IDENTIFICATION Jo Smith, DOB 21/01/1931, Nil known

IDENTIFICATION Jo Smith, DOB 21/01/1931, Nil known allergies. SITUATION For discharge home on care of the dying pathway with support of the community nurses. BACKGROUND Jo lives at home with his daughter. Jo has a history of Alzheimer’s Disease, NIDDM, AF, GORD, CCF, mild depression, and previous hernia and AAA repair and one week ago was diagnosed with advanced CA of the liver and metastases in the pancreas, lungs, and brain. Two weeks ago, Jo was bought into ED by his daughter with a history of new confusion, fevers, and rash, refusing diet and fluids for the previous two days and was jaundiced in colour. Jo deteriorated with sepsis. He experienced a cardiac arrest in ED. Following resuscitation, Jo was transferred to intensive care. He underwent further investigations and was diagnosed with advanced CA of the liver with metastases in the pancreas, lungs, and brain. He was transferred to the medical ward and Jo’s family requested no further active treatment and have asked that he be discharged home with support from the community nurses. ASSESSMENT Palliative care phase 3: Deteriorating. Symptom Assessment Scale (SAS): Pain 5; Nausea 2. Problem Severity Score (PSS): Pain 2; Other symptoms 1; Psychological/Spiritual 0; Family/carer 1. RUG- ADL: 18. AKPS: 20. Airway, breathing, circulation intact. Jo is no longer mobile. He remains confused. He requires full assistance with activities of daily living, nutrition, and toileting. Jo is lethargic, has generalised body pain and nausea. Jo is 50 kgs and is 163 cm tall. Jo has a stage 2 pressure injury on his sacrum. Jo is does not identify with any particular religious denomination however his daughter advises that he is strongly spiritual, and this will need to be considered in planning his care RECOMMENDATIONS Jo needs a care of the dying plan developed. Part A Use the clinical reasoning cycle to create a care plan, based on Jo’s situation following Intensive 2: You will be expected to explore in depth all eight (8) stages of the clinical reasoning cycle and support the discussion with the relevant codes, standards, and evidence-informed sources regarding the initial presentation of Jo. The care plan for Jo should identify & prioritize at least 2 nursing problems. For the nursing problem of the highest importance establish: A minimum 3 goals that include all 5 elements of the S.M.A.R.T acronym A minimum 6 actions per goal, with comprehensive rationales A minimum 1 evaluation of the outcomes for each action 1 : Identify & prioritise at least 2 nursing problems. 1. Pain management (write in form of SMART ) Goals, Actions and Evaluation For the nursing problem of highest importance: Establish a minimum 3 goals for each nursing problem that include all 5 elements of the SMART acronym. List a minimum 6 actions (minimum 6), in order of priority that you would undertake to achieve that goal. Specify if the action is a dependant or independent nursing action. You must consider the holistic requirements of the patient. Provide a rationale that associates the pathophysiological and psychological principles with each selected nursing action. This section needs to be referenced. Describe how you would evaluate the effectiveness of the care provided (i.e. how will you know that your actions were beneficial to the patient?) This section needs to be referenced. A minimum 1 evaluation of the outcomes for each action. 3: SMART goal(s) Actions (at least 6) Rationale (for each action) Evaluate outcomes (for each action) Q) 3 goals of pain management in the form of SMART goal Note: 1. nursing problem (pain management): 3 goals 6 actions for three of goals individually such as goal 1: 6actions goal2: 6 actions goal3: 6 actions

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