Assignent Solutionnurs

This criterion is linked to a Learning Outcome APA
Follows APA Guidelines per APA Manual
5 or more credible sources (1 point) no more than 5 years old -one of your texts used -correct in text-citations -reference page correct (1pt)
Ideas well supported by literature each section should have references -each intervention needs a reference (evidence based practice) (1.5 Pts)
3.5 pts
This criterion is linked to a Learning Outcome Hospice transition
-difference between hospice and palliative care
-Advanced directive, discuss DNR/DNI and futility of other interventions. -Discuss neutropenia briefly and detail what precautions are sensible and what goes against the goals of hospice which focuses on family time and quality of life
1.5 pts
This criterion is linked to a Learning Outcome Addressing depression/spiritual distress
should include a spiritual assessment tool (0.4)
-should include causes of both spiritual distress and depression (0.4)
-should suggest at least 1 pharmacological intervention, with side effects, and action (0.4)
-should include at least 2 non-pharmacological interventions (0.4)
-discuss effects on QOL if left untreated (0.4)
2 pts
This criterion is linked to a Learning Outcome Pain addressed
-pain assessment tool (0.5)
-pharmacological treatments of pain with brief side effects (0.75)
-non-pharmacological treatments of pain (0.75)
-address addiction concerns fully (1.0)
3 pts
This criterion is linked to a Learning Outcome Breathlessness Addressed
-causes of breathlessness (0.5)
-pharm treatments for breathlessness (1.0)
-non-pharm interventions for breathlessness (0.5)
-effects on QOL if untreated or undertreated (1.0)
3 pts
This criterion is linked to a Learning Outcome Insomnia addressed
-causes of insomnia (0.3)
-pharm treatments for insomnia (0.4)
-non-pharm treatments, think sleep hygiene (0.4)
-effects on QOL if left untreated (0.4)
1.5 pts
This criterion is linked to a Learning Outcome GI alterations
-causes of Bill’s nausea (0.4)
-pharmacological treatments for Bill’s nausea (0.5)
-non-pharm interventions for nausea & lack of appetite (0.3)
-causes of Bill’s constipation (0.4)
-pharmacological treatments for Bill’s constipation (0.5)
-non-pharm interventions for constipation (0.3)
-assessment of GI issues (0.3)
-causes of lack of appetite (0.3)
-pharm treatments for lack of appetite (0.5)
3.5 pts
This criterion is linked to a Learning Outcome Signs and symptoms of dying
-common signs and symptoms as death nears (0.4)
-troubling signs and symptoms like death rattle, mottling, Cheyne-stokes breathing, terminal agitation (0.5)
-causes (0.3)
-treatments, pharmacological or non (0.4)
-what can Jenny do? (0.4)
The Dying Process
Bill and Jenny have been your clients for two months. Bill was diagnosed with a rare, aggressive lung cancer: large cell neuroendocrine carcinoma of the lung. His cancer was a stage 4 at diagnosis and with limited research, Bill was placed on a protocol for small cell lung cancer and his cancer progressed. This visit you will transition Bill from Palliative Care to Hospice. You have been dreading this day as Bill and Jenny have three young children under the age of ten. Bill asks you what is the difference between Hospice and Palliative care? Explain the difference and suggest Bill consider filling out an Advanced directive. He would like to know what this entails and asks for some guidance filling it out. Bill is very concerned about the fact that he is neutropenic and what that means for his time with his kids. The hospital was always so careful and wore masks (what are some reasonable precautions Bill can take). He wants to know more about this (define neutropenia) and questions if he should ask his wife to take his kids away from him until his immune system recovers (how do you respond to this? What education is important?).
When you see Bill, he first appears tired but as you start to talk you realize that Bill is depressed. He begins to express that he is a young man with responsibilities and a family. How could this happen to him? He asks why he has to leave his children fatherless. You console Bill by holding his hand and acknowledging how unfair this is. You decide to do a spiritual or depression assessment (which one, briefly describe) and begin thinking of possible causes of his depression and spiritual distress (what are they?). You want to discuss pharmacological and non-pharmacological treatments with Bill (what are they, side effects?). And lastly to convince Bill he should treat his depression/spiritual distress, you tell him how this will affect his quality of life if left untreated.
He tells he cannot sleep at night, instead his mind races. He lies awake breathless, fearing he will die if he closes his eyes. You tell him you have medications that can help him sleep and relax (what medications would you include?) as well as some suggestions on things he can do to promote better sleep (sleep hygiene). Lastly, you explain to Bill the long term effects of insomnia. Bill has been dyspneic since diagnosis. You have him well controlled on 2 liters of O2 and 1-2 mg SL morphine every 2 hours as needed. Bill uses about 5 mg daily, primarily before activity or sleep. Bill has been using ondansetron (Zofran) SL for nausea related to chemotherapy PRN. You have also provided him Colace 100 mg TID PRN and Senna 25 mg BID PRN. You tell Bill you want to establish his dyspnea and pain levels right now so you can adjust his medications if necessary (this includes assessments). Bill tells you his dyspnea is worse but he is hesitant to use more morphine. He is afraid he will get addicted (how do you respond to this? What education is necessary?). He reports minimal pain (what suggestions do you have for pain?). You want to discuss his dyspnea, which is worse, and start by discussing the causes. You then add suggestions for how to alleviate this (pharmacological and non-pharmacological). And end again with how this will affect his life if left untreated.
Bill has been more nauseated since his last cycle of chemotherapy. What is causing his nausea? He has been taking the Zofran around the clock (what else could he try both pharmacologically and non-pharmacologically?). He has not had a bowel movement in two days but is unable to take the docusate and senna as they make him sicker to his stomach (what is causing his constipation?). What suggestions might you have for Bill (medicinal and non). How will you assess his GI tract?
Bill declines quickly in the next four days and you suspect his death will be in the next day or two. His wife has called you back to the house to help her understand what to expect. Briefly explain what the signs and symptoms of dying are and be sure to include any distressing aspects that you should warn Jenny about. (This would include cause, interventions both pharmacological and non-pharmacological).
Ferrell, B., & Paice, J. A. (2019). Oxford Textbook of Palliative Nursing. Oxford University Press. (This is the source that needs to be used)