NURS 217 Health Assessment

1.What historical developments have been most influential in shaping attitudes and beliefs about death and dying in western societies in the 20th century? Consider factors such as:
a) Scientific advances
b) Information technology
c) Health care developments
d) Demographic changes
e) Consumers

2. Think about how you and your immediate family react and respond to death and dying. What cultural or personal factors influenced the way you or your family reacted when someone close to you died?

If you haven’t experienced the death of someone close to you, consider how you think it would make you feel?
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3. Describe the key elements of cultural safety.
4. What are some of the common concerns people facing life-limiting illnesses might have? Satisfactory Not Yet Satisfactory
5. What are some of the physical, psychological and social changes that could make a person with a lifelimiting illness feel a loss of control?
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6. What are the reasons that people often fear pain and other symptoms even when effective symptom management may be available? Satisfactory Not Yet Satisfactory
7. How do you define quality of life?
8. Why is it important for health care professionals to understand a person’s perception of quality of life
and how it changes over time?
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9. The World Health Organization’s (WHO) definition of palliative care states that palliative care ‘is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications’.
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10. Discuss what is meant by ‘early in the course of a life-limiting illness’.
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11. How would you respond in a situation where a caregiver has asked you not to inform the patient about
their illness?
12. How do you respond to a patient who tells you that they have ‘had enough’ and no
longer want treatment?
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13. Review Palliative Care Australia’s publication “Standards for providing quality palliative care for all
Australians” and identify the key points distinguishing the following definitions:
palliative approach
specialist
palliative care provider.
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14. What are the main issues for children when a parent has a life-limiting illness?
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15. How would you respond to a parent who is concerned about the effect of their illness on their children?
16. What are the potential barriers that may hinder discussions between health professionals and patients
about their distress?
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17. What strategies might a health care professional use to introduce sensitive issues, such as spirituality,
intimacy or sexuality?
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18. What might be some of the issues experienced by families and carers in the following
End-of-life care settings:
a) hospital
b) home
c) Hospice?
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19. Review the following terms and provide a definition for each:
a) life-limiting illness
b) illness trajectory
c) prognostic factors
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20. Choose one type of cancer (for example, lung cancer) and one non-cancer life-limiting illness (for
example, chronic heart failure). Research the literature and answer the following questions:
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21. Identify current epidemiological data relating to incidence and survival rates
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22. Identify classifications, staging, grading and/or prognostic factors
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23. What types of health problems or needs might arise throughout the course of the illness trajectory for
these conditions?
24. How are these trajectories similar or different to that of a frail older person who is dying?
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25. List the key principles for undertaking a multidimensional assessment of the symptoms for people with
advanced life-limiting disease?
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26. How would you describe the primary goals of palliative care?
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27. How can you assess a person’s preference for their care?
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28. What are some of the reasons that individuals with life-limiting illnesses may continue to have the goal
of cure?
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29. Visit the Respecting Patient Choices (RPC) website. Review the relevant legislation in conjunction
with the RPC Guide to Advance Care Planning.
Answer the following questions:
a) What are the steps that an individual would follow in order to participate in advance care
planning?
b) What are the implications of the legislation for you as a health professional?
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30. Select the most appropriate answer. Pain is often misunderstood and misjudged because it is:
a) objective and can only be measured through diagnostic data
b) subjective and cannot be objectively measured
c) self-reporting and objective in nature
d) the nurse is the best judge of the client’s pain
31. Select the most appropriate answer. What purpose does pain serve for individuals?
a) To provide gate control
b) To act as a protective mechanism
c) To minimise noxious stimuli
d) To limit movement
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32. Select the most appropriate answer. When objective and subjective data about a client’s pain are in
conflict, which report should the nurse consider to be the primary source?
a) Objective data
b) Subjective data
c) Combination of objective and subjective
d) Objective data and reports of family members
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33. Select the most appropriate answer. During the assessment process, the nurse must remain aware of
their own:
a) Pain levels and tolerance
b) Cultural values
c) Values and expectations of pain behaviours
d) Understanding of types of pain
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34. Select the most appropriate multiple-choice answer. Which theory of pain proposes that pain can be
relieved by blocking the transmission of pain impulses to the brain by physical modalities and altering
the individual has thought processes, emotions or other behaviours?
a) Gate control theory
b) Kussmaul’s theory
c) Perception modulation
d) Transduction
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35. Read the following multiple answer question and select the most appropriate answer. Which type of drug has an addictive effect to analgesics?
a) Adjuvants
b) Anaesthesia
c) Narcotics
d) Opiates
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36. Read the following multiple answer question and select the most appropriate response. For the client
with cancer pain, what is the preferred route of providing pain medication?
a) Intramuscular
b) Intravenous
c) Oral
d) Transdermal
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37. Select the most appropriate answer. Which method of non-invasive pain relief focuses the client’s
attention on something other than the pain?
a) Cutaneous stimulation
b) Distraction
c) Guided imagery
d) Relaxation
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38. Select the most appropriate answer. Which of the following may occur as a side effect when
administering opiates?
a) Anxiety
b) Diarrhoea
c) Palpitations
d) Respiratory depression
39. Select the most appropriate answer. Which route of pain medication administration provides the
MOST rapid onset of pain relief?
a) Intramuscular
b) Intravenous
c) Oral
d) Transdermal
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40. List three (3) major functions of a multidisciplinary palliative care team.
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41. Describe how you could provide a warm, caring environment for a dying resident in an aged care
facility.
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42. What is an advance care plan and how will this assist a palliative care person as their condition
deteriorates?
43. List five (5) physical symptoms associated with incurable illness.
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44. What nursing actions could help an emaciated individual whose pain is controlled but who cannot get
physically comfortable in bed?
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45. Describe five (5) ways you can promote a sense of wellbeing in the partner of a person who is dying in
the acute care hospital setting.
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46. Undertake research on one (1) of the following complementary/alternative therapies listed below.
You are required to identify for this therapy what it is, how this style of therapy could be used as part of a therapeutic regime for a client’s comfort and relaxation. Outline the benefits and contraindications if any. For this suggested complementary therapy what stage of life would benefit from it the most?
The therapies to choose from are –
a) Relaxation
b) Imagery
c) Tai Chi
d) Therapeutic touch
e) Reflexology
f) Aromatherapy
g) Animal assisted therapy
h) Music therapy
i) Play therapy
j) Meditation

