Self Directed Learning Package - University of Queensland

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76 • The Palliative Approach ToolkitAssessmentThinking PointDespite dyspnoea being an increasingly commonproblem for residents who require a palliativeapproach, it is rare to see a care plan that focusesspecifically on management of their dyspnoea.Perhaps this is because many RACFs choose tostructure their care plans around the Aged CareFunding Instrument (ACFI) questions, which onlymentions oxygen therapy in the complex care section.ActivityReview the dyspnoea section in Module 3.ManagementCase Study – AlfredAlfred is nearing the end of his life.Alfred’s main problems are his airways disease, milddementia and progressive decline in functional status. Herequires continuous oxygen, prescribed at 2liters/minute vianasal specs.This morning, carerworkers report Alfred seems to be moreshort of breath than usual during and after his shower. Younote that he has had similar episodes over the last week aswell. He is angry that he can’t find the energy to sit with hismates in the common room for the weekly sing-a-long.Today it appears to be more severe and he has what appearsto be a wheeze and occasional cough.Thinking PointDo residents in your facility who report dyspnoeahave a comprehensive assessment done as part ofroutine practice?• How often is a resident’s dyspnoea assessed?• Do you assess dyspnoea prior to and following anintervention?Key PointBecause health professionals tend to under-report aresident’s dyspnoea, competent residents should beencouraged to rate the severity themselves.Thinking PointWhat additional information might you need beforedeciding on a management strategy?ActivityList the strategies that may help Alfred’s shortness ofbreath. Then separate these interventions into short-termand longer-term strategies, keeping in mind that Alfredis already receiving a palliative approach to his care.Alfred’s GP has decided to treat the dyspnoea with a lowdose of PRN oral morphine. The aim is to changeoverto a sustained release preparation once the doserequirements are clear.His daughter Sarah is concerned about the potential foraddiction of morphine.
77 • Self Directed Learning Package - Advanced Registered & Enrolled NurseThinking PointHow would you respond to Sarah’s concerns?This is a common concern for residents and familymembers. It is often helpful to discuss the pointsoutlined in the Palliative Care Australia pamphlet‘Facts about morphine’ http://www.palliativecare.org.au/portals/46/resources/FactsAboutMorphine.pdf 14You notice that there are reports of dyspnoea in Alfred’s casenotes but no opioids have been administered. When youquestion the RN responsible, he scoffs at the idea that morphinecan help dyspnoea. “That can’t be true, it depresses respirations.I learnt that when I worked on a surgical ward years ago”.Thinking PointHow would you respond to the RN?Unfortunately many health professionals are not aware of thecurrent evidence based interventions for dyspnoea.ActivityIt may be helpful to look on the CareSearch website forthe one page summary about dyspnoea. This wouldbe a good starting point for a discussion with this nurseabout the potential benefits of opioids for dyspnoea.
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