Nursing - Palliative Care Australia - Essay Writing - Assessment Answer

Nursing Assignment

Assignment Task

Topic - Standard 3 of the Standards for Providing Quality Palliative Care for all Australians (Palliative Care Australia, 2005, p. 6) states that “Ongoing and comprehensive assessment and care planning are undertaken to meet the needs and wishes of the patient, their caregiver/s and family”. Choose either breathlessness or delirium and discuss the comprehensive assessment, care planning and management of the symptom, as experienced by a person in your care. You will need to include any tools, aids and tests that might be used in assessment, monitoring and ongoing evaluation of the symptom.

Introduction

Delirium is a medical condition associated with cognition malfunction. Additionally, the disorder is characterized by high morbidity and mortality rates. The early diagnosis of the medical condition is recommended because the condition worsens if it is not detected (Awissi, Bégin& Moisan, 2012). Delirium is a syndrome, which results from combination of factors. The condition is also manifest in neuropsychiatric abnormalities. The clinical detection of the condition is vital. Clinicians usually attribute decreased awareness and a reduction in attention span to delirium. The syndrome is also manifest in waning confusion.

Background

The patient is subject to a fluctuation in focus and consciousness. However, the medical condition is never detected in many cases because of its multiplicity of causes. For instance, it has symptoms similar to dementia, depression, psychotic disorder, aging brain and mania. It is difficult to detect such a syndrome due to such a combination of symptoms. Boogaardet al. (2012) asserts that the risk associated with such a medical condition is that the patient becomes unconscious of his environment. The fluctuation of consciousness and focus is also a great risk because it will involve a tight schedule of nursing. Although the condition is not an emergence case, the patient will require intensive nursing care. Moreover, the syndrome causes disturbance in thinking whereby an individual is confused. The impairment in thinking is a serious problem and it is caused by chronic diseases, a change in metabolic balance, infection and alcohol abuse. Moreover, drugs withdrawal and surgery are also a cause of delirium. The delirium syndrome is common among the old generation because the old people harbor other medical complications (Brummel, Vasilevskis& Han, 2013). The older people are also vulnerable to communicable diseases at the hospital because their immunity levels are low. The assisted living facilities are also areas whereby the old people can easily get infected with some diseases. Moreover, delirium usually occurs with other diseases including dementia.

The comprehensive assessment

Mrs. Everly is an 84 year old woman. She was brought by a neighbor in a collapsed state to the facility. The neighbor found her outside her home and rushed her to hospital for medication. The medical history of the patient indicated that she had mild dementia, osteoarthritis, osteoporosis and diabetes. The disease is usually common among the old people. For this reason, the patient’s symptoms revealed that she had delirium. However, it was prudent and a requirement of the medical profession to undertake her through a medical diagnostic assessment. According to Eeles et al., (2013), the family history of the patient was vital in the assessment process. Fortunately, the ailing lady was staying with her daughter. The daughter served the medics with vital information pertaining to the behavior of her mother. Such information enabled the medic to make informed decision to the actual problem of Mrs. Everly. First the patient was taken through various tests. The fact that Mrs. Everly had mid dementia in the past implies that there is a high likelihood of having delirium. According to Gusmao-Flores et al. (2012),dementia is also caused by Alzheimer’s disease, vascular dementia, lewy body dementia and multi-infarction and Parkinson’s disease. Therefore, Everly may be suffering from delirium.

Mrs. Everly will undergo a nervous system examination. The test will include feelings tests and thinking tests. The motor functioning tests will also be carried out. The sensation test will establish the consciousness of the patient. The cognitive function test will enable the medic establish whether Everly’s thinking is still impaired. The motor function test is also vital in the establishment the level of agitation of the victim. The test is vital because it will enable the medic make informed decision pertaining to the treatment of the patient. According to Lin, Chen & Wang (2012), a delirium patient will also undergo a blood glucose test to establish whether she has diabetes because her past medical history revealed diabetes. The test will establish whether the level of glucose in blood is high. Additionally, osteoarthritis tests will be done to establish whether the disease is a factor in Mrs. Everly’s ailment. In this case, X-ray tests will be done to establish whether she still has the osteoarthritis effects. The joint aspiration will also be carried out in order to make a sound conclusion. The confusion assessment method will be used to ascertain the extent of confusion for the patient. The delirium symptom interview will also be carried out to ascertain whether Everly suffers from delirium. The confusion assessment method for the intensive care unit is also vital because Everly was found by her neighbor in a comatose state.

The assessment will also cover intensive care delirium screening checklist. Additionally, delirium symptom severity will be assessed through the use of the delirium detection scale. The scale will show the doctor the severity level of delirium. Consequently, he will be able to provide appropriate treatment for Mrs Everly. The checklist of the intensive care delirium screening will involve the test on the altered level of consciousness. Various conditions will be assessed in by use of such a test including deep sedation, agitation and coma. Inattention will also be tested especially difficulty in following instructions. Even the inability to logically follow a simple conversation, will be tested. Moreover, the ability of Everly to recognize the ICU medics will also be tested to ensure that the delirium syndrome is deducted. According to Martinezet al. (2012), disorientation is tested during the intensive care screening test. Everly will also be tested on the knowledge of the hospital facility environment recognition. The screening test will also cover the disorientation. The test of disorientation is vital because it will enable the medic understand the actual state of the patient. Hallucinations and psychosis is a symptom of delirium. For this reason, attest of the conditions is vital.

