Shehada Bondad

ELECTIVE COURSE 1
Homework: to be submitted on or before April 7, 2020 till 12MN. Demerit will be applied for late submissions. Please stay home, stay safe, obey the
orders for your safety…God bless you all.

Objective 1: To gain an in-depth understanding on the essential components of palliative care

We have learned that palliative care nursing is an approach that improves the quality of life of patients and their families facing the problem
associated with life-threatening illness, through prevention and relief of sufferings by means of early identification and impeccable assessment and
treatment of pain and other problems: physical, psychosocial and spiritual (WHO).

1. Discuss comprehensively why are the following components of nursing below considered essential?
a. Holistic Care – It is important to care for the whole person and to see them as just that; a whole person, not just a patient or
diagnosis. Holistic nursing care involves healing the mind, body, and soul of our patients. ... Holistic care is a philosophy; it's a method to
ensure care for all parts of a patient.
b. Symptom Control/ Management- The goal of symptom management is to prevent or treat as early as possible the symptoms of a disease,
side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called
comfort care, palliative care, and supportive care.
c. Effective Communication- both intrahospital and interhospital — is important for health care providers to protect their patients, save on
costs, and increase day-to-day operating efficiency. Meanwhile, patients benefit from increased access to their medical histories, which
reduces chances of medical errors.
d. Spirituality- Spirituality in health care is "that part of person that gives meaning and purpose to the person's life. Belief in a higher power
that may inspire hope, seek resolution, and transcend physical and conscious constraints." 1. Spiritual care in nursing is an important part
of overall healthcare.
e. Sexuality-  is an integral part of being human. Love, affection, and sexual intimacy contribute to healthy relationships and individual well-
being. But along with the positive aspects of our human sexuality, there also are illnesses, mixed emotions and unintended consequences that
can affect our sexual health.
f. Complementary Therapies- are used alongside conventional medical treatments prescribed by your doctor. They can help people with cancer
to feel better and may improve your quality of life. They may also help you to cope better with symptoms caused by the cancer or side effects
caused by cancer treatment.
g. Supporting the family- Family is the single most important influence in a child's life. From their first moments of life, children depend on
parents and family to protect them and provide for their needs. ... Children thrive when parents are able to actively promote their positive
growth and development.
h. Living with Loss- is important because it allows us to 'free-up' energy that is bound to the lost person, object, or experience—so that we
might re-invest that energy elsewhere. Until we grieve effectively we are likely to find reinvesting difficult; a part of us remains tied to the
past. Living with loss is not forgetting.
 2. Make a Nursing Care Plan (NCP) for the following symptoms commonly experienced by palliative patients:
a. Pain

ASSESSMENT DIAGNOSIS GOAL AND INTERVENTION RATIONALE EVALUATION

OBJECTIVES
Accute pain After 6-8hrs -Perform a -Provides baseline Pain is reduced /controlled
related by injuring of nursing comprehensive pain information from which a to a tolerable extent as
“I am in pain” agents (biological, intervention the patie evaluation, including realistic plan verbalized.Relieving
verbalized by chemical, physical, nt will beable location, characteristics, can be developed, keeping in methods and relaxation
the patient. psychological) to:>Report pain is onset/duration, mind that verbal/behavioral techniques are understood
evidenced by relieved/controlled, frequency, cues may have little direct and demonstrated.
Expressive with the pain scale quality, severity (e.g., 0– relationship to the degree of
behavior of 3/10 from 9/10> 10 scale), and pain perceived. Note: Often
(restlessness, Verbalize precipitating/aggravati patient does not feel the need
crying, moaning) understandingof ng factors. Note cultural to be completely pain-free but
condition.>verbalize issues is able to be more
method that provide impacting reporting and functional when pain is at
relief  expression of pain. lower level on the pain scale.
>demonstrate use Determine
of relaxation skills and patient’s acceptable
diversional activities level of pain.

-Determine possible
pathophysiological/psy -Pain is associated with many
chological factors that may be
causes of pain (e.g., interactive and increase the
inflammation, fractures, degree of pain experienced.
cancer
process, surgery, grief,
fear/anxiety).

