Case Scenario History Geoff Holder, a 52 year-old owner/oper
Case Scenario History Geoff Holder, a 52 year-old owner/operator of… Case Scenario 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 45° 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 MitchellMS Contin SR 5mg tabletsParacetamol (tablets) 500mgIV bag 0.9% Sodium Chloride, running at 100ml/hr on infusion pumpTeam work – please nominate 1 student who will take on the role of Greg Your team is looking after Geoff this morning. You need to get him ready for breakfast and check on his pain level? He is for review by the palliative care team later today. There is concern about Geoff and his wife. He seems very angry about everything and staff are unsure why this might be particularly directed towards his wife. He has refused all offers for food and fluid overnight and is extremely focussed on controlling his pain so he can go home. He does not want to be here and has expressed quite clearly that he wants to die at home. As a team apply the principles of palliative care to complete a holistic symptom assessment using the Symptom Assessment Scale for Geoff…………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… Discuss and identify how you would assess Geoff’s pain – complete a Brief Pain Inventory form………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. What strategies can your team implement to address the pain?……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. What can your team suggest to help Geoff with his constipation? ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. Complete a Dignity Inventory form for Greg. Using information from the form, create a care plan that shows how you will respect Geoff’s needs in relation to the following: Goal/actionIntervention/rationaleEvaluationLifestyle Social context Emotional Spiritual Discuss your role and responsibilities as an EN when planning palliative care for Geoff………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. Identify the other members who may be part of the interdisciplinary team and their roles………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. ……………………………………………………………………………………………………………….. Provide a report that can be conveyed to your teacher on what you would say to Geoff, his wife and children in regards to the stages of dying, as they are asking for information on what to expect with Geoff at end of life…………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… Within your team identify and document the ethical concerns that may arise from Geoff’s case study. ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… As a group create a poster to share with the rest of the class about ways to ensure that you look after yourself and your colleagues socially and emotionally when caring for patients facing end-of-life-care. Include support networks that you may also access for support. Be creative. ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… At the end of the session participate in a group debriefing and discuss your team’s findings from the case study. Document 5 points that was discussed during the debriefing session…………………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… Health Science Science Nursing HLT 54115
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