The condition is similar to paranoia because the patients with such a syndrome can try catching imaginary objects. Moreover, hallucination can be confirmed by asking Everly to confirm his fear of people. Moreover, the screening assessment will entail psychomotor agitation and retardation. Agitation is a risky behavior. Such hyperactivity is tested to ensure that she is treated of the psychomotor agitation. In this case, sedative drugs can be used to relieve Everly of the hyperactivity. She may easily hit the medical staff or cause harm to herself in the course of treatment hence the need for use of sedatives. The screening test also tests the inappropriate speech variable. The positive results of the tests will reveal that Everly suffers from delirium because they are specific to delirium. Additionally, the sleep-wake cycle disturbance will be tested to ensure that she has not had frequent awakening. The fluctuation of the conditions discussed will also point out to the delirium syndrome. Delirium is also attributed to persistent hospitalization (Saczynski et al., 2012). Frequent use of chemical and physical restraint is likely to cause delirium among the patients.

Care planning

The care plan for Everly, a delirium patient, will include many measures including the reduction of the risk associated with delirium patients. For instance, the potential to hurt themselves should be reduced through administration of sedative drugs. The drugs will reduce their hyperactivity. Everly will also be closely monitored to ensure that she does not exhibit any symptoms of delirium before discharge. The fact that there is a high likelihood of contracting more disease while in the hospital including delirium mans that plans should be made in advance to have her recuperate at her home under the care of her daughter. The patient will also be counseled and guided to learn to trust people again. The change of the thought process is a remedy because it will also serve as psychotherapy. The other nursing care plans that will be made pertain to inability of Everly to cope with other people. There is need for the patient to be given a balanced diet to ensure that the body requirements are met to avoid malnutrition. The impaired verbal communication can be resolved through avoidance of drugs and avoidance of drugs (Sarah et al., 2012). The patient should be exposed to social platforms to ensure that she is social to people. The social interactivity helps to relieve stress and depression, which contributes to delirium. Everly will also be counseled and guided to improve her self-esteem. The self-esteem will enhance self-care and promote quick recuperation. The identity of the patient will determine the nursing care plan to be prepared. The main complaint of the patient, Everly, will determine the care plan to be provided. The nursing plan will involve preventive measures pertaining to dementia because Everly had mild dementia prior to being brought to the hospital. The predisposition factors like old age shod also are factored in during nursing plan preparation. The old age increase the vulnerability of Everly to be readmitted for delirium.

Management of the symptom

The management of delirium involves the measurement of the cognitive function. There is need for the investigation of the patient progress and offering of supportive management. The syndrome can be ably managed in the outpatient care. Therefore, Everly’s daughter must be versed with her obligation with regard to her mother’s condition. The change of environment can be disastrous for most delirium patients. For this reason, it is appropriate to maintain the same environment for Everly. Her home will be a good choice because of such environmental change effect. The change of the environment for outpatient care can be chosen by the patient but there is no need for the change of the environment. Informed consent is vital in the course of managing the delirium condition of Everly. The treatment to be given to Everly must be subject to informed consent. Otherwise, the situation can result in litigations and death. According to Sebastienet al. (2012), the use of de-escalation technique is also allowed to ensure that a delirium patient does not pose danger to herself and other people. The delirium situation can be resolved through supportive, environmental and medical management. Additionally, management post-discharge is vital because the condition is subject to mental disturbance. Supportive management entails many aspects including clear communication, time management and staff consistency. Clear communication is vital because it enables the patient to understand information to avoid confusion. Relaxation is as part of supportive management of the delirium condition.

The technique involves the watching on TV and participation n leisure activities. The involvement of family and friends in delivery of care boosts recuperation because it makes the patient feel appreciated. In Everly’s case, her daughter will provide the required family care and monitoring. Medical management will include the use of drugs to treat the syndrome. In this regard, the appropriate dosage of drugs must be administered after assessment of the severity of delirium. Antipsychotics are a solution to the aggressive delirium patients. The antipsychotics are the best alternatives to the de-escalation techniques. Everly had collapsed hence she could not respond to the verbal techniques. Haloperidol is a drug, which is recommended for use after titration. However, the drug ought to be used for a sort time in small doses. The reason for small dosage of such a drug is that they have side-effects including extra-pyramidal side-effects. However, benzodiazepine drug is used for delirium patients with drug withdrawal effect. Large dose of the drug is discouraged to avoid sedation effects. The post-discharge management of delirium is vital because the underlying conditions may persist even if delirium is healed. This phase of Everly management is vital because it guarantees long-term safety and health of the patient. It is possible for Everly to get discharged with some abnormalities hence the need for post-discharge close monitoring.

Conclusion

Delirium is a syndrome, which is manifest in mental disturbance and confusion. The case study of Everly revealed that Everly had a medical history of dementia. Delirium usually occurs with other underlying diseases like Dementia. There is need for a comprehensive assessment of a delirium patient because it is a medical condition associated with a combination of medical complication including diabetes, dementia, depression and old age. The assessment of the patients will involve the confusion assessment, the delirium symptom interview and the delirium detection scale. The management and care of the patient will include the supportive, medical and post-discharge management to enhance monitoring of progress of the patient.