1 (b) Health Care Developments: Inventions in the medical sector have shaped the attitude and beliefs of people about death (Robbins, 2018). Developments such as palliative care provide emotional, psychological, and physical assistance to individuals with terminal infections. Moreover, the care issues guidance and counseling to the friends and family members of the patient. The health care sector has also created management strategies towards the symptoms.

2. Death and dying create a somber mood in my family. The cultural belief is that death robs the family of an individual who can help in the future. However, palliative healthcare has helped the family to accept death and assist people with terminal diseases. The family undergoes a lot of pain when an individual dies due to a non-terminal condition.
3. Key elements of cultural safety

 The individual should reflect on their culture. Additionally, people should examine the beliefs and attitudes of other individuals. People should hold respectful, open, value-free and clear communication between themselves (McCall et al., 2017). There is also a need for developing long-lasting trust amongst one another. Individuals should identify and avoid barriers due to stereotype. Individuals should be free to share knowledge in interactive communication. Knowledge about cultural shock is essential.

4. Individuals having life-limiting diseases fear that disclosing to family members and close friends can make them isolate him. Therefore, the patients fear the loneliness that can encounter their admission of the state of health (Candy et al., 2015). The affected persons also feel that talking about their condition can make family members overprotective. Other friends start to look at the patient as an already dead individual.
5. Some of the physical changes in terminal disease patients include fatigue and immense pain. The individual feels tired and cannot perform any physical activity (Kendall et al., 2015). The psychological changes include anger, fear, and regret. An individual who is nearing death fears the experience and blames self for the predicaments. The social changes make family and friends move closer to the victim. The family members also become emotional due to the condition of the patient.
6. Individuals with terminal diseases fear pain and other symptoms despite the management strategies since the control has undesirable side effects. The painkillers have side effects such as diarrhea, nausea, and vomiting. The fear of the patient is also due to the physicians’ limited knowledge of analgesics. The patients also have misconceptions about the symptoms of the terminal diseases. A majority of medics lack adequate time to assess and apply the proper symptom management strategy.
7. Quality of life (Q.O.F) is a broad term for the well-being of a person or a society (Dumuid et al., 2017). The term explores the positive and negative sides of an individual’s life. Researchers gauge the quality of life regarding a person’s family, wealth, safety and religious beliefs. Other aspects of QOF include one’s education, environment, education and the physical environment. An individual with proper education has a high quality of life.
8. Healthcare should understand the patient’s perception of quality of life to improve the provision of quality medical attention.  The knowledge enables the caregivers to select the method of treatment that suits the preferences and needs of the patient. Individuals also believe that certain types of medications improve the quality of life. The perception changes with time. Therefore, the care provider must understand the patient and offer the appropriate drug.
9. The statement in the WHO’s definition insinuates that palliative care at the point of diagnosis of the terminal disease. However, the intensity of care should increase throughout the life of the patient. The pillars of palliative care such as decision making and symptom control should kick off after diagnosis. Psychological family and patient care should also start in the early stages of medical attention.
10. I would keep the caregiver’s words not to inform the patient about the terminal illness. The care provider has the expertise of breaking the news to the affected patient. Moreover, the physician may be looking for the best time to break the news to the patient. Otherwise, premature information can be catastrophic to the patient. The affected individual may contemplate actions like suicide and take poison.
11. I would summon palliative specialists to provide guidance and counseling to the patient. I would also convince the patient that the family and friends need her company. Furthermore, I would explain to her the essence of treatment.  I would explain the fact that treatment minimizes pain and other symptoms such as fatigue.
12. (a) palliative approach is a strategy that endeavors to elevate the lives of people with terminal diseases and that of their families (Adelson et al., 2017).

