READ ALL INFORMATION BELOW Patient History and
READ ALL INFORMATION BELOW Patient History and Presentation: Patient details Name: Michelle Smith DOB – 17/07/1950 Background: Michelle is a 70 year old woman who has been admitted to the palliative care unit at the local hospice for pain management due to increased pain that she and her husband are no longer able to manage at home. She has a past history of breast cancer which has been previously successfully treated with chemotherapy and radiotherapy. However after having further scans six (6) months ago they showed that the cancer has now metastasised to her lymph nodes, brain, liver and bones and she has been diagnosed with stage 4 cancer. She has continued to have issues with pain management and has become increasingly lethargic over the last three (3) months. She has developed a malignant, fungating wound on her chest which is producing a malodorous exudate, bleeds and is causing increased pain. Dressing changes are complex and painful. Michelle lives with her husband who is her main carer. They have two adult daughters who no longer live with them. She has identified as Roman Catholic on her admission form. Michelle lives with her husband who is her main carer. They have two adult daughters who no longer live with them.. Michelle also has completed an advanced care directive which states the following: Advanced Care Directive she supports sedation if her symptoms become refractory and she is unable to communicate she would like to donate her corneas upon death she does not want to receive any medical interventions to extend her life if her symptoms indicate imminent death DRUG CHART FOR MICHELLE SMITH Regular medications Metoprolol 50mg PO mane Frusemide 20mg PO daily Perindopril 2.5mg PO daily Prednisolone 5mg POdaily Slow K 1tab PO daily As required “PRN” medications Endone 5-10mg PO 6/24 prn Midazolam 1mg SC TDS prn Haloperidol 2mg IV/IM 8/24 prn Paracetamol 1g PO 6/24 prn Morphine SC/IV 10mg 2/24 prn Glycopyrrolate 0.2mg S/C While in the hospice Michelle’s condition starts to deteriorate. The results of her nursing assessment are detailed below. CNS: The patient is drowsy and confused. Michelle has been moaning all morning CVS: Bilateral pitting oedema to both feet. Cyanosis present in all four extremities. Vital signs not required to be measured. Respiratory: Cheyne-Stokes breathing patterns. Increased oral secretions Renal: No urine output for 12/24. GIT: BNO for three days (3/7). She has not eaten or drunk anything for two days (2/7) and does not respond to encouragement from family. NBM. Musculoskeletal: Full nursing care required. Bedridden. Skin: Skin is dry. Poor skin turgor. Malignant wound on her chest requires re dressing PRN; QUESTIONS Q12: Michelle’s husband questions the use of midazolam. Using your own words provide an example of a conversation you would have with Michelle’s husband explaining the use of this midazolam to him and family members. Q13: Considering Michelle’s deterioration, list the current medications on her drug chart that can be administered to manage her pain. (remember she is nil by mouth) Who would you report or discuss these findings with? Q14: Describe two (2) non-pharmacological pain management interventions with one (1) rationale for each that could be used for Michelle. Q10: Considering Michelle’s deteriorating condition develop two (2) nursing interventions for Michelle Provide one (1) rational for each intervention. Q17: Identify three (3) impacts of loss and grief on Michelle’s family? Q18: Michelle has stated in her Advanced Care Directive that she wishes to donate her corneas when she dies. Her husband tells the nurse that he and the children don’t want this to happen. What will you say to the family? Identify two (2) support services within the palliative care environment you could refer the family to and state two (2) responsibilities of each? Identify one (1) ethical and one (1) legal consideration for both organ donation and autopsy?
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