HLTH7004 Palliative Care

Case Study for Palliative Care Assessment 2

Meet Mrs. Smith

Mrs. Smith, a 71-year-old female, was admitted to the hospital with an exacerbation of her chronic obstructive pulmonary disease (COPD) and pneumonia. Her symptoms were cough, fever, headache, and shortness of breath. Mrs. Smith also had a history of diabetes and was in the hospital with pneumonia three weeks prior.

Over the next few days, Mrs. Smith's condition worsened. She was transferred to the intensive care unit (ICU) when the infection spread to other organs of her body, inducing shock. Her care was transferred to the on-call resident who was unfamiliar with her case. She continued to complain of headache and shortness of breath, and the nurses noted that she was increasingly irritable and hardly slept. During the night, Mrs. Smith suffered an acute nosebleed and aspirated blood into her lungs, causing respiratory distress, and she was intubated. Once an independent woman, Mrs. Smith now lay in the ICU with a spreading infection and a ventilator pumping air into her lungs to keep her alive.

Mrs. Smith's son and daughter-in-law came to visit every afternoon. They noticed a significant change in Mrs. Smith's health status and spirit but remained hopeful that she was “a fighter", and would turn around. By writing on a pad of paper, Mrs. Smith communicated to her son that she was very uncomfortable and particularly worried about missing Sunday Mass. As Mrs. Smith's condition continued to decline, she became confused and disoriented. She did not have an advance health care directive, and when the doctor initiated a discussion about her code status, the family was uncertain of what to do because they had never discussed it before. The family did not understand why her condition was not improving and became increasingly worried about the cost of the hospital stay.

The case of Mrs. Smith presents several concerns:

· First, Mrs. Smith failed to receive adequate pain and symptom management-she continued to be short of breath while her headache and insomnia were completely overlooked.

· Second, inadequate communication between the patient, family, and clinical team meant that goals of care were not discussed while Mrs. Smith was still able to communicate, and the family never realized the severity of Mrs. Smith's condition.

· This led to uncoordinated care that compromised Mrs. Smith's quality of life and her autonomy when decisions needed to be made.

· Mrs. Smith received suboptimal care that failed to meet her physical, psychosocial, and spiritual needs.

Read the case study carefully and respond to the following.

Part 1:  

Analysis (30 marks and approximately 1000 words)

In the context of the case study.

a) Consider physical, psychological, social, spiritual and cultural needs to analyse how life-threatening illness has affected Mrs Smith.

b) Analyse the impact life-threatening illnesses have, in general, on whanau/family. You can write about emotional challenges, financial problems, social isolation, stress and burnout.

Part 2:

Critically discuss (30 marks and approximately 1000 words)

Dying people may experience a range of symptoms including, but not limited to, pain, nausea, vomiting, constipation, excessive secretions, breathlessness, agitation and restlessness. It is the health professionals` role to use their knowledge and skill to assess, plan, implement, monitor and reassess the patient and the effectiveness of interventions to relieve and control symptoms.

Effective communication and patient advocacy are fundamental to achieving a sound symptom control treatment plan.

a) Drawing from the case study, critically discuss how effectively Mrs Smith’s pain and other distressing symptoms were handled by the palliative care team.

b)  From holistic point of view, discuss how important the health professional’s role is in providing symptom control?

c) Critically discuss how emotional and spiritual healing be provided as part of palliative care?

Part 3:   

Examine the health professional’s role (30 marks and approximately 1000 words)

Māori life expectancy is improving, and an increasing number are 65 years of age and older. However, the combination of high rates of life-limiting disease and an increasing aged population suggest that Māori access to palliative care should also be increasing.

a) Examine the role of health professionals in responding to Māori individuals with life threatening diseases, including their whanau/family.

b) Analyse the importance of health literacy and communication for health professionals when providing palliative care for Maori individuals, whanau/family?

c) Discuss significant Māori beliefs and traditions that can influence health professionals’ decisions when providing care and services?