palliative chapter 3-5

8/3/2019 Palliative Chapter 3-5

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A good nurse works sma

It is my dutyDawn Butler, RN(Pennsylvania)

I walk through those doors with pride,Who's life will i save tonight?Someone is waiting for me,

Someone is alive today because of my duty.Sometimes we cry cause we can't save them all,

God sometimes won't let us interfere when he calls.A baby's first breath when he looks at me,

The joy of my first delivery.The tear i wipe a way with my own hands,

The life ending of a gentle old man.The night seems so dark and the morning so bright.

Being a nurse you see life in a different light.Who will i save tonight?

Who will hold my hand during their last breath with no fright?Who will enter this world on my shift?

How many mothers will greet their babies with a kiss?I don't know who these special people are

but i will meet them with every call

I will hold them tight and help the painI will hold them up when they feel faint.

I will be strong when i am neededThat is my job, I am a nurse..that is my duty.


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When you're a nurse you know that every day you will touch a life or a life will touch you

Nurses are

EDUCATORS!!

Providing EDUCATION is anintegral component of any

professionals role.

RNs should endeavor tofind an approach that suitsboth personality and their

skills.


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GOAL:Develop in our everyday

practice as educators - - asnurses!

Develop a passion for learning. If you do, you will never cease to grow. Anthon

Why this

topic???

It is important to choose ateaching approach & learning

style that suits us/you!
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5/87Nurses dispense comfort, compassion, and caring without even a prescription.

Kolbs LEARNING PROCESS

1.PLANNING

2.EXPLORATION3.REFLECTION4.DOING


6/87Panic plays no part in the training of a nurse. ~Eliza

PERSONALITY has an effect on the learninapproach.

. . . should be considered in designingplanning teaching material.


7/87If love can't cure it, nurses can. ~Author Unkn

4 INGREDIENTS OF SUCCESFUL

LEARNING( Race & Brown 1993)1. Wanting

2 & 3. Doing and Feedback4. Digesting


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A nurse will always give us hope, an angel with a stethoscope.

SURFACE LEARNING vs. DEEP

LEARNINGMemorizing important

points, students

concentrate theirefforts on passing theassignments to gain

highest possible marks

Understands thearticle, assimilate

information basedtheir experience

evaluated eviden


9/87Confucius say: "Man who want pretty nurse, must be patient." ~Autho

PEER- ASSISTED LEARNINGTECHNIQUES

A. DEVT THROUGH REFLECTIVE PRACTICE-- according to Quinn & Johns, REFLECTION is a

window through which the practitioner can view

and focus self within the context of his own livedexperiences in ways that enable her to confront,understand & work to resolve contradictions

within her practice between what is desirable &actual practice


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Nurses are the hospitality of the hospital. ~Carrie La

Using a journal of reflection has helped me to

structure my thoughts and feelings appropriately. M

competence, within this clinical skill, has beenfurther developed and I now feel that my personal a

professional development is progressing because of

MSN program of St. Paul University Philippines.

Furthermore as a MSN student and at the same time a

an educator I have recognized that reflection is animportant learning tool in practice. I've learned t

nursing is a great metaphor for life. It's rewardin

and frustrating, utterly fascinating at times and d

as tombs at others; it's funny, sad, beautiful, ugl

dramatic, and unglamorous.


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"Our job as nurses is to cushion the sorrow and celebrate the joy, everyday, while we are 'justdoing our jobs.'"

As a Paulinian nurse we know that a little effo

can go a long, long way. Investing five or ten

minutes in a needy patient at the very beginning o

the shift sets the tone for the entire day, and pay

dividends in decreased anxiety for them . This

principle also works for nightmare-beleaguered

toddlers, stymied spouses, and fussy in-laws. =-)

And yes, I've found that the Golden Rule isapplicable to every possible situation, whether in

nursing or in life: Treat everyone you encounter w

the same respect you would want for yourself or you

loved ones.


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"I can stand out the war with any man. - Floren

Everyone who ever lived is, or was,

someone's parent, someone's sibling, someone's

child, someone's friend. What's more, we are all

members of the human race---including the three-hundred-pound diabetic who smokes like a chimney

and doesn't take her insulin and the homeless

alcoholic who hasn't changed his socks in six

weeks. We judge them only because we fear, deep

inside, that "they" could just as easily be "us"

but for the grace of God and perhaps a fewstrokes of bare good luck.

