment and management strategies in chronic, complex and palliative care. Furthermore, this will look at case study of 70 year old man diagnosed with adenocarcinoma of the right lung. The topics to be covered in this case study are nursing history of the client, nursing assessment, assessment tools and list of care priorities on key issues that associated with the nursing care of the client. Principles of Palliative Care, Chronic and Complex Care The Quality of life is most important principles of palliative care. According to The standards of Providing Quality Care for all Australians (2006) palliative care offers to all who have a chronic and life limiting disease, with slight or not vision of cure and for whom the main treatment option is to increase the quality of life. We will write a custom essay sample on Principles of Palliative Care, Chronic and Complex Care or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Alber et al ( 2010, p. 8) states that the symptom and pain management, spiritual care, psychological care and social support can be used to advance the quality of life of patients for whom there are no any other option of treatment.. If the client has a clear understanding of his diseases trajectory he will be able to make clearer choices. Parker Arandra (2009, p. 157) believes that most people with terminal illness will want to keep on living as long a quality of life is reasonable. Alber et al (2010, p. 19) also believes that to improve the quality of life in cancer patients, palliative care is one of the important treatment for them. Therefore, when measuring quality of life, diseases, and treatment related symptom physical functioning and psychological emotional wellbeing and social interaction are significant areas that need to be integrated. The provision of comfort care and symptom management is extremely important in palliative care. As previously mentioned they impact greatly on a person’s quality of life. Aranda (2007, P. 7) believes that alleviation of symptoms is closely tied to the palliative care goal of maximizing quality of life. Furthermore, Ferrell et al (2010, p. 06) states that the palliative care approach to the symptom management is based on through assessment o current symptom and planning a ahead for general problems. The study shows that a small but reliable optimistic impact of palliative care services on quality of life, symptom management and satisfaction at the end of life (Abernethy et al. , 2008, p. 586). Lewis and Kitchen ( 2010) states that effective communication skill plays significant role to the delivery of high quality palliative care to patients and their carers. In addition, education from the health workers to the patient, especially using easily understood terms is beneficial. It is important to use effective communication skills listen observe and instruct. A multidisciplinary approach is very important in palliative care. According to Hermsen and Henk (2005, p. 561) the care of person dying with chronic illnesses is not essay and needs a team of people who have special skills and expertise. It is a network that includes formal support from health care team members and informal support from family and friends. Moreover, holistic care is also one of the important principles of palliative care. It is not just a managing a client symptoms but it includes person as a whole. In palliative care to a certain extent holistic care will also incorporate the family. Street et al (2005, p. 44 ) states that nursing will be the key discipline in ensuring that emotional, social and spiritual dimensions are addressed but through consolations with and referral to colleagues in these dimensions of care. The end of life planning is also important key factor in palliative care. McDonald and Hobbs (2008, p. 1680) states that benefit of knowing in advance that death is imminent is that it provides an opportunity to accomplish preparation of death tasks. It gives the client and family time to communicate, discuss matters that are important to them. They are able to implement a plan of care and make choices as their care. Case study History of Present illness Mr. M. S 70 year old man diagnosed with metastatic lung cancer when he developed pain in his (R) shoulder and (R) hip and this was followed by investigation showing adenocarcinoma cells in bronchial washings. He underwent radiation treatment to the (R) shoulder. He has also been having chemotherapy. Over the last few weeks he has noticed lower limb oedma developing to the mid tibia. As a result, he had disturbed sleep decreased appetite and excessive weight loss in last few weeks and also experiencing increasing breathlessness and moist cough for past 3 weeks. He has pain in right shoulder radiating around in to scapular and in the hip area. He has constipation since starting opioids. Family History – His mother died age of 60 with lung cancer. Social History He belongs to Indengious family. Living with wife and two daughters are living in Sydney. He has no contact with daughters. Medical History – He has history of hypertension, high cholesterol epilepsy and hypothyroidism Present Medications He is on carbamezepine 200 mg, Fentanyl 100mcg, oxynorm 20mg, ibuprofen 400mg and simvastatin. His analgesic regime is ideal and he has noted improvement once Fentanyl dose has been commenced. Psycho emotional Consideration— He is anxious due to new diagnosis and fear of the unknown discussion. He has a current will no. POA pays into a funeral fund. However, has not decided on burial