-Assess patient’s
perception of pain,
along with behavioral
and psychological
responses. Determine
patient’s attitude
toward/use of pain
medications and locus
of control
-Helps identify patient’s needs
and pain control methods
found to be helpful or not
helpful in the past. Note:
Individuals with external
locus of control may take little
or no responsibility for pain
management.
(interna-Assess degree
of personal adjustment
to diagnosis, such
as anger, irritability, -These factors are variable
withdrawal, acceptance. and often affect the
perception
-Discuss with SO(s) of pain/ability to cope and
ways in which they can need for pain management.
assist patient
and reduce
precipitating factors. -Promotes involvement in
care and belief that there are
-Identify specific things they can do to help.
signs/symptoms and
changes in pain -Unrelieved pain may be
requiring notification of associated with progression
healthcare of
provider/medical terminal disease process, or
intervention. be associated with
complications that require
-Involve caregivers in medical management.
identifying effective
comfort -Managing troubling
measures for patient, symptoms such as nausea, dry
e.g., use of nonacidic mouth, dyspnea, constipation
fluids, oral can reduce patient’s
swabs/lip salve, suffering and family anxiety,
skin/perineal care, improving quality of life
enema. Instruct in use and allowing patient/family
of oxygen/suction to focus on other issues.
equipment as
appropriate.l/external).
ASSESSMENT ANALYSIS GOAL AND INTERVENTION RATIONALE EVALUATION
OBJECTIVES
I’m so tired, I Fatigue related to Short term Evaluate the patient’s Using an appropriate After 1 hour of nursing
need some lethargy as goal:Within 1 hour description of fatigue: quantitative scoring scale, 1 interventions,the client
rest,” as manifested by of nursing severity, changes in to 10 for example, can aid identifiedbasis of fatigue.
verbalized by lack of energy interventions,the severity over time, the patient formulate the
the patient. and disinterest in client will aggregating factors or amount of fatigue After 8 hours of nursing
the identifybasis of alleviating factors. experienced. Further scoring interventions,the client
-Inability to surroundings.  fatigue. scales can be developed by reportedimproved sense
maintainusual  using pictures or descriptive of energy.
routines/level Long term goal:Within language. This system allows
of physical 8 hours of nursing
the nurse to weigh against
activity interventions,the
changes in the patient’s
client will
fatigue level over time. It is
- Increase in reportimproved sense
restrequireme of energy. important to conclude if the
nts patient’s level of fatigue is
constant or if it varies over
- Inability time.
to restoreen
ergy even after Fatigue can restrict the
Assess the patient’s
sleep patient’s ability to
ability to perform
participate in self-care and
ADLs, instrumental
- Increase in do his or her role
activities of daily living
physicalcompl responsibilities in the family
(IADLs), and demands
aint and society, such as working
of daily living (DDLs).
outside the home.
Observe physiological
reaction to activities Tolerance varies
such as any alterations significantly, depending on
in BP, respiratory rate, the phase of the disease
or heart rate. progression, nutrition
condition, fluid balance, and
quantity or sort of
opportunistic diseases that
patient has been subjected
Restrict environmental
to.
stimuli, especially
during planned times
for rest and sleep. Vivid lighting, noise, visitors,
 numerous distractions, and
litter in the patient’s
physical surroundings can
Aid the patient with limit relaxation, disturb rest
developing a schedule or sleep, and contribute to
for daily activity and fatigue.
rest. Emphasize the
importance of frequent A plan that balances periods
rest periods. of activity with periods of
rest can aid the patient
Promote sufficient complete preferred activities
nutritional intake. without contributing to
levels of fatigue.
Provide comfort such
as judicious touch or
massage, and cool The patient will need properly balanced intake of fats, carbohydrat
showers. to provide energy resources.

Aid the patient develop

habits to promote These may reduce nervous
effective rest/sleep energy that lead to
patterns. relaxation.

Promoting relaxation before

sleep and providing for
several hours of
uninterrupted sleep can
contribute to energy
restoration.