So many lessons........so many opportunities to grow in

compassion and wisdom.


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Constant attention by a good nurse may be just as important as a major operation by

GIBBs REFLECTIVE CYCLE

1.DESCRIPTION

2.FEELINGS

3.EVALUATION

4.ANALYSIS

5.CONCLUSION6.ACTION PLAN

SUPERVISION


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"Good teachers are those who know how little they know. Bad teachers are those who thinknow more than they don't know.-- R. Verdi

SUPERVISION-- refer to providing a safe environment toexplore issues of concern to the individual

practitioner through reflection and self-awareness-- HOW?

1. Supervisee + supervisor agree on same

time2. Supervisee brings issues to the meeting for

discussion3. Using reflection, supervisor facilitates

supervisee to come to their ownconclusions


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"the character of the nurse is as im ortant as the knowled e she ossesses

D. DEVT THROUGH

PRECEPTORSHIP-- BUDD SYSTEM providing informal support

and orientation to the work environment-- the PRECEPTOR is shadowed while

involved in their normal work; OBSERVERwitnesses the experienced practitioner in

action


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Nursingwould be a dream job if there were no doctors. ~Gerh

PROBLEM-BASED LEARNING

-- student-focused learning

-- a stated problem is the stimulus for studentsto use their cognitive skill to gain knowledge of

the concepts and issues identified-- HOW IS IT DONE?

1. Problem is presented before the learners2. Learners define the nature of the problem,

identify additional resources needed andfind viable answers

3. Teachers act as facilitators by asking

questions and monitor studentsprogresses


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Wives are oun mens mistresses com anions for middle a e andold mens

PROBLEM: MAY JEANMay Jean, 49 years old female, was admitted to a tertiary hospital Metro Manila last Feb. 19,2008 with the following presentingsymptoms: aural fullness and abdominal pain with enlargement. Tpatient was placed on low fat, low sodium diet and has undergoneCBC. As the admitting nurse, plan for the care of MJ. How do youassure the continuity of your care during the hospitalization of MJ?

On Feb. 20, an ultrasound-guided paracentesis of theabdomen was performed; examination of the abdominal fluid was

done. A catheter was inserted draining to bag. Patient was referredDr. Juco with new orders. Dr. Jucos evaluation noted that MJ isknown to be a case of ovarian CA s/p chemotherapy s/p TAHBSO.

As the nurse on duty, in the light of this information, whatmodifications would you do in the NCP designed bu the admitting

nurse? How would you involve head nurse and colleagues?


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The trained nurse has become one of the great blessings of humanity, taking a place beside the physician and the priest.... Famous Saying


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Nursing is a work

WHAT CANCER CANNOT DOby Kristen Homandberg

Cancer is so limited that:

It cannot cripple loveIt cannot shatter hopeIt cannot corrode faith

It cannot destroy peace

It cannot kill friendshipIt cannot suppress memories

It cannot silence courageIt cannot invade the soulIt cannot steal eternal life

It cannot conquer the spirit


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HOLISMGreek word holos which

means entire/whole

Develop a passion for learning. If you do, you will never cease to grow. Anthon

Why this

topic???

Inner resources are asimportant as external ones
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Nurses are the heartbeat of

The WHO defined health as

"a state of complete physical, mental

and social well-being and not merelythe absence of disease or infirmity."

HOLISTIC CARE focuses on

healing the whole person

through the unity of body,

mind, emotion, spirit and

environment.


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Blessed are the nurses, for they help us heal through love

Nightingale believed that Godhad called her to be a nurse.

She was dubbed "TLady with the Lamp

The NIGHTINGALE PLEDGE taken bynew nurses was named in her honor, andthe annual INTERNATIONAL NURSESDAY is celebrated around the world onher birthday.

Florence Nightingale syndrom

Florence Nightingale


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Behind every good doctor is a

FRAMEWORK

(Dr. Keri Thomas)

Work as a team and ensure continuity of carPlan for developments in patients illnessProvide patients with the best symptom

controlGive support to patients and carers

1. Proper use of NURSING


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ONE MAJORPOINT!

Look at the PATIENT as a UNIQU

individual so that we, NURSES, can

create an ENVIRONMENT thatfacilitates INNER HEALING thus

reducing suffering.


