Case Study Analysis – Integrating Palliative Principles into Chronic Disease Management

NURSING AND HEALTHCARE: NURS3020 – CHRONIC ILLNESS AND PALLIATIVE CARE

Assessment Task 2: Case Study Analysis – Integrating Palliative Principles into Chronic Disease Management
Weighting: 50%
Due Date: Week 7, 2025

Assignment Brief

Scenario:

You are a Registered Nurse working in a community palliative care service. You are assigned to conduct a home visit for Mrs. Evelyn (Evy) Jones, a 74-year-old female (identifies as she/her) who has been referred for support.

Mrs. Jones lives with her wife of 45 years, Margaret, in their single-storey home in a suburban area. She has a progressive chronic illness and her condition has recently declined, prompting her GP and specialist to suggest a palliative approach.

Medical History:

• Primary Diagnosis: Idiopathic Pulmonary Fibrosis (IPF), diagnosed 4 years ago.

• Other Comorbidities: Osteoarthritis (hips and knees), Osteoporosis, Bilateral Cataracts (awaiting surgery).

Current Status:
Mrs. Jones was previously independent but is now largely housebound. Her main concern is her increasing breathlessness, which she describes as “feeling like I’m drowning on dry land.” She is dependent on oxygen via nasal prongs at 4L/min at rest, which increases to 6-8L/min on minimal exertion (e.g., transferring to the commode). She is currently using a wheeled walker for short distances indoors.

Medications:

• Nintedanib (Ofev) – continues but with significant gastrointestinal side effects.

• Prednisolone 10mg daily.

• Paracetamol 1g QID for arthritic pain.

• Furosemide 40mg daily.

• Oxygen therapy (as required).

Current Symptoms & Assessment Findings:

• Respiratory: RR 28-32 at rest, SpO2 88-91% on 4L O2, drops to 82% on exertion. Persistent, dry, ineffective cough. Reports significant air hunger and anxiety related to breathlessness.

• Functional: Profound fatigue. Requires assistance with all Activities of Daily Living (ADLs) – showering, dressing, and toileting. Margaret is providing all care and appears exhausted.

• Nutritional: Poor appetite and nausea. Has lost 6kg in the last 2 months. Finds it difficult to eat and breathe simultaneously.

• Psychosocial: Expresses feelings of being a “burden” to Margaret. She is tearful and states, “I’ve had a good life, but this is no way to live. I’m scared of suffocating.” She and Margaret have not discussed her end-of-life wishes in detail.

• Cognitive: Fully orientated and possesses decision-making capacity.

Referral Information:
The goal of the palliative care referral is to optimise symptom control, facilitate advance care planning, and support Margaret as the primary caregiver.

Assessment Questions

Answer all the following questions in relation to the case of Mrs. Evelyn Jones.

1. The Palliative Approach in Non-Malignant Disease (approx. 500 words)

• a) Define the ‘palliative approach’ and explain how it differs from a traditional curative model of care. Justify why a palliative approach is appropriate for Mrs. Jones at this stage of her chronic illness, Idiopathic Pulmonary Fibrosis.

• b) Identify four (4) key physical and psychosocial symptoms you would prioritise for management in your initial nursing assessment of Mrs. Jones. Provide a brief rationale for your prioritisation.

2. Complex Symptom Management (approx. 600 words)

• a) Breathlessness (dyspnoea) is a complex and distressing symptom. Describe three (3) non-pharmacological nursing interventions you could implement to manage Mrs. Jones’ breathlessness and the underlying rationale for each.

• b) Create a sample nursing care plan for the diagnosis of “Chronic Pain related to osteoarthritis and immobility.” The plan must include:

  • One (1) patient-centred goal.

  • Two (2) evidence-based nursing interventions.

  • One (1) rationale for each intervention.

  • One (1) method for evaluating the goal.

3. Psychosocial, Spiritual, and Cultural Care (approx. 500 words)

• a) Analyse the psychosocial impact of Mrs. Jones’ illness on both her and her wife, Margaret. Identify two (2) specific nursing strategies to support Margaret in her role as the primary caregiver.

