History Geoff Holder, a 52 year-old owner/operator

History Geoff Holder, a 52 year-old owner/operator of a pest control franchise, has been admitted to the medical ward. He was admitted from home via the emergency department and arrived on the ward at 0200hrs this morning. Geoff has a history of Diabetes Mellitus Type II which has been previously well controlled by diet and exercise. He was diagnosed with pancreatic cancer six months ago and underwent a Whipple’s procedure with initially good outcomes. Geoff lives at home with his wife and eight year old son: his daughter from a previous marriage lives with Geoff’s ex-wife and attends university, studying education. Geoff has increased contact with his daughter since his diagnosis and she has dinner / visits with his family at least once a week. Geoff’s father died aged fifty in hospital from liver cancer, after a history of heavy alcohol and cigarette use. Geoff was twenty years old and recalls him experiencing significant pain before he died. Geoff’s mother has dementia and has lived in a residential dementia unit for two years. Geoff has limited contact with his only sibling, a brother who lives in Perth. Since his diagnosis of pancreatic cancer six months ago and after his Whipples procedure which initially was successful Geoff was able to continue working from home, but now is extremely fatigued, cannot undertake activities of daily living and has increased pain, his diabetes is also now not well controlled. He presented to the emergency department at 1800hrs for pain control and reluctantly consented to admission for review by the palliative care team today. He has not accepted community services, including community palliative care services, to date. His medications from home (Ordine) have been brought in and are locked in the controlled drugs cupboard. He has an Acute Resuscitation Plan and is not for active resuscitation. His care has been managed by the GP since his discharge after the Whipple’s procedure. Since being on the ward he has had two episodes of break through pain (9/10) that he was given oral analgesia for, the first at 0230hrs of 5 mg of Ordine and another 5mg of Ordine at 0500hrs. This reduced his pain to a score of 4/10, but the pain continues to worsen. He says his pain score goal is to remain below 3/10. He has been too fatigued to mobilise to the toilet. His blood sugar level was 8.2mmol/L at 0600 hrs, and this is being checked three times daily. He is for review by the palliative care team later in the day. Vital signs: T 37.2, BP 108/70, P 110/regular, R 16, SpO2 98% on room air Position supine, bed head at 45Ëš and pillow propped behind right shoulder to lift him slightly ID Band (UR: 106425, Geoffrey Ray HOLDER, 10 Luca Street, Brighton. DOB: 07.02.1960, Male) Medications as per the medication chart are Ordine (Morphine Sulphate) 1mg/1ml – order for 2.5-5mg PRN by Dr Mitchell MS Contin SR 5mg tablets Paracetamol (tablets) 500mg IV bag 0.9% Sodium Chloride, running at 100ml/hr on infusion pump. HINTS GIVEN Now, in the table below, use the following book from ClinicalKey for Nursing to complete the below care plan that will address Geoff’s needs: Title: Nursing Care Plans, Tenth Edition – it is recommended you review nursing texts to assist with wording. – Ensure you are relating your responses to the case study Hints Goal/action Intervention/rationale Evaluation Lifestyle Goals for each area should be clear, concise and relevant – written with SMART goal principles One goal for each area is adequate Goals are to be reflective of each area Each area should include a minimum of (2) interventions – rationales should accompany all interventions – (in other words, why have you chosen that intervention) This is related to the expected outcome and should link to the goal and measurable Example of evaluation wording is Geoff states… Geoff demonstrates… Xyz allied health professional reports… Geoff attended appt with xzy Social context Emotional Remember this is not HOW you will evaluate, but what the expected outcome looks like Spiritual Remember spiritual is not always related to religion Identify and document the ethical concerns that may arise from Geoff’s case study. Hint- There are several ethical issues within the case study – your are not expect you to solve the issue or say what you will do, but rather to identify the actual or potential ethical issue Consider the 4 main ethical principles in nursing to help you identify some of the issues – its recommended these are referenced in your response and a reference source provided with your answer Your response should cover at least 4 ethical issues – and providing a clear understanding of where the ethical concern that MAY arise Refer to week 5 and 6 ppts for additional resources 3. Document 3 points that you would reflect on during a debriefing session regarding the care of the patient. Hint Consider in your response how it may impact on you looking after Geoff as a patient and what kind of things you may discuss during a debriefing session …………………………………………………………………. Remember debriefing is for staff – it is recommended you research what debriefing is to support you with your response and incorporate that information on what you may reflect on if Geoff was your patient Ensure you Include 3 points in your response –

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