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SYMPTOM MANAGEMENT

KEY PRINCIPLES1. In implementing any intervention or tx r/t th

management of symptoms, the preferred

choice of the patient should be the forefront o

the minds of the carers. This includes to non-treatment as an option

2. Open communication decision-making. Pt & fy

3. Listen to patients own story. Including past &

present life experiened


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PROCESS OF SYMPTOM MANAGEMENT1. EVALUATIONestablishing the cause of the

symptom involves taking hx, including gen

trends and recent changes. effectiveness of

interventions that have already been

implemented2. Use of tools- Verbal rating scales

3. Visual analoges scale


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1. EXPLANATIONabout care and treatment

options is vital to the delivery of effective car

and empowers patients and carers to beinvolved as equal partners in decision makin

process.

- info about the disease process and

significance of symptoms should be provided

- Poor communication skills can give detrimenta

effect on pt. outcomes

PROCESS OF SYMPTOM MANAGEMENT


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PROCESS OF SYMPTOM MANAGEMENT

3. MANAGEMENTbuilds on the assxprocess.

- all professional involved in patient car

should be working towards same goal4. MONITORINGdet hw efective d int..

Cont reassesmnt

5. ATTENTION TO DETAIL


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-- educate patients in coping techniques in advance the terminal phase of disease-- breathing and relaxation techniques-- oxygen therapy--help them accept the limitations of their diseasePHARMA MNGT

-- bronchodilators, steroids, furosemide,

nebulized saline, use of sedation, nebulized

opoids

COUGH- common wt lung ca


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COUGH- common wt lung ca

++WET Cough

-- bronchodilators, nebulized saline,

expectorants, mucolytics, antibiotic therapy

++ DRY Cough

--antitussive, nebulized local anesthetics

** Proper coughing technique

** Postural drainage

** steam inhalations

PAIN


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PAIN-must be a

prioprity

An unpleasant sensory and emotional


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-An unpleasant sensory and emotionalexperience associated with actual or

potential tissue damage, or describes interms of such damage- the unrelenting nature can impact on a

aspects of a persons life, includingactivities of daily living , sexual and soc

relationships, sleep patterns, thought

processes and existential domain


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INCIDENCE OF PAIN-2/3s of pt. with cancer suffer pain while 1/3 do not experany pain at all.

PHYSIOLOGY1. PHYSIOLOGICAL PAIN is the least intricate and occ

when the nociceptive system warns of impending injur

the body, providing direct pain information to the brain.2. CHRONIC PAIN long standing pain which can lead t

increased pain response.3. NEUROPATHIC PAIN commonest cause of complex

is current or past damage to the nerve fibres, which cafollow damage to the periprhal nerves or injury to the scord or brain.


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- Somatic pain- pain that arises in theskin, muscle, periosteum or fascia.This type of pain is localised

- Visceral pain- results from infiltration,compression, distension or strecthing

of the thoracic or abdominal viscera.Poorly localised and oftenaccompanied by nausea.

ASSESSMENT OF PAIN


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ASSESSMENT OF PAIN-history1.Site and n0. of pains

2. Intensity and severity of pain3.Radiation of pain4.Timing of pain5.Quality of pain (burning, stabbing)

6.Aggravating or relieving factors7.Aetilogy of pain8.Type of pain9.Analgesic drug history10.Presence of any clinically significant psychia

WHO GUIDELINES for Cancer pain relief


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p1.By the mouth the oral route remains the lea

& safest method drug administration and

provides a rap id onset of analgesia2.By the clock- since most oral analgesics act

only for 4 hours or less, oral analgesics shouldbe prescribed 4- hourly in order to achieve

therapeutic levels of analgesia rather thanwaiting for the pain to occur

3.By the ladder- pain free with as few sideeffects of the medication. 3 possible stepsdependent upon the severity, type and cause othe ain.

STEP1 ild i


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STEP1: mild pain.This involves the use of a non- opioid

analgesic e.g paracetamol, NSAIDS,diclofenac or ibuprofenSTEP2: mild to moderate pain.

