NRSG374 Unit Outline Assessment Task 2 Details
Students are to provide an 1800 word critique of the provided case study using only ONE CPG.
To complete this task you will need to discuss and critique relevant elements of the CPG and case study whilst upholding the National Palliative Care Standards at least one of:
• NMBA standards and/or
Do we need to use all of these standards to do well?
• As the rubric states if you provide -Outstanding knowledge of themes and principles associated with palliative care- this will demonstrate an outstanding application of your knowledge to practice therefore using standards from more than one of the above and relating them together to uphold your critique of the patient care and support the clinical practice guideline selected will demonstrate excellent knowledge and understanding. Using one standard from one of the above will not provide strong application of knowledge. However, a comparison of multiple standards that as registered nurses we are required to uphold will absolutely demonstrate very strong knowledge and understanding, if you link them together well with evidence based practice (EBP)
Where do I find all of these standards?
You should be aware of all of the standards above as they have been discussed in many units throughout your degree, so now it is time to demonstrate your knowledge and bring them together. to assist you We have provided links below to each of the standards we would like you to utilise in your critique.
Eight National safety and Quality Health Service Standards to provide a nationally consistent level of care that can be expected by all consumers from all health organisations
Seven Standards that all Registered nurses must uphold to ensure that they maintain their registration and provide person centred and evidence based preventative, curative, supportive, formative and palliative elements to their practice
National Palliative Care Standards
Nine National palliative Care standards that you know well as they have formed the framework of NRSG374 and were fundamental for assessment task 1
How do I relate these standards to the case study?
This is where your critical thinking and application of theory to practice is required, we cannot tell you how to do this, as a final year nursing unit it is essential that you are aware of how all of these standards, uphold and maintain, patient centred care, dignity, patient assessment and safety to name a few. Spend some time reviewing these and map out the ones that you believe are important for your critique.
Students are required to demonstrate an understanding of how theory translates into practical nursing care and how evidence underpins best practice. Each student will review and critique the care given in the Case Study provided according to their choice of ONLY ONE of the provided Clinical Practice Guidelines (CPG’s) best suited to the highlighted discussion.
Where will I find the CPG’s that you want me to use?
You are provided with CPG’s for this task, in this booklet .
You need to choose one of these only to demonstrate the area of care that you are providing a critique of. You are not expected to look for other CPG’s to support your work, however evidence based practice of peer reviewed journal publications are expected to further reinforce the critique.
Learning outcomes assessed: LO1, LO5, LO7
How to submit: Electronic Submission via Turnitin
Return of assignment: The assessment feedback and grade will be returned via Turnitin.
Assessment criteria: The assessment will be marked using the criteria-based rubric. Please note that in-text citations are included in the word count whilst the reference list is not included in the word count. Words that are more than 10% over the word count will not be considered.
AETIOLOGY OF MOTOR NEURON DISEASE
Motor neuron disease (MND) is a progressive neurological disorder characterised by loss of motor neurons (Brown, Edwards, Buckley & Aitken, 2017). There are 4 main types of MND, depending of the level of motor neurone involvement and where symptoms begin. These include:
· Amyotrophic lateral sclerosis (ALS)
· Progressive bulbar palsy (PBP)
· Progressive muscular atrophy (PMA)
· Primary lateral sclerosis (PLS)
MND usually leads to death 20-48 months after symptoms begin, however 5%- 10% of patients may survive for more than 10 years (MND New Zealand, 2018). The onset of MND is usually between 40 and 70 years of age and is more common in men than women by a ratio of 2:1 (MND Australia, 2018). The prevalence is approximately 8.7 in 100 000 in Australia (MND Australia, 2018).
Motor neurons in the brainstem and the spinal cord gradually degenerate. Dead motor neurons cannot produce or transport signals to muscles. Consequently, electrical and chemical messages originating in the brain do not reach the muscles to activate them. The typical symptoms for diagnosis of MND are limb weakness, dysarthria and dysphagia (Brown et al., 2017). Muscle wasting and fasciculations results from the denervation of the muscles and lack of stimulation and use. Other symptoms include pain, sleep disorders, spasticity, drooling, emotional liability, depression, constipation and oesophageal reflux (Brown et al., 2017). Death usually results from respiratory tract infection secondary to comprised respiratory function.
Throughout the illness trajectory for MND, the patient remains cognitively intact while physically declining. The patient should be encouraged to partake in moderate intensity, endurance-type exercise for the truck and limbs as this may help reduce MND spasticity.
Nursing interventions include but are not limited to (Brown et al., 2017):
· Facilitating communication
· Reducing the risk of aspiration
· Facilitating early identification of respiratory insufficiency
· Decreasing pain secondary to muscle weakness
· Decreasing risk of injury related to falls
· Providing diversional activities such as reading and companionship
CONSIDERING THE PATIENT’S SITUTION
Tyler Morton is a 40-year-old man who spent is childhood and teenage years in Brisbane. Tyler, whilst growing up excelled in all sports and represented QLD in the state Cricket Team. Upon completing high school, Tyler graduated from the University of Queensland with a Bachelor of Business Management before joining the Royal Australian Airforce as a Pilot in 2004. Whilst training to become a Pilot, Tyler met is future wife Catherine in Newcastle and this is where the couple settled to commence their family. Tyler and Catherine have 3 Children. Catherine is a stay at home Mum to:
· Andrea (8 Years)
· Jessica (5 years)
· Erin (2 Years)
Being from Newcastle, Catherine’s Family is very close to Tyler and Catherine and spend a lot of time together. Tyler’s Family is in Brisbane and has only minimal contact with Tyler and his young Family. Unfortunately, Catherine and Tyler’s mother Joyce do not get along and this causes a lot of conflict in the marriage.
