Palliative Nursing Care for COPD and Heart Failure: Case Study of Mr Nguyen

Case Study Assignment (2025)
Unit Code: NRSG2025
Unit Title: Chronic Illness and Palliative Care Nursing
Assessment Type: Individual Written Case Study
Word Length: 2,000 words (+/-10%)
Weighting: 40%
Due Date: Week 9, Friday 11:59pm

Case Study Background

Mr. Daniel Nguyen is a 68-year-old male admitted to the palliative care unit following progressive decline from stage IV chronic obstructive pulmonary disease (COPD) with comorbid congestive heart failure (CHF). Over the past six months, he has experienced increasing shortness of breath, frequent hospital admissions for exacerbations, and significant weight loss.

Mr Nguyen migrated from Vietnam to Australia 40 years ago and speaks both Vietnamese and English, though he prefers English for medical discussions. He lives with his wife, Linh, who is his primary carer, and their adult daughter who visits regularly. His wife reports struggling with his increasing care needs and feeling exhausted.

Medical history

• COPD (diagnosed 12 years ago, GOLD stage IV)
• Congestive heart failure (NYHA Class III)
• Hypertension
• Benign prostatic hyperplasia
• Past history of smoking (quit 8 years ago, 35 pack-year history)

Medications

• Salbutamol (inhaler, PRN)
• Tiotropium (daily inhaler)
• Furosemide
• Metoprolol
• Ramipril
• Morphine (low dose for dyspnoea and pain)

Admission observations

• BP: 140/85 mmHg
• HR: 96 (irregular)
• RR: 28 (laboured)
• Temp: 37.2°C
• SpO₂: 90% on 2L nasal prongs
• Weight: 54kg (baseline 62kg six months ago)
• Height: 172cm

Current issues

• Dyspnoea on minimal exertion and at rest
• Fatigue and inability to perform activities of daily living independently
• Weight loss and poor appetite
• Anxiety about breathlessness episodes
• Wife experiencing caregiver strain

Learning Outcomes

This assessment will allow students to:

1. Demonstrate an understanding of chronic illness trajectories and palliative care needs.
2. Apply nursing frameworks to holistic patient care.
3. Communicate effectively with patients, families, and interdisciplinary teams.
4. Identify physical, psychosocial, cultural, and spiritual issues in chronic illness and palliative care.
5. Develop evidence-based care planning and interventions for symptom management.

Task Instructions

Using the case of Mr. Daniel Nguyen, address the following questions in your essay:

1. Chronic Illness Context
   • Describe the trajectory of COPD and CHF in the context of chronic illness.
   • Discuss how these conditions impact quality of life in the palliative care stage.
2. Holistic Assessment
   • Identify and discuss four (4) priority nursing assessments for Mr Nguyen on admission.
   • Include consideration of physical, psychological, cultural, and social aspects.
3. Symptom Management
   • Explain evidence-based nursing interventions for managing dyspnoea, fatigue, and anorexia in palliative patients.
   • Include pharmacological and non-pharmacological approaches.
4. Family and Caregiver Support
   • Discuss caregiver strain experienced by Mrs Nguyen and identify two (2) nursing interventions that support family carers in palliative care.
5. Communication and End-of-Life Care
   • Using the ISBAR format, outline a clinical handover to the palliative care team at shift change.
   • Discuss how culturally sensitive communication strategies can support Mr Nguyen and his family during end-of-life care planning.
6. Care Planning
   • Select three nursing diagnoses relevant to Mr Nguyen’s condition.
   • For each, provide:
     • Two (2) nursing interventions
     • One (1) rationale per intervention
     • One (1) evaluation measure

Submission Guidelines

• Submit as Word or PDF through the LMS portal.
• Format: 12-point Times New Roman, 1.5 spacing, APA 7th edition referencing.
• Minimum of four (4) peer-reviewed sources (2019–2025).

Assessment Criteria

• Clinical Knowledge (30%) – Understanding of chronic illness and palliative care needs.
• Application of Nursing Process (30%) – Evidence-based care planning, interventions, and evaluation.
• Communication (20%) – ISBAR clarity, academic writing, and cultural sensitivity.
• Use of Evidence (10%) – Scholarly sources, APA referencing.
• Critical Thinking (10%) – Integration of psychosocial and cultural perspectives.

Suggested References (APA 7th Edition)

Johnson, M. J., Booth, S., Currow, D. C., & Ekström, M. (2020). Chronic breathlessness: re-thinking the symptom. European Respiratory Journal, 55(3), 1901878. https://doi.org/10.1183/13993003.01878-2019

Lanken, P. N., Terry, P. B., Delisser, H. M., Fahy, B. F., Hansen-Flaschen, J., Heffner, J. E., … & Yankaskas, J. R. (2020). An official American Thoracic Society clinical policy statement: Palliative care for patients with respiratory diseases and critical illnesses. American Journal of Respiratory and Critical Care Medicine, 182(4), 480–485. https://doi.org/10.1164/rccm.2009-2730ST

Moss, K. O., Douglas, S. L., & Han, H. R. (2021). Caregiver burden in chronic illness: A systematic review and meta-analysis. Journal of Nursing Scholarship, 53(6), 686–695. https://doi.org/10.1111/jnu.12689

Reid, J., Porter, S., & McKeown, M. (2019). Supporting family caregivers in palliative care: A systematic review of interventions, outcomes, and experiences. International Journal of Nursing Studies, 97, 28–38. https://doi.org/10.1016/j.ijnurstu.2019.04.014

Yohannes, A. M., & Alexopoulos, G. S. (2019). Depression and anxiety in patients with COPD: Recognition and management. Drugs & Aging, 36(8), 713–725. https://doi.org/10.1007/s40266-019-00685-0