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NSB334 Integrated Nursing Practice Assignment - Queensland University of Technology, Australia

Assessment Task - Collaborative Practice Simulation Workbook

Learning outcomes -

1. Demonstrate evidence-based practice, clinical reasoning and decision-making to provide culturally safe, quality, person-centred care consistent with the NMBA Registered Nurse Standards of Practice and the National Safety and Quality Health Service Standards.

2. Coordinate and lead provision of care for consumers, families, and the broader community.

Task description - You will need to analyse the simulation and undertake a holistic understanding of the situation drawing on prior knowledge and skills.

1. Review the knowledge and skills relating to the National Health Priorities of Cancer.

2. Attend the NSB334 Case Based Simulation Scenario.

3. Complete the on-line module for this National Health Priority.

4. Complete the NSB334 Assessment Task 1 Workbook on the case scenario of Mr. Dwight and answer all questions.

Solution -

Introduction

In this assignment, the case study is explored on Mr. Dwight bowel cancer and the answers for the provided work book questions related to the case and offers an accurate answer based on the study and investigation of palliative care in improving the quality of life of Mr. Dwight and provided with the necessary explanation to the given questionnaires based on the knowledge and application level.

Work Book Questions

1a. The strategies which helps in the identification of bowel cancer as per Dwight complaints is vomiting and abdominal pain and in general includes various diagnostic interventions which are employed to find cancer, frequently suggested by preference and local expertise.

• The interventions in relation to cancer screening of bowel includes barium enema CT colonography, flexible sigmoidoscopy but the entire diagnostic study needs a meticulous bowel cleansing preparation (Halloran S 2009, p -1)
• When the bowel cancer screening is considered to find out early lumps and polyps in the big intestine, these kind of screening will identify problems which are taken care before cancer sprouts or spreads, or screened for CRC through FOBT or colonoscopy, high sensitivity annual FIT (Bilimoria, 2009 , p-4)

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1b. The barriers for patients are considered in accessing the screening includes a few percentage of fear and a few percentages rely on the bowel prep and 3 out of 11 highest barriers were particular to endoscopy. The bowel cancer screening is done depends on the age which creates fear. The screening is generally start with the after 45 years because it is does not any symptoms until it goes to the advanced level.

• In this scenario the personal history of bowel cancer is placing the main barrier.
• Another barrier is based on the heredity based colorectal cancer syndrome because the family background is also considered for this type of cancer (Bilimoria, 2009 , p-4)

2a. The Hartmann's steps are employed to treat a cancer of colon category or inflammation. The important four pre operative things of education to be offered to Mr. Dwight includes

• the procedure or an instruction on fasting before the operation
• anaesthesia
• medications and
• care instructions after operation (Dones et al, 2015, p-5)
• All these preoperative things of education need to be clearly stated for the under stability of the importance of the procedure. It all creates the Dwight to cooperate well with the situation without any flaws

2b. The education approaches or a strategy of the essential pre operation procedure will be in

• the form of live class room set up or
• it will be in the form of one to one interaction session between the doctors or nurses or the patient.

Whatever may be the scenario, the final outcome of the patient is the thing which focus on the Dwight like patient to cooperative suitably in the direction of successful operation procedure (Brinkman et al., 2015, p-1).

2c. The effectiveness of the education will be measured through the mindset of the patient after the pre operation counselling, physical well being and the psychometric assessments. The effectiveness of the education is measured with the outcome of the people understanding and the screening test taken by the people or patient. The pre-operative process is help to avoid the critical situation due to the unawareness about the symptoms and also it is avoid the death due to the unawareness about the cancer type (Bilimoria, 2009 , p-4)

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3a. The four observations related to surrounding skin problems in the phase of post operative includes

• Erythema or redness
• Erosion and Maceration
• Hypopigmentation
• Papule and
• Ulcer

It is highly recommended to gain knowledge on these skin problems surrounding the stoma to alert on the problems linked to stoma in a post operative phase operation (Brinkman et al., 2015, p-5). There are so many consequences, the more general one is considered as an over range of fissure operated in the abdominal wall during the surgery

3b. The treatment offered in case of skin problem occurring in the area of stomal or the solution for the skin problem treatment includes

• Application of Benzyl Benzonate over the affected area and leaving it for 24 hours prior to washing off. For some patients it may lead to irritant and eczema.

Other alternatives includes

• topical sulphur
• oral and topical ivermaectin
• gamma benzene hexachloride
• permethrin, etc. ( Roderick p -4 )

4a. Mr. Dwight experiences bowel obstruction symptoms like vomiting and abdominal pain, the reason for occurrences in the background of bowel malignancy includes many, the few are impacted stools, gallstones, intestine blocked by tumours, etc. This education that is closure of the colostomy and bowel function is considered with educational strategy that is related to the various analyses for Mr. Dwight benefits. The study about the bowel cancer is helping the patient or user to understand the symptoms of the deceases and how to screening them self then monitoring the status of them. The strategy of providing awareness of the people in the early stage of the cancer is considered as one kind of the benefit.

4b. The recognition of three symptoms which shows the bowel obstruction and the reason for the occurrences in the background of big bowel malignancy associated with pathophysiology includes

• loss of hunger
• vomiting
• constipation and
• abdominal cramping pain arrives and moves

because all these symptoms shows its inability in the movement of bowel. Once all these symptoms are happened, it has to be shown to the medical practitioner immediately to avoid the severe problems related to bowel obstruction as lethargic action may lead to serious trouble (Rhodri, 2011, p -12)

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5a. The four unfavourable effects happened on managing blood products includes

• chills
• fever
• bacterial defect in the products of blood and
• urticaria.

