NUR 212: Concepts of Nursing Care of the Adult I

Pre-Class Assignment: Week 1

Palliation
NOTE TO STUDENTS: Syllabus reading for this assignment Giddens: Chapter 31,32, 52, and
53 Lewis: Chapter 4, 6, and 9. This is a lot of material, however the chapters are short and will
be very beneficial to the first exam.

Task
Comparing and contrasting
Compare and contrast palliative care, hospice, and end of life care. Using your own words,
define each term. Provide examples of patients you have cared for that are examples of each
type of care, then discuss the overall short term and long term goals when planning care for
each.

Definition Example Patient Short-term Goals Long-term Goals

Cancer, Heart failure. Prevent and relieve Improve quality of
COPD, Dementia. suffering. life.
Palliative care
Regard dying as a Offer support to
Any form of care or
normal process. family during the
treatment that
patient illness and in
focuses on reducing Offer support to
their own
the severity of the patients to live
bereavement.
disease or actively as possible
symptoms. until death.

Hospice Cancer, patients with Facilitate palliation of Promote the dignity

terminal illness physical, emotional and independence of
Concept of care that
and spiritual distress. our patients to the
provides
greatest extent
compassion,
possible.
concern, and support
for persons in the last
phase of a terminal
illness.
End of life care 50-year-old Provide comfort and Help ensure a
terminally ill with supportive care dignified death,
Issues and services
metastatic breast during the dying provide support to the
related to death and
cancer. process. Improve the family.
dying
quality of the
patient’s remaining
life.
Stress Death of loved one, Sleep better, be in a Less muscle tension

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 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Is a feeling of loss of job better mood

emotional and
physical tension
Constantly changing Cancer patients, Prevent and relieve Minimize
cognitive and kidney patients suffering
behavior changes
and efforts to health risk
manage internal and
external demands.

Coping
The activity or Elderly, Immobility Promote health living Improve quality of
professional of patients life.
regularly looking after
a child, sick or
elderly.

Caregiving

Misc notes: _____The overall importance is to improve the quality of life of the patient in the
long and short run period.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________
Task
Clustering related information
Discuss the connection between palliative care and health care economics.
THE GROWTH IN THE HEALTH CARE PREMIUM DISPLACES WAGE INCREASE AND THE
INCREASING INSURANCE COST. WE ARE IN GREAT NEED FOR PALLIATIVE CARE BUT
IT IS VERY EXPENSIVE. _____________________
Task
Clustering related information
Comparing and contrasting

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 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Review the case of Amelia Sung whom you cared for earlier this quarter. As you review her
entire history, explain which how he might be used as an example of a patient needing palliative
care and perhaps hospice care. Ms. Sung had Lung Cancer six months after giving birth and we
will further evolve the Scenario to include that the lung and lymph node biopsies were
Grade IV and there is evidence of metastasis to her brain. Explain your answers.
Ms. Sung as an example of a patient Ms. Sung as an example of a patient
needing palliation needing hospice care
Pain not control Given only six months to live.
Patient is in Respiratory Distress Stop responding to treatment.
The family don’t know how to care for the Stage IV cancer.
patient.

Task
Clustering related information
For each interrelated concept discuss how it is related to the concept of palliation.

Interrelated Concept How it is related to palliation

To ensure care and quality of life.
Evidence
Cultural/ spiritual and emotional needs should
be addressed.
Ethics
Patient receiving palliative care are
vulnerable to patient safety incidents.
Safety
A patient treatment is based off their cultural
aspect.

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 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Culture
Allowing family to make important decision to
help transition.
Family dynamics

Task
Clustering related information
Identifying signs and symptoms
Predicting and managing potential complications
Review the case study on page 485 in the Giddens book. Develop a nursing care plan from this
patient requiring palliative care from a concept perspective. Use the concept map care plan
format from your clinical documents as shown below.

Conceptual Care Plan

Ethical and
legal
PHYSICAL

Health
disparities

Palliative care
Sleeping,
nutrition, fatigue

Structure
Cultural
process
care
evidence Care
coordination

Spirituality,
communication
Care giving

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data
 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Task
Evaluating data
Consider the care plan during the previous task. What outcome data will you collect to
determine if the plan is working for the overall goal of providing palliative care or non-curative
treatment? Be sure to address psychosocial issues as well as physical.
How these data provides information
about effectiveness of nursing
Outcome data to collect
interventions
SHOWS IF SOB, WEAKNESS HAS
IMPROVED

PHYSICAL DATA
SHOWS IF TREATMENT ARE IMPROVING
PT MENTAL STATE
EMOTIONAL DATA

LET’S YOU KNOW IF PATIENT IS

INTERACTING WITH OTHERS AND
PARTICIPATING IN GROUP ACTIVITIES.
SOCIAL DATA
DEMONSTRATES HOW SHE HAS
ACCEPTED HER SITUATION OF PROBLEM
SPIRITUAL DATA
AND IF SHE HAS A BETTER QUALITY OF
LIFE.