• b) Mrs. Jones expresses, “I’ve had a good life, but this is no way to live.” This statement touches on existential and spiritual distress. Describe how you, as the nurse, would respond therapeutically to this statement and what further assessment or support you might consider.

4. Communication and End-of-Life Care Planning (approx. 400 words)

• The GP has suggested it is time to discuss “Advance Care Planning” (ACP).

  • a) Explain what Advance Care Planning is and its key components within the Australian healthcare context.

  • b) Outline your nursing approach to initiating a conversation about ACP with Mrs. Jones and Margaret. What factors would you consider to ensure this is a sensitive and patient-led discussion?

5. Interprofessional Collaboration (approx. 400 words)

• Optimal care for Mrs. Jones requires a multidisciplinary team (MDT).

  • a) Identify FOUR members of the MDT (besides the Registered Nurse) who should be involved in Mrs. Jones’ care.

  • b) For TWO of these team members, justify their specific role and describe one key intervention they could provide to address the needs of either Mrs. Jones or Margaret.

References (APA 7th Format)

Luckett, T., Disler, R. T., Phillips, J., Currow, D. C., & Hosie, A. (2021). A palliative approach for people with chronic or advanced non-malignant respiratory disease: A systematic review of evidence. Palliative Medicine, 35(6), 1026-1046.

Hui, D., Bohlke, K., Bao, T., Campbell, T. C., Coyne, P. J., Currow, D. C., … & Bruera, E. (2021). Management of dyspnea in advanced cancer: ASCO guideline. Journal of Clinical Oncology, 39(10), 1389-1411.

Van der Baan, F. H., Koper, I., van der Heide, A., van der Rijt, C. C. D., & Janssen, D. J. A. (2023). The impact of palliative care on quality of life in patients with advanced chronic obstructive pulmonary disease: A systematic review. Chronic Respiratory Disease, 20.

Horey, D., Street, A. F., Sands, A. F., O’Connor, M., & Lee, S. F. (2022). The effectiveness of nurse-led advance care planning interventions: A systematic review. Journal of Advanced Nursing, 78(4), 943-959.

Hudson, P., Trauer, T., Kelly, B., O’Connor, M., Thomas, K., Summers, M., … & White, V. (2020). Reducing the psychological distress of family caregivers of home-based palliative care patients: Longer-term outcomes from a randomised controlled trial. *Psycho-Oncology, 29*(5), 891-897.

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II;

NURSING AND HEALTHCARE: NURS2015 – ACUTE CARE NURSING 1

Assessment Task 2: Case Study Analysis – Complex Care Following an Ischaemic Stroke
Weighting: 40%
Due Date: Week 9, 2025

Assignment Brief

Scenario:

You are a Registered Nurse working on the acute neurology ward at Metro South Hospital. You are assigned to care for Mr. Arjun Sharma, a 52-year-old male (identifies as he/him) who was admitted via the Emergency Department 24 hours ago.

Mr. Sharma was found by his wife slumped in his home office chair, experiencing acute onset of a severe headache, confusion, and left-sided weakness. He was diagnosed with a right-sided ischaemic cerebrovascular accident (CVA) and was within the thrombolysis window. He was immediately administered tissue plasminogen activator (tPA).

Background:

• Born in India, migrated to Australia 15 years ago. Speaks fluent English and Hindi.

• Identifies as Hindu. His wife has requested a vegetarian diet and has brought him a small religious token (a picture of a deity) for his bedside.

• Lives with his wife and their 18-year-old son, who is currently studying for his final secondary school exams.

• Works as a senior IT project manager, a high-stress role.

Medical History:

• Hypertension

• Hypercholesterolemia

• Type 2 Diabetes (diet-controlled until recently)

• Obstructive Sleep Apnoea (uses a CPAP machine at home)

Medications on Admission:

• Perindopril, Atorvastatin, Metformin

Current Status (24 hours post-admission):

• Observations: BP 145/88, PR 78 reg, RR 18, SpO2 97% on room air, BGL 10.2 mmol/L, GCS 14 (E4, V4, M6).

