Get Answer: Case Scenario Enrolled Question Guide

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Original Question

Case Scenario: You are an Enrolled Nurse working in a residential facility. Mrs Hong has been a resident at your facility for 10 months. After the initial settling in period, which Mrs Hong found difficult due to her limited English and early dementia, she is now settled and has a good routine that she and her daughter are happy with. Mrs Hong’s daughter, Yu Yang, visits her mother daily and assists with bringing in Asian food for Mrs Hong. At times however, Mrs Hong still finds it challenging to interact with other residents and staff and can become quite upset and distressed, especially if her daughter is late with her food. Five months ago, it was noted that Mrs Hong had a deformity in her right breast. On examination it was determined that Mrs Hong had stage 3C breast cancer. Mrs Hong and her daughter, Yu Yang, were provided with information relating to the condition and the options available. They have decided to opt for palliative care. Mrs Hong does not want any active treatment and an advanced care directive has been completed with her instructions. In the last 2 days, Mrs Hong has shown signs of deterioration with her condition, is unable to eat or drink, and is confined to bed. She remains conscious at present and her daughter, Yu Yang, is with her for most of the day. As part of your role, you are working with a Registered nurse to provide care for Mrs Hong considering her choices for palliative care. Character Briefs reviewed: Mrs Fei Hong: Mrs Hong is a 70 year old lady of Chinese origin. Mrs Hong’s background includes: – Comes from one child family, Chinese background Speaks little English Has no extended family Came to Australia to help her daughter, Yu Yang, raise her son 19 years ago. Is beginning to demonstrate signs of dementia Interferes in parenting of twins Dictates cooking must be Asian Has hearing and sight impairment Mrs Yu Yang McFarlane: Mrs McFarlane is Mrs Hong’s daughter. She is 38 years old and married to George McFarlane. She has a son, Jason, and 3 year old twins. Mrs McFarlane’s background includes: – Came to Australian as a University student Fell pregnant at the age of 19 – did not marry Married George 5 years ago Has 3 year old twins at home One twin has developmental disorder English language is good Was/Is isolated with no extended family Her issues will be those of isolated immigrant Prefers to cook Asian food Needed help with raising child and invited Chinese mother to Australia to help out Mr George McFarlane: Mr McFarlane has been married to Yu Yang for 5 years. He is 53 years old. Mr McFarlane is reliant on Yu Yang to all domestic duties as he is not self-sufficient. He is a long- haul truck driver and is often away for work. He earns good money. Question 1 Define the term ‘holistic care’ Provide examples of how you would provide holistic palliative care to Mrs Hong and her family in each of the following 10 aspects. Response: CATEGORY EXAMPLES Definition of Holistic care Pain relief – pharmacological Pain relief – non- pharmacological Physical care Nutritional support Elimination support Social support Social support Cultural support Religious support Emotional support Reference TASK Assessment Criteria Question 2 What document would outline Mrs Hong’s wishes for her care if she was unable to tell you? What details might this document include? Response: REFERENCE: TASK Assessment Criteria Question 3 Reflect on and outline your values, beliefs and attitude towards death and dying – give an example. State how your beliefs and values may affect your provision of care to the client- give 2 examples. Response: PART A: Reflect on and outline your values, beliefs and attitude towards death and dying PART B: State how your beliefs and values may affect your provision of care to the client EXAMPLE- EXAMPLE- TASK Assessment Criteria Question 4 What is the scope of practice for an Enrolled nurse when caring for a dying client? (Refer to the NMBA Enrolled Nurse standards for practice -especially Code Conduct 3.6- End of Life Care). Describe how these standards and codes dictate the care ENs provide – give 4 points from the STANDARDS FOR PRACTICE and Codes of Conduct. References: review mapping Standard 3 Code of Conduct reference Standard 3 TASK Assessment Criteria Question 5 Identify physiological changes by body system that you may observe in a client who is dying- List two per system Response: Cardio- vascular Respiratory Neurological Urinary/Renal GIT Integumentary Metabolism Psychological REFERENCE: TASK Assessment Criteria Question 6 Provide examples of 3 members of the Multidisciplinary Team (MDT) and how each one will assist in providing holistic care to Mrs Hong and her family NB. If including nurses please include specialist nurses – state their specialty). Response: MDT member 1: Role MDT member 2: Role MDT member 3: Role REFERENCE: TASK Assessment Criteria Question 7 Identify signs of swallowing and breathing difficulties. Which nursing management strategies could you use in each case? b) Why is oral care important to consider in a client who is unable to eat or drink? Response: a) Swallowing difficulty Nursing management strategies x 2 ) 1. 