Add more rows as needed.

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 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Task
Clustering related information
Determining the importance of information
Ms. Sung’s cancer has become very aggressive. It has metastasized throughout all his major
organs. He has been placed on hospice care with the physician stating he likely have only one
or two months to live. Apply that information to 5 competencies selected from the AACN's
competencies for end of life nursing care (refer to the URL listed on the weekly outline). That is,
what nursing care will you plan for Ms. Sung to meet that competency? Use the content in both
the Giddens and Lewis texts as the basis for your answers.

Competency Nursing Care for Ms. Sung

CONSULT RESPIRATORY, PT AND DR. FOR PAIN
MANAGEMENT.
Collaborate with the interdisciplinary team
members while implementing the nursing role
in end of life care.
FIND OUT GOALS AND OUTCOMES AND
INCORPORATE THEM INTO THE PLAN OF CARE.
Demonstrate respect for the patient's views
and wishes during end of life care.
HAVE FAMILY PARTICIPATE IN FINAL DECISION.
HAVE FAMILY HELP IN CULTURAL BELIEFS FOR
Assist the patient, family, colleagues, and EFFECTIVE TREATMENT.
one's self to cope with suffering, grief, loss,
and bereavement in end of life care.
PROVIDE PATIENT TEACHING THAT WOULD BE
MOST EFFECTIVE TO PATIENT AND FAMILY.
Communicate effectively and
compassionately with the patient, family, and
health care team members about end of life
issues.

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 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

PROVIDE MANAGEMENT OF SYMPTOMS AND

IMPROVING QUALITY OF LIFE.
Promote the provision of comfort care to the
dying as an active, desirable, and important
skill, and an integral component of nursing
care.

Task
Identifying assumptions
Following is another competency from the AACN. Discuss what you will do to meet that
competency:
Recognize one's own attitudes, feelings, values, and expectations about death and the
individual, cultural, and spiritual diversity existing in these beliefs and customs.

__RECOGNISING YOUR OWN BIAS WAYS AND FEELINGS TOWARDS A PATIENT DECISIONS. I
WILL BE OPEN TO THE PATIENT SPIRITUAL AND CULTURAL BELIEFS I WILL ALSO RESPECT THE
FAMILY AND PATIENT WISHES.
__________________________________________________________________

Task
Develop medication sheets for:
 Morphine
 Fentanyl
 Methadose (methadone)
 Ativan (lorazepam)
 Hyoscyne (hyoscyamine)
 Atropine

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 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Medication Map

Classification/Group Name: Morphine_______________________________

General Purpose: The medication is used to help relieve moderate to severe pain. It works in the brain to change how the
body feel and responds to
pain.____________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_

Action/System: The net effect of morphine is the activation of descending inhibitory pathways of the
SIDE EFFECTS ADVERSE
CNS.____________________________________________________________________________________________________
EFFECTS
________________________________________________________________________________________________________
Nausea Headache
________________________________________________________________________________________________________
Vomiting Drowsiness
________________________________________________________________________________________________________
Constipation Dry mouth____
_
____________________________________
____________________________________
3 Medications from this classification: ____________________________________ INTERACTIONS
1.Morphine sulphate________________ (with Medications, OTC, Herbals, Foods)
____________________________________
(generic)  Some products that may interact
____________________________________
_____MS CONTIN________________ with this drug include mixed
(brand)
____________________________________
opiods, naltrexone, Normal
2._morphine sulfate_______________ ____________________________________
diet___________________________
(generic) ____________________________
______Astra morph________________  _The medication interfere with lab
(brand) tests.
3.___morphine sulfate__________________ ______________________________
(generic) Page 8 of 12
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NURSING CONSIDERATIONS:
Patient/Family Teaching
 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Medication Map

Classification/Group Name: _________________________________

General Purpose: Fentanyl is a powerful synthetic opioid used to treat patients with severe pain or to manage pain after surgery.
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
_____________________________________________________________________________________

Action/System: several formulation of fentanyl transdermal system have been developed to improve the drug
delivery._________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
_________________________________________________________________________________

3 Medications from this classification: SIDE EFFECTS ADVERSE EFFECTS

1.__fentanyl__________________ (generic)
_____Abstral_________________ (brand)
2._____Fentanyl________________ (generic)
______Actiq________________ (brand)
3.___Fentanyl__________________ (generic)
________ Fentora_______________ (brand)
TIPS for recognizing this class:
____________picture__________________
_________________________
_Vomiting Restlessness
Nausea sweating
Dizzness_ Loss of appetite
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
INTERACTIONS
(with Medications, OTC, Herbals, Foods)
 ___Don’t drink grapefruit juice
while taking fentanyl.
______________________________
_______________________
 Don’t take fentanyl with
Buprenorphine can cause
dangerous side effects to the
body._________________________
______________________________