• Neurological Deficits:

  • Left-sided hemiparesis (pronounced in the arm).

  • Left-sided facial droop.

  • Left-sided sensory neglect.

  • Spatial-perceptual deficits (difficulty judging distances).

• Other Issues:

  • Expressive dysphasia (struggles to find words, uses short phrases).

  • Mild dysphagia – currently on a texture-modified diet and thickened fluids after Speech Pathology review.

  • Appears anxious and frustrated, stating, “I can’t even think of the words… my job is my mind.”

Initial Medical Orders & Plan:

• Neurological observations 2nd hourly.

• Continue IV therapy.

• Commence Aspirin 100mg daily.

• Physiotherapy and Occupational Therapy review.

• Monitor for post-thrombolysis complications (e.g., bleeding).

• Plan for transfer to the inpatient rehabilitation unit in 5-7 days if stable.

Assessment Questions

Answer all the following questions in relation to the case of Mr. Arjun Sharma.

1. Holistic Admission and Assessment (approx. 500 words)

• a) Beyond the standard physical preparation, describe two (2) specific strategies you would implement when preparing the environment and your approach for Mr. Sharma’s admission to ensure culturally safe and therapeutic care.

• b) Identify four (4) key pieces of assessment data you would prioritise collecting in the first hour of your shift, justifying their priority in relation to his condition and recent thrombolysis therapy.

2. Clinical Communication and Interprofessional Care (approx. 400 words)

• Using the ISBAR format, provide a structured written handover you would use to communicate Mr. Sharma’s status to the incoming Registered Nurse at the end of your shift. Ensure the handover reflects his current risks and holistic needs.

3. Pathophysiology and Comorbidity Management (approx. 600 words)

• a) Compare and contrast the pathophysiology of an ischaemic CVA (like Mr. Sharma’s) and a haemorrhagic CVA. Your answer should include the underlying mechanisms and common causes.

• b) Mr. Sharma has several comorbidities (Hypertension, Diabetes, Hypercholesterolemia). Explain how TWO of these conditions are both risk factors for his ischaemic CVA and present ongoing management challenges during his acute recovery.

4. Psychosocial Care in Acute Illness (approx. 400 words)

• Mr. Sharma is 52 years old, in a high-pressure career, and is the primary income earner for his family. Analyse how his sudden loss of function and communication deficits (expressive dysphasia) are likely to impact his psychological well-being and identity during this acute phase of his illness.

5. Nursing Care Planning (approx. 700 words)

• The Registered Nurse has formulated the following four (4) nursing diagnoses for Mr. Sharma. For each diagnosis, complete the table below by providing:

  • Two (2) evidence-based nursing interventions.

  • One (1) clear rationale for each intervention, linking to pathophysiology or clinical evidence.

  • One (1) method for evaluating the effectiveness of each intervention.

References (APA 7th Format)

Campbell, B. C. V., & Khatri, P. (2020). Stroke. The Lancet, 396(10244), 129–142.

Middleton, S., Dale, S., Cheung, N. W., Cadilhac, D. A., McInnes, E., Considine, J., … & Grimshaw, J. (2019). Nurse-initiated hyperacute stroke treatment protocol improves thrombolysis rates and time to treatment. Journal of Clinical Neuroscience, 65, 174-179.

Brady, M. C., Ali, M., VandenBerg, K., Williams, L. J., Williams, L. R., Abo, M., … & Marshall, J. (2020). Communication, swallowing and care in acute stroke: A systematic review of the literature. International Journal of Stroke, 15(5), 467-480.

Kitzman, P., Hudson, K., Sylvia, V., Feltner, F., & Lovins, J. (2021). Caregiving for patients following stroke: A narrative review. Journal of Gerontological Nursing, 47(4), 15-21.

Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. International Journal of Molecular Sciences, 21(20), 7609.