2. Breathing Difficulties Nursing Management strategies x 2 1. 2. Oral Care REFERENCE: TASK Assessment Criteria Question 8 Mrs Hong’s breast tumour has developed into a malignant wound. Explain what malignant means and describe how you would care for the wound. Response: REFERENCE: TASK Assessment Criteria Question 9 What signs/ changes may you observe in Mrs Hong that may indicate that she has deteriorated further? Who would you report these changes to? Explain how would you support Mrs Hong’s daughter as she witnesses her mother deteriorating? Response: Deterioration signs and changes B. Reporting Explain how you would support Mrs Hong’s daughter: – REFERENCE: TASK Assessment Criteria Question 10 Mrs Hong is no longer conscious but is demonstrating signs of distress by groaning in pain. (Include also nonverbal cues of pain and distress). What is the most appropriate Nursing tool to use and what else can you observe to assess Mrs Hong’s pain? Response: REFERENCE: TASK Assessment Criteria Question 11 Split into two boxes Mrs Hong is no longer conscious but is demonstrating signs of distress by groaning in pain- you have assessed Mrs Hong and decided to assist in decreasing Mrs Hong’s distress. What options for pain relief would you consider if Mrs Hong cannot take oral medications? (non-pharmacological treatment options) Outline 4 methods used to administer pharmaceutical pain relief to Mrs Hong now she is unconscious and no longer able to swallow Response: Reference: Non -Pharmaceutical Pain relief B) Outline methods of pharmaceutical pain relief administration TASK Assessment Criteria Question 12 Discuss and recommend 3 nursing daily living activities which will be required for Mrs Hong now that she is unconscious and no longer able to provide for her own self care needs. (consider activities of daily living that Mrs Hong can no longer do for herself) Response: 1. 2. 3, REFERENCE: TASK Assessment Criteria Question 13 You assess Mrs Hong and believe she has died. What action should you take within your scope of an Enrolled Nurse? Identify one legislation for the notification of a death in a healthcare facility in your state? In what circumstances should a death be referred to the coroner? Response: REFERENCE A. B. TASK Assessment Criteria Question 14 a) What care activities are undertaken once a person dies? Please list. b) How would you maintain respect and dignity for a client when preparing their body after death (include one cultural or religious practice)? Response: a) b) REFERENCE: TASK Assessment Criteria Question 15 How does the care requirement change for a patient after death who: Requires an autopsy Wants to be an organ donor (consider the legislative requirements for the care of a person after death who requires an autopsy or chooses organ donation) Response: An Autopsy Pt has chosen organ donation Definition Reason 1 Reason 2 Consent requirement – who from Cause of death & signing death certificate Chain of notification responsibility- EN & RN Nursing care (3 for each) REFERENCE: TASK Assessment Criteria Question 16 List three ethical and legal considerations for organ donation? Response: 1. 2. 3. REFERENCE: TASK Assessment Criteria Question 17 How would you provide support to Mrs Hong’s daughter (Mrs McFarlane) after her death? Outline 3 community services you could refer Mrs McFarlane to, to support her with grief and loss? One service from your local/home area. Response: REFERENCE: Support for Mrs Mc Farlane Community services 1. 2. 3. TASK Assessment Criteria Question 18 How would you support your own self-care after caring for a long term client who has died? Provide 3 examples of ways you could take care of your own wellbeing Response: Supporting self- Care Personal Wellbeing 1. 2. 3 TASK Assessment Criteria Question 19 What services are available which can assist you and your healthcare colleagues to debrief after a death in your workplace? (Provide 3 examples of general services available and how they can assist with debriefing and supporting healthcare professionals). Please provide one example of a service in your local area. Response: General services 1. 2. 3. Local Area resource: REFERENCE

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