ASSESSMENT DIAGNOSIS GOAL AND INTERVENTION RATIONALE EVALUATION

OBJECTIVES
"I'am having It is very crucial to carefully After 8 hours
difficulty in Constipation After 8 hours of Check on the usual know what is “normal” for of nursinginterventions,the
defecation related to nursing intervention, pattern of elimination, each patient. The normal client wasable to establishor
because of my observed hard, the patient will regain including frequency frequency of stool passage return tonormal patternsof
dry stool," as formed stool as normal pattern of and consistency of ranges from twice daily to bowelfunctioning.
verbalized by evidenced by bowel functioning.  stool. once every third or fourth
the patient. distended
abdomen and day. Dry and hard feces are
palpable common characteristics of
abdominal mass.  constipation.

Irregular mealtime, type of

Check out usual food, and interruption of
dietary habits, eating usual schedule can lead to
habits, eating schedule, constipation.
and liquid intake.

Encourage the patient Sufficient fluid is needed to

to take in fluid 2000 to keep the fecal mass soft. But
3000 mL/day, if not take note of some patients or
contraindicated older patients having
medically. cardiovascular limitations
requiring less fluid intake.

A sitting position with knees

Unless flexed straightens the
contraindicated, rectum, enhances the use of
encourage the patient abdominal muscles, and
to use the bathroom. facilitates defecation.
For bedridden
patients; assist the
patient in assuming a
high-Fowler’s position
with knees flexed.
 Abdominal massage Abdominal massage has
Using the heel of the been known to be helpful in
hand or a tennis ball, neurogenic bowel disorder
apply and release but not for constipation in
pressure firmly but older adults.
gently around the
abdomen in a
clockwise direction.

ASSESSMENT DIAGNOSIS GOAL AND INTERVENTION RATIONALE EVALUATION

OBJECTIVES
"I always feels Nausea related to After 4 hours of Determine causes of Assessing the patient with After 4 hours of nursing
like to vomit." chemotherapy nursing intervention, nausea. the causes of nausea will intervention, the patient was
As verbalized secondary to the patient will report guide the choice of reported decreased nausea
by the patient. increased decreased nausea as interventions to be used. as experienced. The patient
salivation reports experienced. The Treatment may not be was identified foods or
sour taste in patient will identify needed if the stimulus is beverages that do not
mouth. foods or beverages eliminated. increase nausea. The patient
that do not increase was described factors that
nausea. The patient A thorough assessment and increase nausea.
will describe factors
Assess nausea evaluation of nausea can
that increase nausea.
characteristics: help determine
 History interventions to lessen or
 Duration ease the problem.
 Frequency
 Severity
 Precipitating
factors
 Medications
 Measures used
to alleviate the
problem Nausea is usually correlated
Record the patient’s with vomiting that can
hydration status, daily change a patient’s hydration
weights, BP, intake and status because of fluid loss.
output, and assessing
skin turgor. Nausea and vomiting are
closely related. Keep emesis
Provide an emesis basin out of sight but within
basin within easy the patient’s reach if nausea
reach of the patient. has a psychogenic
component.

A series of tests may be used

to determine the
Assist the patient in contributing factor (e.g.,
diagnostic testing upper gastrointestinal tract
preparation. study, abdominal computed
tomography scan,
ultrasonography.)

This can be helpful in

reducing the risk.
Position the patient
upright while eating
and for 1 to 2 hours
post-meal

Most antiemetics work by

Administer antiemetics increasing the threshold of
as ordered. the chemoreceptor trigger
zone to stimulation. Drugs
with antiemetic actions
include antihistamines, antic
holinergics, dopamine antag
onists, serotonin (5-HT3)
receptor antagonists,
and benzodiazepines.
Glucocorticoids and
cannabinoids are useful to
treat chemotherapy-induced
nausea and vomiting. For the
preoperative patient,
administration of
 antiemetics prior to surgery
has been shown to reduce
postoperative nausea and
vomiting.

