Palliative and end of life care.

    Evaluate the holistic assessment in the delivery of quality palliative and end of lifecare.2- Examine the assessment of two common symptoms experienced by your patientwith an advanced disease. Common symptoms are: pain, fatigue, nausea and vomiting,3- Critically evaluate two evidence-based interventions to manage these twocommon symptoms experienced by your patient with an advanced progressivedisease and discuss the impact that these interventions have on your patientsquality of life.4- Evaluate the importance of cultural and religious beliefs in the context of end-of-lifecare for your patient. 5- Investigate the importance of meeting spiritual, psychological, cultural and socialcare needs of your patient receiving palliative and end of life care. 6- Analyse two interpersonal skills and the importance of the therapeutic relationshipat the end of life.This is the case study, please use this to answer the above 6 points.Case Study AMary is a 55-year-old woman who has been admitted to the hospital with symptomsof fatigue, confusion, jaundice, nausea and abdominal swelling. After a series oftests and evaluations, she has been diagnosed with end-stage liver failure, acondition in which the liver is severely damaged and is no longer able to functioneffectively. Mary has a history of alcohol abuse and has been struggling with liverdisease for several years. Mary is an active member of her local church whom sheattends with her son, David. She has no other family close by after her husband diedsuddenly 10 years ago from a stroke. Since her admission she is struggling to attendto her daily activities of needs and self-care at the end of life.-

Sample Solution

     

. Holistic Assessment:

A holistic assessment for Mary in palliative care would encompass several aspects:

  • Physical Symptoms: Pain, fatigue, nausea, vomiting, confusion, jaundice, and abdominal swelling.
  • Psychological Distress: Anxiety, depression, fear of death.
  • Social Needs: Limited self-care ability, social isolation due to lack of close family.
  • Spiritual Needs: Importance of faith and church community.
  • Cultural Needs: Respecting Mary's cultural background and any preferences related to end-of-life care.

Full Answer Section

      Symptom Assessment:
  • Pain: Assess location, intensity, and character of pain. Consider using pain scales.
  • Fatigue: Evaluate severity, impact on daily activities, and potential causes (e.g., underlying disease, medications).
  1. Evidence-Based Interventions:
  • Pain Management:
    • Medications: Opioids are often used for moderate to severe pain, along with adjuvants like laxatives for constipation caused by opioids.
    • Non-pharmacological interventions: Massage therapy, relaxation techniques, and physical therapy can provide additional relief.
  • Nausea and Vomiting:
    • Medications: Anti-emetics like ondansetron can be helpful.
    • Dietary modifications: Small, frequent meals, bland foods, and avoiding triggers like greasy or spicy foods can help.
Impact on Quality of Life: Effective management of pain and nausea can significantly improve Mary's quality of life. Reduced pain can allow her to participate more in activities she enjoys, while controlled nausea can improve her appetite and energy levels.
  1. Cultural and Religious Beliefs:
Mary's religious beliefs and church community are important to consider. Her faith might provide comfort and guidance during this difficult time. Spiritual leaders can offer support and ensure her end-of-life care aligns with her religious beliefs.
  1. Meeting Spiritual, Psychological, Social, and Cultural Needs:
  • Spiritual Care: Encourage Mary to connect with her church or a spiritual leader if she wishes.
  • Psychological Support: A social worker or therapist can help Mary cope with emotional distress and fear.
  • Social Support: Facilitate connections with her son, David, and encourage visits from church friends, if appropriate.
  • Cultural Considerations: Learn about any cultural preferences Mary may have regarding end-of-life care and involve her in decision making as much as possible.
  1. Interpersonal Skills and Therapeutic Relationship:
  • Active Listening: Listen attentively to Mary's concerns and needs without judgment.
  • Empathy: Acknowledge and validate Mary's emotions, fears, and anxieties.
  • Building Trust: Create a safe space where Mary feels comfortable expressing herself openly.
Therapeutic Relationship: A strong therapeutic relationship is crucial for effective end-of-life care. This relationship allows Mary to feel supported and cared for during this challenging time. Building trust enables her to openly discuss her needs and wishes. Additional Considerations:
  • Advance Directives: Discuss Mary's wishes regarding medical treatment and end-of-life care. Encourage her to complete an advance directive if she hasn't already.
  • Family Support: Provide support and guidance to Mary's son, David, as he copes with his mother's illness.
By implementing these holistic care strategies, the healthcare team can ensure Mary receives the physical, emotional, spiritual, and social support she needs during her end-of-life journey.  

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