18 months ago
Tyler experienced some weakness in his left hand. His grip strength was not a strong as his right hand and he found he would be dropping anything that he picked up. Tyler also noted he was getting short of breath without exertion. Considering his general fitness is quite good, this was highly abnormal. Tyler made an appointment with the GP on the Airforce base to discuss this concern.
After multiple MRI’s and blood tests and lumbar punctures (over a 3-month period), Tyler was diagnosed with Amyotrophic lateral sclerosis (ALS). At the time of diagnosis, Tyler’s weakness in his left hand had progressed to his right hand and he had developed a foot drop in his left ankle.
Upon diagnosis, Catherine was adamant that the children were not going to be told the reason that Dad is no longer working. Tyler’s diagnosis also caused more stress and tension with the relationship between Catherine and Joyce. Joyce wanted to visit and be there with her son, however Catherine was not supportive of Joyce and Tyler’s brothers visiting.
12 months ago
Around 6 months after initial symptoms and 3 months after diagnosis, Tyler’s condition had deteriorated. Tyler now required a walking frame to mobilise. His dyspnoea has increased, he was suffering from headaches and was generally fatigued. Tyler was being assessed by a respiratory specialist for the requirement of Non-invasive ventilation (NIV) especially at night. Tyler now suffers from dysphagia and was being assessed in consultation with the respiratory specialist and dietician for the need for a gastrostomy.
6 months ago
Tyler’s condition has continued to deteriorate. Due to insufficient nutritional intake secondary to dysphagia, Tyler had a gastrostomy inserted. Since insertion, he has had numerous infections at the insertion site. Tyler also requires assistance of NIV mainly at night, however the demand has increased significantly over the last couple of weeks. Tyler’s mobility is limited. He walks intermittently with the use of an aid and one person. His mobility is limited due to progressive foot drop and increased dyspnoea. With his condition worsening, Tyler initiated the difficult conversation with Catherine about his mortality. Catherine is still not accepting of Tyler’s condition nor is she wanting the Children to know the extent of Tyler’s condition. Tyler completed an Advanced Health Care Directive and he ensured both Catherine and his mother Joyce had a copy. Tyler is currently visited weekly by the Community Palliative Care Team and he has daily support from Community nurse to assist with his activities of daily living.
Despite Tyler’s progressive physical deterioration and the ongoing tensions with Catherine’s inability to acce
Motor neuron disease (MND) is a progressive neurological disorder that affects nerve cells in the brain and spinal cord that control voluntary muscle movement. MND is a terminal illness, with most people living for 2-5 years after diagnosis.
The case study of Tyler Morton provides a detailed overview of the physical and emotional challenges that people with MND and their families face. Tyler was diagnosed with ALS, the most common form of MND, at the age of 40. He was initially reluctant to share his diagnosis with his family, but eventually told his wife, Catherine, and their three young children.
Tyler’s condition has progressed rapidly since his diagnosis. He is now wheelchair-bound and requires assistance with all activities of daily living. He is also experiencing difficulty breathing and swallowing. Tyler’s wife, Catherine, is struggling to cope with the demands of caring for her husband and children. She is also feeling isolated and unsupported.
The Community Palliative Care Team has been providing support to Tyler and his family. They have helped Tyler to develop an Advanced Health Care Directive and have provided Catherine with information and support about caring for a loved one with MND.
The case study of Tyler Morton highlights the importance of providing comprehensive care to people with MND and their families. This care should include physical, emotional, and spiritual support. It is also important to provide information and support to families about the disease and how to cope with the challenges of caring for a loved one with MND.
The following are some specific nursing interventions that can be used to provide care to people with MND:
Facilitate communication: People with MND may experience difficulty speaking, swallowing, and writing. Nurses can help to facilitate communication by using alternative communication methods, such as speech-generating devices or sign language.
Reduce the risk of aspiration: People with MND may have difficulty swallowing, which can increase the risk of aspiration. Nurses can help to reduce the risk of aspiration by positioning the person in a safe position, feeding them slowly and carefully, and avoiding foods that are difficult to swallow.
Facilitate early identification of respiratory insufficiency: People with MND may experience difficulty breathing as the disease progresses. Nurses can help to facilitate early identification of respiratory insufficiency by monitoring the person’s respiratory rate, oxygen saturation, and effort of breathing.
Decrease pain secondary to muscle weakness: People with MND may experience pain due to muscle weakness. Nurses can help to decrease pain by administering pain medication, providing heat or cold therapy, and positioning the person in a comfortable position.
Decrease risk of injury related to falls: People with MND may be at increased risk of falls due to muscle weakness and balance problems. Nurses can help to decrease the risk of falls by providing a safe environment, assisting the person with ambulation, and using assistive devices, such as a walker or wheelchair.
Provide diversional activities such as reading and companionship: People with MND may experience boredom and isolation as the disease progresses. Nurses can help to provide diversional activities by reading to the person, playing games, or providing companionship.
In addition to providing these specific nursing interventions, it is also important to provide emotional and spiritual support to people with MND and their families. This support can be provided by nurses, social workers, chaplains, and other members of the healthcare team.
The care of people with MND is a complex and challenging task. However, by providing comprehensive care that addresses the physical, emotional, and spiritual needs of the person and their family, nurses can make a significant difference in the quality of life of those affected by this disease.