It would be an excellent choice to complete the Vila

IDENTIFICATION Biden Smith, DOB 21/05/1931, Nil known allergies. SITUATION For discharge home on care of the dying pathway with community nursing and other supports. BACKGROUND Jo lives at home with his daughter. Jo has a history of Alzheimer’s Disease, NIDDM, AF, GORD, CCF, mild depression, and previous hernia and AAA repair. Two weeks ago, Jo was bought into ED by his daughter with a history of new confusion, fevers, and rash, refusing diet and fluids for the previous two days and was jaundiced in colour. Jo deteriorated with sepsis. He experienced a cardiac arrest in ED. Following resuscitation, Jo was transferred to intensive care. He underwent further investigations and was diagnosed with advanced CA of the liver with metastases in the pancreas, lungs, and brain. He was transferred to the medical ward and Jo’s family requested no further active treatment and have asked that he be discharged home with appropriate supports. ASSESSMENT Palliative care phase 3: Deteriorating. Symptom Assessment Scale (SAS): Pain 5; Nausea 2. Problem Severity Score (PSS): Pain 2; Other symptoms 1; Psychological/Spiritual 1; Family/carer 1. RUG-ADL: 18 AKPS: 20 Airway, breathing, circulation intact. Jo is no longer mobile. He remains confused. He requires full assistance with activities of daily living, nutrition, and toileting. Jo is lethargic, has generalised body pain and nausea. Jo is 50 kgs and is 163 cm tall. Jo has a stage 2 pressure injury on his sacrum Jo does not identify with any particular religious denomination however his daughter advises that he is strongly spiritual, and this will need to be considered in planning his care. RECOMMENDATIONS Jo needs an assessment and a care of the dying plan developed. Interpret: In the following table, list the cues of concern from the scenario above Cues of concern (Subjective & Objective) Subjective Objective Process Information. Interpret, analyse, discriminate, relate, infer, match, and predict. Are there recognisable patterns when the cues are clustered? Are there comparisons which can be drawn with previously observed clinical presentations? Consider thinking ahead: What could happen if you took no action? From the cues/information above identify and prioritise 3 nursing problems. Nursing problem 1 Nursing problem 2 Nursing problem 3 Goals, Actions and Evaluation For each of your 3 chosen nursing problems: Establish a minimum 2 goals for each nursing problem that include all 5 elements of the SMART acronym (Specific, Measurable, Achievable, Realistic, Timebound). List a minimum 2 actions to achieve each goal in your chosen order of priority. For each action provide a rationale that evidences the relevant pathophysiological and palliative care principles. This section must be appropriately referenced. For each action describe how you would evaluate the effectiveness of the care provided (i.e. how will you know that your action/s were beneficial to the patient). This section must also be referenced. You must include at least 1 evaluation measure for each action. SMART goal(s) Actions (2 per goal) Rationale (for each action) Evaluation measure (for each action) Nursing problem 1 Goal 1 Goal 1 Action 1 Goal 1 Action 1 rationale Action 1 evaluation measure Goal 1 Action 2 Goal 1 Action 2 rationale Action 2 evaluation measure Nursing problem 1 Goal 2 Goal 2 Action 1 Goal 2 Action 1 rationale Action 2 evaluation measure Goal 2 Action 2 Goal 2 Action 2 rationale Action 2 evaluation measure Nursing problem 2 Goal 1 Goal 1 Action 1 Goal 1 Action 1 rationale Action 1 evaluation measure Goal 2 Action 2 Goal 2 Action 2 rationale Action 2 evaluation measure Nursing problem 2 Goal 2 Goal 1 Action 1 Goal 1 Action 1 rationale Action 1 evaluation measure Goal 2 Action 2 Goal 2 Action 2 rationale Action 2 evaluation measure Nursing problem 3 Goal 1 Goal 1 Action 1 Goal 1 Action 1 rationale Action 1 evaluation measure Goal 1 Action 2 Goal 1 Action 2 rationale Action 2 evaluation measure Nursing problem 3 Goal 2 Goal 2 Action 1 Goal 2 Action 1 rationale Action 2 evaluation measure Goal 2 Action 2 Goal 2 Action 2 rationale Action 2 evaluation measure Part B: Family discussion Watch the video titled: ” Jo Smith discharge planning conversation” (available in the MyLO Assessment Resources Tab) The video captures the conversation between the consultant caring for Jo and his family. Jo is not present as he is too unwell. Following the meeting, Jo’s family relocates to the family room. You are the nurse assigned to care for Jo. You approach the family, and they ask you the following questions. Explain how you would respond to each question. You may answer these questions in the first of third person. How will we care for dad at home. Who will help us? Will he be in a lot of pain? How will we manage his pain? What if it gets really bad? What happens to dad after he dies at home? What do we do? Who do we contact?

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