The cause of it may happen due to destroying possibility of red blood cells through the individual system of immune and the allergy causing reaction encountered by an individual due to many medical complications in the health care sector (C K Palmer 2014, p - 4). In common, it is probable to have some unfavourable reactions through allergy to the receiver of blood at the time of transfusion still the giver is with right type of blood

5b. Representation of six activities needed for the nurse in case of adverse reaction to occurrences of blood products includes

• Administration of blood product that is the care of not maintaining the blood in the client zone for greater than 30 minutes. So the transfusion must be made shortly and,
• Patient monitoring,
• Finding and controlling any probable reactions of transfusion and quality procedure.
• Once the problem is identified, the further step for consideration by the nurse is to make sure on the interventions of nursing to outfit the framework and related to proof centric with also considered on the control measures on the infection related to hospital obtained, blood administration ,
• proper use of oxygen in patients with COPD,
• Blood pressure measurement, etc . (Richard, 2011 p -1)

6a. The rationale reason for Mr .Dwight need of nasogastric tube as he is in need of some particles to the stomach and it is employed to place some nutrients straight a way to the stomach while he is not in the condition to consume food or mouth intake (Balboni et al., 2017, p - 9)

6b. The defective check of the location of the NG which the RN can do in the ward includes other than performing the methods like requesting the person to talk or hum or a syringe irrigation, chest x ray or downing the open need of the tube of NG to the cup of water (Ettema et al., 2015, p - 2)

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Questions on Mr. Dwight Palliative Care Consultation

12. The priority 2 clinical problems which can happen for Mr. Dwight at the time of entry to the palliative care unit related to fluid and nutrition which is generally seen in the setting of palliative care includes

• Side effects in terms of NG, ND Nasoduodenal or Nasogastric tube feeding instalment
• Problem of Reducing the level of infection and keeping strength through PEG percutaneous Endoscopic Gastrostomy tube feeding and feeding tube placement through surgical in the duodenum or jejunum and total parenteral nutrition and peripheral (Roschelle et al., 2010, p -5).

As the Mr. Dwight is having severe secondary metastases in the spine, liver and lung, he had only fluid that too very little

13. The goal identified for Mr. Dwight management by employing SMART framework of the priority problem related to clinical problem of minimizing the infection level and maintenance of strength includes

Objective towards relief from the stress and infection and improving the quality of life

This is considered as one of the main goal of palliative care unit as it deals with people like Mr. Dwight of medical care with serious illness like bowel or colon cancer.

14. As per the goal of Q13, the two interventions in the form of nursing, pharmacological or collaborative that will support to attain Mr. Dwight goals includes

• Assessment of need through appropriate study of Mr. Dwight observations and results examination
• Monitoring the symptoms along with post treatment monitoring process

(Taylor, 2015, p -4)

15. The two methods to measure the outcomes of the interventions specified in the question no. 14 involves

• Numerous studies reported that the enough way of employing a method on the management of symptom can minimize the distress, delay in treatments or negative aspects of life quality and by educating patients to understand the treatment, may result in better outcomes in the treatment
• By employing the method of nursing interventions positively on the management of need assessment based on the observations, the quality of life will be enhanced with minimization of cancer outcomes. The Oncology nurses can be employed to assure the best care with quality to attain best probable outcomes. (Julia et al., 2016, p -4).

On thinking about interventions and the way of evaluating Mr.Dwight is required for the huge category of psychosocial interventions which is improved as the number of patients goes on increasing with cancer having lengthy survival. The majorly employed four interventions includes training on a behavioural aspect, education, team interventions and independent psychotherapy (Ettema et al., 2015, p - 5)

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16a. The four multi disciplinary members who are indulged in the palliative patient care of Mr. Dwight includes the specialist like

• Psychiatrists,
• health nurses,
• psychologist,
• occupational therapist social workers, medical or physical secretaries ,
• special clinical nurses or community nurses for mental health

(Steinhauser et. al., 2017, p - 4).

When the learning part is considered and the requirement needed to follow up with is concerned on offering treatment and optimal care the nurses are required to find out the progression of disease of the patients. The knowledge of the nurse related to pathophysiology allows greater efficient partnership with all the multi disciplinary members. The knowledge in pathophysiology makes the palliative care of Mr. Dwight by multi disciplinary specialist readily to identify the state of syndrome or infection along with it state of progression (Balboni et al., 2017, p - 4).

16b. The major benefits of the patient of palliative care like Mr. Dwight to have a multidisciplinary team indulged in planning process and care in the delivery to think the role of the team along with its merits states that a team of multidisciplinary is a collection of professional from more than one clinical disciplines were allowed to make major decisions related to suggested treatment of a particular person like Mr. Dwight. The team of multidisciplinary may be specialised in certain conditional area like cancer care. The inherent feature to its multidisciplinary characteristics and capability to offer care in various settings, the palliative care offerers see families and patients where the care is required for them to obtain treatment successfully. To go over again, the care provider in various settings can allow for the proper understanding of the nature of patients along with their family requirements. The allied multi disciplinary experts or doctors or professionals are university represented well educated practitioners in the health care sector who perform their job as a kind of person from the palliative care team members. The team members assist in treating various symptoms of various health disorders related to palliative care manages every day activities and offers an emotional balancing support and help to the patients and the other members of their family and also offers rehabilitation servicing tasks (Woolf et al., 2015, p-5).

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