Provide an evidence-based discussion on the inter professional management of Nancy during the dying phase of her illness.
Provide a 750 word discussion in length and must be supported from evidence based peer review sources(in total) addressing both Parts A and B. (Please refer to Assessment information).
Part A: Prevention and Health Promotion for COPD. What advice would you give to Nancy in relation to prevention of exacerbations and promoting ongoing health and wellbeing for Nancy with COPD?
Part B: Interprofessionalteam work. In the management of Nancy’s care she will require the involvement of many interprofessional team members. Provide an evidence-based discussion on the interprofessional management of Nancy during the dying phase of her illness.
“Bailey, P. H., Boyles, C. M., Cloutier, J. D., Bartlett, A., Goodridge, D., Manji, M., & Dusek, B.(2013). Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD. Journal of Nursing Education and Practice, 3(1), 108-122. “
Read the following chapters of your Chang and Johnson text:
Chapter 2: “Role of the intedisciplinary and multidisciplinary team”.
Chapter 19: “Chronic obstructive pulmonary disease”.
Engel, J., & Prentice, D. (2013). The ethics of interprofessional collaboration. Nursing Ethics, 20(4), 426-35. doi:http://dx.doi.org/10.1177/0969733012468466
McNeil, Karen Anne; Mitchell, Rebecca J and Parker, Vicki. Interprofessional practice and professional identity threat [online]. Health Sociology Review: The Journal of the Health Section of the Australian Sociological Association, Vol. 22, No. 3, Sep 2013: 291-307. Availability: http://search.informit.com.au.ezproxy.une.edu.au/documentSummary;dn=74122 152200410;res=IELAPA>ISSN: 1446-1242. [cited 25 Mar 15].
The case scenario
Nancy has been living with COPD for some time, and has began to deteriorate over the past 12 months, experiencing multiple admissions to hospital
Age: 69 (DOB- 18/10/45)
Marital status: Married for 47 years, to Phil.
Occupation: Retired book keeper.
Children: 5 children, 6 grandchildren and 2 great grandchildren.
Medical Hx: COPD, CVD, hypertension, angina, ex-smoker (quit smoking last year), depression and osteoarthritis.
Social Hx: Multiple hospitalisations over past 12 months, due to COPD exacerbation. Nancy’s ability to manage her activities of daily living has been progressively worsening.
Religion: Dedicated Catholic, who used to attend church regularly and volunteer in her spare time. Since Nancy has been unwell, a priest from her church has been providing home visits weekly, for her spiritual comfort and encouragement.Click here for more on this paper…….
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Nancy is admitted to hospital
‘I just feel so exhausted…’
Nancy is 69 years old. She has been suffering from Chronic Obstructive Pulmonary Disease (COPD) for many years. Her primary carer is Phil, her husband of 47 years, over the last 12 months Nancy has had multiple admissions to hospital with acute exacerbation of her COPD. The disease progression is causing Nancy to become increasingly fatigued. Nancy reports that when she is at home, she feels so exhausted that she often remains in bed throughout the day.
Three days ago, Nancy was readmitted to hospital for the third time in the past four months. On this occasion Nancy has presented with an exacerbation of COPD secondary to pneumonia. Whilst on the ward Nancy has had her medications reviewed, her new medication regime includes the following drugs- MS Contin 20mgs BD, PRN Ordine liquid 1ml (5mgs) 4 hourly for breathlessness, Ativan 0.5-1mg sublingually PRN for anxiety, Endep 50mgs nocte for depression, anginine 600mcgs PRN for angina, Cardizem 180mgs daily, Voltaren 25mgs daily, Flucloxacillin 500mgs TDS p.o, Coloxyl with Senna 2- 3 tablets nocte, Paracetamol 1000mgs TDS, Predinisolone 40mgs, Frusemide 40mgs, Salbutamol 5mgs via Nebuliser
As her breakfast tray is delivered Nancy states she is “exhausted” and says she “no longer wants to go on”. From her charts it is clear that she has been refusing meals and most medications.
Nurse: Nancy, I see you haven’t eaten your breakfast… I have some tablets here for you to take. Do you want to have them now with your brekky?
Nancy (in a weak and breathless voice):I ….don’t … want … anything…
Nurse: Is it the food? Don’t you like Weetbix? I can get you something else if you would like.
Nancy:No.. I don’t … want … anything…Please understand..I’m exhausted… I don’t … want … anything to eat… I just don’t ….want to… go on …anymore!
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