NURSING CONSIDERATIONS:
Patient/Family Teaching
(MONITORING & INTERVENTIONS)
(what should they know about this medication to get the best benefit from it & to
prevent adverse reactions?)
_________________________________________________________
________Monitor breathing rate, blood pressure, liver and kidney
_______Don’t store this medication in moist or damp area. Keep the Page 9 of 12
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drug in the original unopened
addiction._________________________________________________
pouch.____________________________________________________
_________________________________________________________
__________________________________________________________
 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

General Purpose: Hyoscyamine is used to treat many different stomach and intestinal disorder and also used to control mucsle spasms in the bladder
, kidney or digestiv
e tract._______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
__________________________________________________________________

Action/System: Take this medication by mouth as prescribed before meals or as directed by the
doctor________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
__________________________________________

3 Medications from this classification: SIDE EFFECTS ADVERSE EFFECTS INTERACTIONS

1._______Hyoscyamine_____________
(generic)
___Symax___________________ (brand)
2.___Hyoscyamine__________________
(generic)
__Levsin____________________ (brand)
3._____hyoscyamine________________
(generic)
______Anaspaz_________________ (brand)
TIPS for recognizing this class: label
______________________________
Patient/Family Teaching
(what should they know about this medication to get the best benefit from it & to
prevent adverse reactions?)
__________________________________________________________
__________________________________________________________
______Tell the doctor if your taking other products that cause
drowsiness
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
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__________________________________________________________
_Dizziness Trouble sleeping (with Medications, OTC, Herbals, Foods)
 Some products interact with the
Headache Dry skin
drug like anticholinergic drugs
Drowsiness Constipation
______________________________
__________________________
Highlight Top 3 Priorities
 Have to eat before you take the
medication____________________
______________________________
______
 ____________________________
NURSING CONSIDERATIONS:
(MONITORING & INTERVENTIONS)
_________________________________________________________
_________________________________________________________
______Monitor for heart beat, difficulty urinating, decreased sexual
ability and loss of
cordination._______________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
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_________________________________________________________
_________________________________________________________
 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

Medication Map

Classification/Group Name: _________________________________

General Purpose: Ativan is used to treat anxiety which act on Brain on nerves to produce a calming
effect.______________________________________________________________________________________________________
___________________________________________________________________________________________________________
______________________________________________________________________________________________________

Action/System: This drug works by enhancing the effects of the natural chemical in the body
(GABA)_____________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________

3 Medications from this classification: SIDE EFFECTS ADVERSE EFFECTS INTERACTIONS

1.__Lorazepam__________________ (generic) Drowsiness Headache (with Medications, OTC, Herbals, Foods)
___Ativan___________________ (brand)  Interact with several other
Dizziness Nausea
2._____________xanax________ (generic) medications and
Weakness Slowed breathing_
___________Lorazepam___________ (brand) supplements__________________
3.___Benzodiazpine__________________ _________________________________________
____________________________
(generic) _________________________________________
__________
______________Lorazepam_________ (brand) _________________________________________
 Taking Ativan with herbs can
_________________________________________ cause sedative
TIPS for recognizing this class: ______________ effects_______________________
______________________________ Highlight Top 3 Priorities ____________________________
_________________________
NURSING CONSIDERATIONS:
Patient/Family Teaching
(MONITORING & INTERVENTIONS)
(what should they know about this medication to get the best benefit from it & to
prevent adverse reactions?)
__________________________________________________________ Page 11 of 12
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__________________________________________________________
___They should be taken as prescribed by the doctor
__________________________________________________________ Monitoring for cardiovascular and respiratory status and use of the
 NUR 212: Concepts of Nursing Care of the Adult I
Pre-Class Assignment: Week 1

General Purpose: Atropine is used before eye examinations and to treat certain eye
conditions_____________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________

Action/System: It also has CNS activity which may be stimulating or depressing depending upon the
dose._________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
_______________________________________

3 Medications from this classification: SIDE EFFECTS ADVERSE EFFECTS

1.______Atropine______________ (generic) Blurred vision Nausea
___Atropine care___________________
High Pressure in the eye Dizziness
(brand)
2.____Atropine_________________ (generic) Abdominal blockage Dry mouth
____Isopto Atropine__________________ Eye
(brand) Cardiovascular
3._____Atropine________________ (generic) _________________________________________
___Ocu-Tropine____________________ _________________________________________
(brand)
_________________________________________
TIPS for recognizing this class: _________________________________________ INTERACTIONS
Check for label (with Medications, OTC, Herbals, Foods)
 __Avoid overheating
Patient/Family Teaching
(what should they know about this medication to get the best benefit from it & to  Have food before taking the
prevent adverse reactions?) medication____________________
______________________________
__________________________________________________________
____
________Take the prescription as directed by the
 This medication may interact with
doctor____________________________________________________ several
________+- medication____________________
B ______________________________
NURSING CONSIDERATIONS:
(MONITORING & INTERVENTIONS)
_________________________________________________________
_______Monitoring for the eye , cardiovascular Page 12 of 12
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_________________________________________________________
_________________________________________________________