or cremation. Spiritual consideration – He has no spiritual considerations. Nursing diagnosis The first nursing diagnosis is ineffective airway related to secretion, pain, weakness and fatigue. Severe pain related to cancer and affecting daily activities. Furthermore, fear related to situational crises, change health status and perceived threat of death. The last one is deficient knowledge related to treatment, condition, prognosis, and self care. Nursing Assessment and Assessment Tools An accurate holistic nursing assessment is important to enhance the quality of life in palliative care patient. Yohannes (2007, p. 4) states that assessment of patient’s physical disability, psychological morbidity and impaired quality of life is the foremost step towards planning good end of life care. As Mr. M. S belongs to indigenous culture, it is the responsibility of nurse to provide culture competent care according to his culture, values and beliefs. Nurses are required to provide culturally safe practice because whenever they are interacting with a client they are entering bicultural relationships (Crisp Taylor 2008, p. 119). It is necessary to assess physical symptom of the patient related with cancer such as anorexia, pain, breathlessness, constipation and weight loss. All these symptoms affect his daily life activities. The main key issue for this patient is pain and nutritional status. The main concerns expressed by patients who are diagnosed with cancer are that they experiencing severe pain. Some patients are willing to follow the treatment would increase their quality of life. It is important that client and his families be confident that pain will be reassured successfully (Evan Higginson 2010, p. 425). The 70% to 90% patients who treated with pain medication properly they feel better. Nevertheless, studies also shows that around 30% to 60% of cancer patients fail to get satisfactory pain relief, with more than one-third experiencing moderate-to-severe pain (Ferral et al . , 2010, p. 06). Pain usually occurs due to the stage and location of the tumor. The Edmonton Staging system (ESS) pain assessment tool is used to measure the client pain. It is based on clinical staging of cancer pain. This tool is providing good understanding of pain type, frequency, description, aggravating factors, relieving factors and known prognostic factors response to treatment (Tere sa et al. , 2011, p. 10). In case of Mr. M. S he is experiencing constant stabbing pain in the right shoulder and right hip. His daily activities affected by the pain that are movements, traveling, walking and sleeping disturbances. The second issue is weight loss and anorexia due to chemotherapy. It is important to maintain good nutrition level to enhance quality of life. Chang Johnson (2008, p. 181) states that cancer patient has always poor appetite related to diseases, chemotherapy and pain, that results in excessive weight loss. The tool used for the assessment of nutritional status is Mini Nutrition Assessment (MNA). This tool provides proper screening of food intake, weightloss, mobility, psychological stress and body mass index. This has total 12 points that means if patient has 12 points. There is no risk of malnutrition, however, if patient has 11 points or less than that means malnourished and needs to be continue assessment (Morley 2011, p. 86). The main nursing care priorities for this patient is to maintain patent airway, pain related limitation in activities of daily living, risk of fall related to weakness, comfort measures to treat fatigue, well balanced diet, psychological and emotional support, transport, medications regime, counseling and education related to diseases prognosis, involvement of palliative care nurse, dietician, occupational therapist, general practitioner, family and relatives is necessary. Conclusion In conclusion, it is necessary in palliative, chronic and complex care that we recognize and manage emotional physical concerns early to achieve better outcomes for clients and family. We need to mindful that the goals of palliative care are unique to the client and in implementing them it is important to be aware of the patient’s choices and maintain their dignity at all times. References (APA Style) Abernethy, P. A. , Currow, C. D. , Fazekas, S. B. , Luszcz, A. M. , Wheeles, L. S. , Kuchebhatla, M. (2007). Specialized palliative care services are associated with improved short- and long-term caregiver outcomes. Journal of Palliative Care, 16(4), 585-597. Aranda, S. (2007). Euthanasia nursing and care of dying: Rethinking. Australian Journal of Nurses, 3(2), 1-18. Albers, G. , Ectheld, A. M. , Philipsen, O. D. B. , Linden, M. , Deliens, L. (2010). Evaluation of quality-of-life measures for use in palliative care: a systematic review. Journal of Palliative Medicine, 24(1), 17–37. Chang, E. , Johnson, A. (2008). Chronic Illness and Disability: Principles for Nursing Care. Sydney, Australia: Elsevier. Crisp, J. , Taylor, C. (2008). Culture and Ethnicity: in fundamental of nursing . Sydney, Australia: Elsevier. Hermsen, A. M. , Henk, A. M. (2005). Palliative care teams: Effective through moral reflection. Journal of Interprofessional Care, 19 (6), 561-568. Higginson, J. I. , Evans, J. C. (2010). What is the evidence that palliative care teams Improve outcomes for cancer patients and their families? Journal of Cancer, 16(5), 423-425. Ferrell, Betty. , Koczywas, M. , Grannis, F. , Harrington, A. (2010). Palliative Care in Lung Cancer, Journal of Palliative Care, 9(1), 403-407