Subject Code & Title :- NUR272 Palliative Rehabilitation And Continuing Care
Assessment Type :- Assignment
Weighting :- 50% of total mark.
Individual/Group :- Individual.
Goal : To apply knowledge to practice in a selected case study to demonstrate skills in assessment and person-centred care planning.
Course Learning Outcomes assessed :-
1.Demonstrate critical thinking in the decision making care planning care delivery and management which align to the socio ecological framework.
2.Provide rationales for factors that may facilitate contribute to or hinder goals in the management of the case.
NUR272 Palliative Rehabilitation And Continuing Care Assignment – Australia

Task instructions :-
1.Read these Task Instructions and the Rubric very carefully.
2.You are encouraged to use the Assignment Calculator to plan your work.
3. Read the Case Study below and use the required structure to provide answers to specific questions.
4.Conform to the requirements of academic writing including academic language and document layout font style and size line spacing and margins. Use APA7 referencing style.
5.Submit first for the Turn-It-In check, submitting your work as a Word document. A Turn-It-In report will be generated indicating any inadvertent plagiarism. Amend your work if required.
6.When you are ready to submit your final version, upload your completed work as a Word document.

Presentation requirements :-
• Use the structure provided in the Task Instructions.
• Conform to the requirements of academic writing including academic language and document layout font style and size line spacing and margins.
• Use APA7 referencing style (see the sway in the Assessments section).

Assessment criteria :-
1.Demonstrates knowledge and comprehension of relevant assessment components in P EoLC relevant to the case study.
2.Demonstrates knowledge and comprehension of relevant management components in PEoLC relevant to the case study.
3.Demonstrates an overall critical approach that includes appropriate application of peer-reviewed literature to provide rationales for components of assessment and management.
4. Structure presentation and clarity of expression Submission as per Task Instructions Logical organisation of ideas and writing. Spelling grammar and punctuation accurate. Clear and concise introduction and conclusion.
5.Ethical use of intellectual property Compliance with APA7 guidelines for paraphrasing referencing and citation Literature cited is contemporary relevant and academically credible.

CASE STUDY SCENARIO
Background
This case study introduces you to Margaret Mc Nolan an 80-year-old woman living in a small town of 800
people near a medium sized regional city in southeast Queensland. “Marg” was previously married and has two children Matt 58yo and Helen 55yo. Marg was divorced in her mid-30 s but remarried Tony in her late 60 s Tony died only three years ago although his own family remains involved in Margs life. Margs life has been hard. She has always lived in her town, married a local man and raised her two children there. After her first husband left suddenly, Marg had to work at the local dairy factory to make ends meet.
Her kids moved away once they left school although Helen now lives in the nearby city. Marg is some thing of a local character in the town – she’s a straight-talking, no-nonsense woman whose strident opinions on most matters are both admired and feared!

Diagnosis and prognosis
After Tony’s death Marg finally went to their GP about her shortness of breath and chronic cough which she put down to the exhausting demands of care giving and she reluctantly admitted her decades-old heavy smoking habit. After investigation it was established that Marg had chronic obstructive air ways disease COPD with a post-bronch odilator FEV1/FVC <0.7 In the three years since Marg has become more and more frail with marked weight loss and increased breathlessness even at rest which is severe at times. She uses intranasal oxygen via a concentrator at home.

Helen has been asking to be appointed as her mothers Enduring Power of Attorney and Marg has dismissed her requests suggesting that Tonys son Ken a lawyer should do it. This remains unresolved.

Clinical presentation
Marg has been admitted to the medical ward in the regional hospital following a sudden increase in her
shortness of breath. She is alone although her daughter is on her way. On physical examination you observe that Marg is obviously short of breath with an audible wheeze and requires great effort to breathe in and out. Her respiratory rate is 26 breaths min and her pulse rate is 110. Marg’s temperature is 38.0°C and her cough is intermittent but productive of dirty yellow phlegm. She has dusky dis colouration of the nail beds and lips and says she fees utterly exhausted. She has a mild tremor in the hands. Marg reports being bunged up for days ie: constipated. She seems very agitated and anxious.

Marg’s current medication is:
• Ventolin inhaler, 2 doses every 4 hours
• Ultibro Breezhaler (110/50), 1 doses in the morning
• Diazepam 5mg tablet 2 times a day prn
• Coloxyl & Senna 2 tablets at night
• Temazepam 20mg capsule nocte prn
• Intranasal oxygen 94% on 3L/min

Instructions:
• Create a new Word document to address the questions below.
• There is no requirement for an Introduction or Conclusion – but you must include a Reference List.
• Please number your answers to correspond to the numbering of these questions.
• Don’t write out or cut and paste the questions onto your answers.
• The total word count is 2000 words. As a guide each answer should be around 220 words how ever there is flexibility in this, and it is the total word count that will be counted by the markers. It is essential how ever that each question is answered comprehensively.

PART ONE: CLINICAL ASSESSMENT

1.What is the likely trajectory of Marg’s illness? You can use a diagram to illustrate. Explain the 5-year life expectancy of someone with COPD.

2.Those with a multidimensional symptom experience require multidimensional assessment. How would
you under take an assessment of Marg’s case?

3.Consider your approach to the assessment of Marg’s fatigue. How could you assess the functional impact of her fatigue?

4.Consider your approach to the assessment of Marg’s constipation. What elements of her bowel function
should you assess? What assessment tool/s might be helpful to assess her constipation?

5.Explain which social elements are important to consider in your assessment of Marg if she is to return
home.

PART TWO: CARE MANAGEMENT

6.Identify the likely members of the multidisciplinary team for Marg during her hospitalisation. Select two of these and explain how their roles address the care needs identified during assessment.

7.Consider your approach to the management of Marg’s fatigue. What interventions might be required
during her hospitalisation and upon her return home?

8.Consider your approach to the management of Marg’s constipation. What interventions might be required during her hospitalisation and upon her return home?

9. Explain how a discussion of goals of care could inform Marg’s discharge and care at home. Who are some of the key people in her circles of support? Select two of these and explain how they might support Marg at home.