Mr K is a 58-year-old Maori man who migrated from New Zealand 15 years ago. He has been complaining of a persistent cough for the last 3 months and has noticed he has been a little more breathless on exertion over the last few days. Mr K lives with his wife of 25 years and they have a daughter M who is 20 years old.
Mr K was retrenched from his job in the WA mines three months ago. He was a fly in fly out worker living in Melbourne until his retrenchment. Mr K has smoked for 20 years but gave up 3 years ago. Mrs K works as a PCA in an aged care facility; M is studying hospitality at university.
Mr K has been healthy all his life and worked out in a gym when in WA to keep himself fit and occupied. He is 30kg overweight but thinks this is probably muscle. His favourite food is chips and parma and pasta.
Recently Mr K has complained of;
- increased SOBOE
- chest pain on deep breathing and laughing
- hoarseness of the voice
Mr K has explained these symptoms to the GP and the GP ordered a chest x-ray. Results of the x-ray showed ‘shadows’ so he was referred to a Respiratory Specialist.
The Respiratory Specialist has carried out a physical examination, collected a sputum sample and ordered a CT of the lungs and performed a lung biopsy. A PET scan was also performed and Mr K had to wait for the results. The next day some results were clear enough to safely say Mr K had Small Cell Lung Cancer (SCLC).
This comes as a complete shock to Mr and Mrs K because he has been so fit and healthy all of his life. He does not want to go into hospital and the respiratory specialist has advised Mr K that the SCLC is scattered throughout his lobes and is not operable. He has organised chemotherapy to start as soon as a port can be arranged. Mr K has been put on respiratory dilators and analgesics for pain. He has had difficulty coming to terms with his diagnosis, stating he has a daughter and wife to care for; he is the ‘breadwinner’. He has been referred to (you) the palliative care nurse for care as an outpatient in his own home
1. For each of the five symptoms Mr K has complained of, please apply knowledge of the pathophysiological changes associated with each of these symptoms. For each symptom you need to describe at least two (2) changes that have happened or are happening to Mr K’s body. Please ensure you use the correct anatomical and medical terminology to do with the body systems (1 mark awarded for each change). (10marks)
2. Mr K has received “bad news” and he is having difficulty accepting his diagnosis. As his palliative care nurse, document three (3) ways you can alleviate Mr K’s anxiety. Your answer should identify and respect Mr K’s needs in relation to his lifestyle, social context and emotional and spiritual choices. (2 marks awarded to each strategy identified) (6 marks)
3. Mr K introduces you to his wife and daughter on your first visit to their home. Describe three (3) issues you will need to be aware of when communicating with Mrs K and daughter M. What are three (3) psychosocial impacts Mr K’s diagnosis will have on them (what potential changes will be make within the family daily routine)? (2 marks for each impact described)
4. In all of your professional interactions with Mr K and his family you must comply with the core practice standards as set out in Standards for Practice: Enrolled Nurses (2016). As Mr K’s palliative care nurse, please identify two (2) “Indicators” for each of the three (3) domains set out in this document (6 marks) that are relevant to your interactions with Mr K and his family. To support your answer, for each domain, you must also provide one (1) specific example (3 marks) relating to the nursing care you provide Mr K and his family in their home. (9 marks)
5.What can the interdisciplinary health care team offer Mr K and his family at this time? Identify three (3) services. (3 marks)
Mr K is now too weak to get out of bed and refuses to eat puree food. He has sips of fluid when he is awake. You make him comfortable with pillows and turning him; taking note of his body changes. He has strong pain when you turn him so you have a special mattress for his care and you provide hot towel baths to help ease his pain. Mr K has lost a great deal of weight, his face is drawn and his confusion lasts longer. He tries to speak but struggles for energy. Over the next 24hrs Mr K’s body shows signs of ‘shutting down’ and by 3pm the next day he passes away
1. Describe the pathophysiology of dying on the cardiovascular system. For two (2) signs of “shutting down” describe what is happening to the body at a cellular, tissue level. (4 marks)
2. For the signs of cardiovascular “shut down” you have identified above, explain how you will support Mr K and his family during this time, specific to the signs you identified. How can you reassure Mr K and his family while Mr K is experiencing these signs? Describe two strategies. (4 marks)
3. Describe the pathophysiology of dying on the respiratory system. For two (2) signs of “shutting down” describe what is happening to the body at a cellular, tissue level. (4 marks)
4. For the signs of respiratory “shut down” you have identified above, explain how you will support Mr K and his family during this time, specific to the signs you have identified. How can you support Mr K and his family while Mr K is experiencing these signs? Describe two strategies (4 marks)
5. What skills does the palliative care nurse have in identifying and acting on the needs of the family and carers during the final stages of life? Discuss four (4) skills. (4 marks)