ASSESSMENT DIAGNOSIS GOAL AND INTERVENTION RATIONALE EVALUATION

OBJECTIVES
"I can't breath Difficulty of After an 30 minutes of The average rate of Patient verbalized feeling
well because breathing related nursing intervention, Assess and record respiration for adults is 10 comfortable when
of my chest to difficulty of the patient will able to respiratory rate and to 20 breaths per minute. It breathing.
pain," as breathing as do coping depth at least every 4 is important to take action  
verbalized by manifested by mechanisms to hours. when there is an alteration
the patient. prolonged improve his breathing  
in the pattern of breathing to Each visit,patient reports
expiration phases pattern. (When it detect early signs of
than inspiration. comes to difficulty of that she feels rested
respiratory compromise.
(Remember that breathing, nursing
expiration, also intervention must Assess ABG levels, This monitors oxygenation
called exhalation done in a short period according to facility and ventilation status.
is breathing out of time). policy.
while inspiration,
Determine if it is acidosis or
also known as 1. Note the pH.
inhalation is alkalosis.
breathing in.
Is it normal, increased, or
Note the PaCO2. decreased?
Is it normal, increased, or
Note the HCO3. decreased?

Excess or deficit?
Note the base.
To determine if there is
Note the PaO2. hypoxia.

Paradoxical movement of the

Monitor for abdomen (an inward versus
diaphragmatic muscle outward movement during
fatigue or weakness inspiration) is indicative of
(paradoxical motion). respiratory muscle fatigue
and weakness.

Orthopnea is associated with

Assess the position that breathing difficulty.
the patient assumes for
breathing.
Pulse oximetry is a helpful
Utilize pulse oximetry to tool to detect alterations in
check oxygen saturation oxygenation initially; but, for
and pulse rate. CO2 levels, end tidal CO2
monitoring or arterial blood
gases (ABGs) would require
being obtained.

This will reduce the patient’s

Stay with the patient anxiety, thereby reducing
during acute episodes oxygen demand.
of respiratory distress.

Maintain a clear airway This facilitates adequate

by encouraging patient clearance of secretions.
to mobilize own
secretions with
successful coughing.
Objective 2: To further develop skills in the different roles a nurse performs in palliative care

Nurses play a significant role in palliative care. With the following Nurses’ Role, how can we be effective in:
a. Providing Direct Care by Meeting the Physiologic Needs of the Client?
= Communicate to understand their life stories
= Connect to help enhance their quality of life
= Directly address issues to assure quality of death
= Each one of them is a whole person
like you and me
They are not our care objects
They need our companioning
Being with them
without judgment, advice, expectation
Offering our presence
with humility and gratitude
b. Being an Advocate?

1. = Ensure Safety. Ensure that the patient is safe when being treated in a healthcare facility, and when they are discharged by communicating with case managers
or social workers about the patient’s need for home health or assistance after discharge, so that it is arranged before they go home.
2. Give Patients a Voice. Give patients a voice when they are vulnerable by staying in the room with them while the doctor explains their diagnosis and treatment
options to help them ask questions, get answers, and translate information from medical jargon.
3. Educate. Educate patients on how to manage their current or chronic condition to improve the quality of their everyday life is an important way nurses can
make a difference. Patients undergoing chemotherapy can benefit from the nurse teaching them how to take their anti-nausea medication in a way that will be
most effective for them and will allow them to feel better between treatments.
4. Protect Patients’ Rights. Protect patients’ rights by knowing their wishes¾this might include communicating those to a difficult family member who might
disagree with the patient’s choices and could upset the patient.
5. Double Check for Errors. Everyone makes mistakes. Nurses can catch, stop, and fix errors, and flag conflicting orders, information, or oversights by physicians
or others caring for the patient. Read the orders and previous documentation carefully, double check with other nurses and the pharmacist, and call the doctor if
something is unclear before administering chemotherapy.
6. Connect Patients to Resources. Help patients find resources inside or outside the hospital to support their well-being. Be aware of resources in the community
that you can share with the patient such as financial assistance, transportation, patient or caregiver support networks, or helping them meet other needs.

c. Being a Counselor like Providing Spiritual Support?

= Some people will need more support and may want to talk to you about their spiritual concerns. Encourage the person to explore their worries and fears.
Listen without passing judgement or dismissing their concerns. Try to understand and listen to your patient's beliefs, without imposing your own.

d. Collaborative Role
=To provide proper care and improve patient outcomes, today's nurses must collaborate effectively with members of the healthcare team from other
disciplines. That means working together as team members and team leaders. To do that, they must understand each member's education, scope of practice, and
areas of expertise.