Nursing Case Study Palliative Care

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The writer intends to reflect on and critically analyse the provision of palliative care within her clinical setting, a twenty-one bedded medical unit, with reference to one case study in particular, as well as on a more general level based on her experiences to date. The writer intends to discuss one case study in reference to the guiding principles of palliative care and the concept of a good death in relation to that individuals care and the setting in general.

A high proportion of patients are elderly and have one or more life limiting conditions. A survey of attitudes and experiences in relation to dying and death by the Irish hospice foundation (2004) found that in Ireland approximately 30,000 individuals die yearly; 43 percent die
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He was referred early in his admission to the specialist palliative care team as he fitted eligibility criteria for access to this service. They met with Kevin and his family and provided recommendations over a two-week period. Kevin’s physical symptoms included; 1) increased respiratory secretions in upper airways. 2) Retrosternal burning pain. 3) Dysphagia with nausea. 4)Shortness of breath. The impression was that this was due to oesophageal stenosis and increased respiratory rate was secondary to anxiety. The management plan included hyoscine butylbromide to help dry up secretions. This drug was chosen because as Ingleton and Larkin (2016, p123) state it is non sedating, it does not travel across the blood brain barrier and there is a slow onset of motion. This was prescribed on a pro re nata basis to ensure its effectiveness. Alternative pharmacological agents include hyoscine hydrombromide or glycopyrronium. Lokker et al (2014) concludes that there is no proof that one of these drugs is greater over another, choice of drug depends on drug characteristics and clinical requirements. Kevin’s pain was considered visceral (nociceptive) due to infiltration, compression and stretching of the soft tissues in the oesophagus and neuropathic due to tumour compressing on nerves. He described his pain as “deep” and he felt “pressure”. It is important to identify the source, type and intensity of pain as this will indicate which intervention and treatment may be of benefit. This type of pain is usually opioid sensitive. Kevin was prescribed palladone immediate release orally or hydromorphone subcutaneously PRN and these medications have a dual control effect. The World Health Organisation (1996) three step pain ladder provides a structure for opioid use in cancer patients. Pain is perceived in the somatosensory cortex. The opioid acts on pain receptors in the brain and spinal cord. The goal of pain

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