(b) A specialist is a palliative caregiver who provides treatment to a specific symptom due to a terminal illness (Adelson et al., 2017).

(d) A palliative care provider is a healthcare professional who offers care to individuals with life-limiting diseases (Adelson et al., 2017). Furthermore, the caregiver also attends to the emotional needs of the family.

14. The child experiences loneliness when they start to visualize life after the death of the parent. The status of the parent distracts the young ones; hence, they cannot concentrate on school work. The child is on the verge of losing parental love, and financial support after the parent passes on. The young ones can also lose hope in life.
15.  I would tell the parent that it is normal to get worried about the effects of terminal diseases on the children. However, I would summon the palliative care specialists to provide psychological assistance to the parent and the children. I will show love to the children and help them to accept the fact that the parents can depart anytime.
16. The first barrier to the discussions between physicians and the distressed patients is the concern of how the patients can react to the news of death.  Certain caregivers lack sufficient knowledge on the management of the terminal diseases. The unpleasant experience of discussing with previous patience limits physicians from talking to their present patients. A language barrier is another hindrance to the discussion of patient and caregivers.
17.  Introducing sensitive issues such as spirituality and intimacy is a difficult task for health professionals. They can introduce the topics by supplying spiritual and intimacy books and journals to the patients. The caregivers should encourage them to read the books as the content reduce pain and speeds up the recovery process.  The physicians can also communicate to family members who then introduce the topics to the patients.
18. (a) hospital. The family members complain of hygiene standards of the health facilities. The family has a feeling that patient care is inadequate at the hospitals. The caregivers find difficulties in the discussion of end-of-life care with the patient.

(b) Home. The family gets emotional as they find it hard to accept that the patient will eventually die. The caregiver has a difficult time in balancing capacity and burden.

(c) Hospice. The family believes that the hospice providence an appropriate place for patient care. The care providers have adequate resources to attend to the patient.

19. (a) Life-limiting illness (LLI) is a disease whose direct consequence is death. Examples of the disease include heart diseases, cancer, COPD, and renal diseases (Kutner et al., 2015). Other LLL include heart failure and neurodegenerative diseases.

(b) Illness trajectory refers to the course of a disease from the moment an individual undergoes diagnosis until the point of death (Luttik, Jaarsma, and Strömberg, 2016).

(c) Prognostic factors are variables that physicians monitor to estimate whether an individual can survive an infection or otherwise (Johung et al., 2016).

21. (a) The statistics of lung cancer in Australia indicate that 9.2% of the population has the disease in 2018. Out of the affected individuals, 18.9% have no chance of survival. Only 15% of the patients can survive for more than five years (Torre et al., 2015).

(b) The survival rates due to heart failure are low in Australia. The prevalence of the disease ranges from one to two percent of the total population (Torre et al., 2015).

22. (a) Lung cancer branches into small cell carcinoma and non-small cell carcinoma. Lung cancer has the limited stage and the long stage (Torre et al., 2015). The limited stage is when the carcinoma is affecting one lung and the lymph nodes. Extensive stage involves the spread of cancer to other body organs and the next lung. The carcinoma has more than ten prognostic factors which include sex, age, histology, hemoglobin level among others. The carcinoma can be high or low grade (Torre et al., 2015). Small-cell carcinoma is high-grade lung cancer.

(b) Heart failure (HF) has four classes. Individuals in the first class can conduct physical activity without limitations (Sahle et al., 2016). Those individuals in the second class encounter minimal limitation when conducting physical activities. The third class limits the ability of a person to conduct the physical exercise. People in the fourth class experience discomfort when conducting the physical exercise.

The disease has four stages. Individuals at the first stage are at risk of contracting CHF. However, the heart lacks structural disorder. Persons in the second stage have a heart with a structural disorder (Sahle et al., 2016). However, the individuals require CHF symptoms. Individuals at stage three also experience CHF symptoms. The fourth phase is the end-stage. The individual needs specialized medical attention. A prognostic factor such as improved medical care has improved the survival rates due to HF (Sahle et al., 2016). Other factors include ICD and device therapy.

