Self Directed Learning Package - University of Queensland

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54 • The Palliative Approach Toolkit6. A resident is always short of breath on exertion. You should administer a PRN dose of morphine mixtureafter she has a shower and is recovering on her bed.• Residents with dyspnoea benefit from having a preventative plan of care that decreases the distress andanxiety of dyspnoea before it occurs.• This resident would benefit from this medication at least ½ hour before showering (just as analgesicsare given prior to activities that are known to cause pain).TrueFalseSection 27. Family members have the right to determine if a resident should attend a palliative care case conferenceon the grounds that ‘it will only upset her’.• As nurses our primary role is to provide resident centred care which includes advocating on the resident’s behalf.• Perhaps the resident would be upset about what is discussed, but it is up to them (while they are cognitivelyable to make decisions competently) to decide whether they will attend.• Most residents choose to attend case conferences and can provide insights into their condition that family andstaff may not have known about otherwise.• If a resident is likely to become distressed or fatigued, consider holding the case conference in their roomwhere they can rest on the bed. Ask their permission to continue the discussion elsewhere with theremainder of those attending.8. Regardless of the language a resident speaks or where they were born their care needs are the samewhen they are dying.• All residents require careful assessment to ensure that assumptions are not made about cultural needs based ona resident’s language, religion or country of origin. Similarly, the care needs for members of our indigenouspopulation (Aboriginal and Torres Strait Islanders) requires careful assessment and planning.9. If a resident tells you they have pain, is it good practice to ask how severe it is on a scale of 0 to 10.• The use of horizontal or vertical pain scale which asks the person to rate 0 (no pain) or 10(worst pain possible) is a good way to assess pain for residents who do not have severe cognitiveimpairment.10. Facial expressions and vocalisations can indicate if a resident is experiencing pain.• The Abbey Pain Scale lists whimpering, groaning, and crying as possible indicators of pain.
55 • Self Directed Learning Package - Introductory Registered & Enrolled Nurse11. A resident was taking an average of 30mg of oral morphine every 24hrs. Now that he cannot swallow theGP has changed the order to morphine 30mg/24hrs via a subcutaneous infusion pump.This is an appropriate order.• The parenteral dose of morphine is approximately one-third of the oral dose.• The dose ordered by the GP is effectively tripling the previous dose and is likely to result in adverse effects.TrueFalse12. Every resident who cannot eat or drink should be fed through a tube (e.g. PEG gastrostomy).• There is no evidence that tube feeding prolongs life, improves comfort or quality-of-life, prevents aspirationpneumonia, leads to better nourishment or decreases the risk of pressure sores.• Although artificial hydration can be useful to treat reversible causes of dehydration, it is not normally usedwhen a resident is expected to die within 48 - 72 hours.13 Pineapple juice on a mouth swab is an effective way of treating a dry but otherwise clean mouth forresidents who cannot swallow anymore.• Pineapple contains an enzyme that chemically cleans but is too strong and damaging if usedundiluted and for long periods.• Do not use mouthwashes and swabs containing:- lemon and glycerine- sodium bicarbonate (high strength)- preparations containing alcohol or hydrogen peroxide- pineapple or other juices.14 A resident has not responded to environmental or nursing interventions for her delirium. A benzodiazepinewould be the most appropriate drug to control 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 drugsuch as haloperidol.15. A combination of changes in breathing patterns, decreased consciousness and irreversible weight lossmay be signs of approaching death.Three or more of the following indicates an End of Life Care Pathway may be appropriate and that theresident is likely to be approaching death:• rapid day to day deterioration that is not reversible• requiring more frequent interventions• becoming semi-conscious with lapses into unconsciousness• increasing loss of ability to swallow• refusing or unable to take food, fluids or oral medications• irreversible weight loss• an acute event has occurred requiring revision of treatment goals• profound weakness• changes in breathing patterns.
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