Self Directed Learning Package - University of Queensland

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106 • The Palliative Approach ToolkitSelf-directed learning package:Advanced nurses quiz answersSection 11 The resident and/or family must provide the nurse with information concerning their wishes about end oflife care at the initial assessment and care planning interview after admission.• An advance care plan does not have to be completed in one sitting. The best outcomes may come from anynumber of conversations. Giving a resident the time to think about your questions is very important.• Advance care planning should be part of the routine processes for every resident soon after admission to aresidential care facility.• A nurse-led care conference is recommended to facilitate this process. We suggest that the residents GP beinvited to attend (or at least be made aware of any wishes or decisions regarding advance care planning).TrueFalse2 There is no way of recording treatment preferences for a resident who has advanced dementia and did notrecord their wishes on a legal document when they still had mental capacity.• The resident’s wishes can still be obtained from family members if known and recorded in the clinical recordas an important but not legally binding guide for members of the health care team to follow.• A good example Is the “good palliative care plan”.3 Regular reviews of advance care plans mean checking if there is a form in the clinical records from when theresident was admitted.• Reviewing does not simply mean checking if there is an advance care plan present in the notes. The actualdecisions a resident has made need to be reviewed with them on a regular basis.• As part of your holistic care review (every 3 months?) ask:- Are these still your wishes?- Has anything changed in your life since our last review?- Do any of these changes reflect on your documented wishes?- Are there any changes you would like to make to your advanced care plan?4 The “Understanding the Dying Process” brochure is appropriate to give to family members at a palliativecare case conference.• Often in times of stress, residents and family members may not remember all that is discussed. Suitableresources should be available in order to complement the information you provide them in the case conference.• However written information should not be used as a substitute for personal conversations.
107 • Self Directed Learning Package - Advanced Registered & Enrolled NurseTrueFalse5 It is appropriate to accept a careworker estimation of the severity of a resident’s dyspnoea if they cannotremember what rating score a resident provided them.• Because health professionals tend to under-report a patient’s breathlessness the resident should be encouragedto rate the severity themselves (if cognitively aware).6 Attitudes and beliefs of residents, family and health professionals can be barriers to effective pain management.• Attitudes and beliefs can cause reluctance to report pain or prescribe/administer appropriate analgesics.• Examples of faulty attitudes/beliefs include:-“People with dementia don’t feel pain”-“It’s normal to have some level of pain as you age”-“Opioids hasten death”.7 A resident with chronic pain that is moderate to severe intensity will look pale, perhaps be sweating and havechanges in their heart rate and/or blood pressure.• In palliative care, pain is usually chronic and the obvious signs such as pallor, sweating, or changes in bloodpressure may not be seen.8 A tingling, burning pain that runs around one side of the chest wall between two ribs is most likely to beneuropathic in origin.• Neuropathic pain often follows dermatome/nerve distribution paths.• It is described as burning, shooting, radiating, tingling, numbness, pins and needles or deep aching.9 It is up to the nurse to assess the condition of a resident’s oral health each day.• Careworkers are in an ideal position to check for problems related to oral health.• Encourage them to check and report to a nurse anything out of the ordinary at meal times, when providingmouth care, cleaning dentures etc.10 A resident with dementia exhibits fluctuating confusion and wakefulness. This is best attributed to thedementia itself.• Dementia has no diurnal effects and symptoms are progressive yet relatively stable over time.• Delirium however has short, diurnal fluctuations in symptoms; worse at night in the dark and on awakening.11 Alfred has not responded to environmental and nursing interventions for his delirium. You should questionthe GP’s order of a dose of diazepam to help manage Alfred’s hallucinations.• Benzodiazepines do not improve cognition but may help associated anxiety.• Benzodiazepines may in fact worsen delirium if not used in combination with an antipsychotic drug suchas haloperidol.
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