23. The first issue is a consistent progression of the complication and an evident end-phase of the disease (May et al., 2016). The second health problem is the slow decline of the patient and other moments of rapid deterioration. The patients of the life-limiting illness may show points of complete recovery. Some patients also encounter unexpected and untimely death. A specific group of patients undergoes a gradual and prolonged decline.
24. The continuous and continued slump is a trajectory that is similar to that of a frail old person who is dying. The elderly also undergo a consistent progression and an evident end-phase. Therefore, the health issues in life-limiting conditions are similar to those that the old experience when they are approaching their terminal stage in life.
25.  The first principle is to evaluate the factors contributing to the disease (McCall et al., 2017). Secondly, the physician should gauge the symptoms’ characteristics. Thirdly, check at what the symptom means to the bearer. Fourthly, check at how the symptom interferes with the patient’s behaviors.
26. Primary goals of Palliative Care

The first goal is to reduce the pain of the patent (Wiener et al., 2015). The terminal illnesses induce physical to the patients. The medical team has the responsibility of using clinical methods to minimize the pain. The other goal is medical attention to treat the symptoms of the diseases. Palliative Care also endeavors to assist the patients in locomotion. The care allows for constructive engagement between the client, their close friends, community, and families.

27. Assessment of an individual’s preference for care is achievable by asking the patients about their preferred choice of medication. I would also look at relevant data about the individual. The data includes the medical history of the patient. Other data collection methods such as questionnaires are also useful in the assessment.
28. A supportive family gives hope of a cure to an individual with the terminal disease. The affected individual lives a happy life when the friends and family keep them company. Caregivers who provide efficient person-centered care make the patients have the goal of cure. The patient’s response to medication also gives them goal for the cure. Therefore, family members, caregivers, and the medications provide patients with the goal of cure.
29. (a) the first step involves thinking about the right things for an individual. Secondly is to research on medical procedures. Thirdly is choosing an individual’s second decision maker (Lum, Sudore, and Bekelman, 2015). Fourthly is to discuss one’s wish with the chosen decision maker. Fifthly is to record an individual’s wishes for end-of-life care.

(b) Advanced care planning has the support of the Australian laws. Therefore, the law protects the health professional.

30 (b) subjective and cannot be objectively measured

31 (b) to act as a protective mechanism

32 (b) subjective data

33 (a) pain levels and tolerance

34 (a) gate control theory

35 (d) Opiates

36 (c) Oral

37. (c) Guided imagery

38 (d) Respiratory depression

39 (a) Intramuscular

40. Functions of a multidisciplinary palliative care team.
41. The team fights for the rights of patients, their families, and care providers (Amorim et al., 2018).
42. The team also implements various strategies that address individual needs.

• The team implements the planning of advance care process.

41. I would support the patient to locate from one place to the other. Additionally, I would cook for the patient. I would also keep the patient company at most times. Moreover, I would also conduct other errands for the patient such as washing the clothes and fetching water.
42. (a) Advanced Care Planning involves decision making about the type of care that individuals would like to receive when they cannot speak for themselves (Imam et al., 2016). The decisions depend on an individual’s preferences, values, and conversation with friends and family members.

(b) The Care planning enables the family members to conduct the wishes of a patient of terminal disease after their death (Imam et al., 2016). The plan also ensures that the patient receives person-centered care at the hospital.

43. Physical Symptoms of Incurable Illnesses
44. Anorexia (Doherty et al., 2017)
45. Dyspnoea

• Pain

1. Fatigue
2. Constipation
3. The first action is to induce a remedy that can make the emancipated person relax. The nurse should also counsel and supervise the patient. The caregiver should also calm the patients and enable them to maintain an appropriate sleeping position in bed. The care provider should conduct specialized training for the emancipated patient. The nurse should ensure person-centered for the patient.
4.  The first way is teaching the spouses about skills and knowledge about caring for terminal disease patient. Secondly, the nurse should help the partners to cope with the emotional and physical demands of caring for the patients. Thirdly, the family members should support the spouse to care for the patient. Fourthly, nurses should train the spouses on the caring methods for the patient. Fifthly, the government should provide financial support to the spouses.
5.  Tai—chi: is a Chinese tradition that involves movement in a focused and slow manner (Kurlan et al., 2015).

Benefits: the exercise incorporates meditation, gentle movement, and breathes control to strengthen and stretch muscles (Zeng et al., 2014). Tai-Chi relieves pain from lingering injuries, arthritis, and headache. The exercise mostly benefits the elderly and has no contradictions.

References

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