Use of weak opioids, most contain codeinwc should be excess of 30 mg to be effecte.g. dihydrocodeine & dextropropoxypheneSTEP3: Moderate to severe pain

Morphine + non opioids and adjuvants


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MONITORING PAINThe site of the particular pain being

experienced, using the body chart of thinitial assessment, as the patient may

have multiple pains and the pains can labelled a,b,cWhether it is linked to movement or reThe level of pain, and this should be

elicited from the patient

NON DRUG INTERVENTION


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NON DRUG INTERVENTION-Aromatherapy

-Massage-Hypnosis

-Relaxation therapy


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EVALUATION


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U OAssessment of:1.A detailed hx, including tumor histology a

spread and previous tx2.Onset of symptoms3.Physical examination

4.Evaluation of biochemical status5.Factors that exacerbate or relieve sympto6.Effects on activities of living

7.Further investigations if necessary eg.Radiological investigation

MONITORING


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MONITORINGThe vomitus should be observed and its

characteristics recorded: amount, colour,odor, presence of blood, undigestedfoodstuffs or fecal fluid

CONSTIPATIONThe effect of the illness can also lead to


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-The effect of the illness can also lead todehydration poor food and fiber intake, lack ofexercise, weakness and confusion-Patients taking strong opioids require laxatives

EVALUATION

-The appearance of the stool often gives indicatioof the nature of the problem:small, hard stools may mean a slowing of thetransit time through the bowel

: ribbon-like stools may point out stenosis:blood in stool may indicate tumor or hemmorrhoi


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DEPRESSION


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DEPRESSION-Coexists with other physical symptoms in

palliative care patients-Frequently reported psychiatric symptompatients with advanced cancer


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EFFECTS OF ADVANCED ILLNESS ON

THE THREAT OF ILLNESS TO FUTURE LIFE ANDPLANS

If a person become aware that they have a

potentially fatal disease, they are stopped intheir tracks. It is a threat to the very core of selfand can undermine their sense of security andability to plan for the future

THE THREAT OF ILLNESS TO PHYSICAL AND


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THE THREAT OF ILLNESS TO PHYSICAL ANDPSYCHOSOCIAL INDEPENDENCE

A stressful situation could lead to depression if tindividual believed that it was impossible to conthe situation

-Loss of independence can be shattering to selfesteem.-They lack understanding of their bodies,undermining their sense of power and control.- no longer being able to trust their abilities and

THE THREAT TO BODY IMAGE AND


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SEXUALITY

THE THREAT TO SOCIAL ROLES AND STATU

As disease progresses people are likely to feel lessconfident in their roles as partners, friends and workers-Many found themselves temporarily unable to do so ana few were permanently unable to cope- serious illness and its treatment impose physicallimitations

THE THREAT TO RELATIONSHIPS


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THE THREAT TO RELATIONSHIPS

Close relationships form a part of a perso

identity and give feelings of security andcompetence

- As the seriousness of their illness becommanifest, people often go through a perioof feeling less confidant in their relationsh

THE THREAT OF STIGMA AND


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THE THREAT OF STIGMA ANDISOLATION

Serious illness can make them feel

powerless and unsure of their

status, especially if they aresubjected to others negative

expectations and labelling


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THE THREAT TO FAITH AND HOPE

A life threatening illness may cause aperson to grow spiritually or fall into

doubt and despair- Its a n important part of identity

SUPPORTING PERSONHOOD IN ADVANC


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ILLNESS-Normalizing the distressing symptoms, making anto maintain eye contact with patients experiencingdistressing or embarrassing symptoms-Acknowledging the delicate balance between prov

total care for patients and promoting theirindependence, and respecting their decisions aboupersonal and medical care-Helping patients to have control over their persona

appearance and environment ( pts. Were allowed tdecorate their bedsides with photos and items from

Caring for the unconscious patient


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Caring for the unconscious patient-nurses talked to and touched patients and

encouraged the family to do the same asthey might still be able to hear.


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NONVERBAL COMMUNICATION


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-SUCH AS JOINT GAZE AND THE USE OF gesturhave been found important in the construction ofmeaning-It has been estimated that non verbalcommunication carries four times the weight of verb

communication-Perrys 2 importance of NVC1.Dialogue in silence2.Mutual touch

Humour- perrys 3rd encompassing NV and V


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A human being is not attaining his full heights until he


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"Learning is what most adults will do for a living in the 21st century.-- Pere


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palliative chapter 3-5

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