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Palliative Care Practice

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Palliative Care Practice

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Question:
Discuss about the Palliative Care Practice. 
 
Answer:

Actual nursing plan:
Name of patient: Mohammed Rizzo
Actual nursing diagnosis: Fluid Balance deficit related to acute lymphoblastic leukaemia being NBO before and after, fluid loss during chemotherapy, vomiting and nausea as evidenced by Hypotension 90/50, Tachycardia 112, short breath, thirst, poor skin turgor, and dry mucous membranes. The patient is 7 years old, a Muslim and lives with his grandmother in the villages.
Pathophysiology
The fluid volume deficit refers to a decrease in the inter/intrastitial fluids in the intravascular system of the body. It is caused by excess loss of fluids especially due to vomiting and diarrhoea, poor fluid regulation mechanisms or insufficient intake of water. The fluid volume deficit can occur singly or in combination with electrolyte and acid-base fluctuations. The major cause of fluid volume deficit is increased loss of fluids in the gastrointestinal tract. Specifically, this loss is through diarrhoea, vomiting, intestinal fistula and drainage, renal loss of water and sodium from kidneys and through sweating and finally through increased bleeding. In the case of fluid volume deficit resulting from inadequate intake of fluids, this can be due to lack of sufficient fluids, inability to swallow fluids or gastrointestinal trauma. It is important however, to note that the old age predisposes people to fluid volume deficit. This condition can either occur slowly or fast depending on the cause of the fluid loss (LeMone, 2017). When extracellular fluids are lost, this results in an inability for blood to circulate. This is because there are electrolytes which are also lost along with the fluids and creates an isotonic fluid volume deficit. Loss of fluids together with electrolytes makes the sodium ions level to be at normal range while the level of potassium drops. 

Nursing diagnosis

Goals

Interventions

Rationaile

Evaluation

fluid deficit volume as a result of acute lymphoblastic leukaemia  

The extracellular cells volume will be restored in order to attain a homeostatic state.

Fluid challenge- it is the increase in the stroke volume by about 15 % upon administration of 500 mL of crystalloid fir ten to fifteen minutes.

The fluid challenge involves administration of small amounts of fluids within a short period of time intervals (Mallat et al., 2015). It helps in the determination of whether there patient has got a preload reserve which can then be used to raise the stroke volumes.

Fluid challenge in this goal of care, the effectiveness can be determined by observing arterial pressure which is above 65 mm Hg, increased blood pressure of above 90 mm Hg, polyuria, and decrease of heartbeats to 72 heart beats per minute and reduced lactic acidosis.
 

Potential Plan
Name of patient:   Mohammed Rizzo
Potential nursing diagnosis: Mr Mohammed Rizzo is at risk of anxiety. This is evidenced by, the patient’s age (7 years); he is suffering restlessness, poor control of impulse, apprehensiveness and low attention.
Pathophysiology
Anxiety is a feeling of uneasiness upon activation of the nervous system in response to some stimuli which in turn cause cognitive, behavioural, physical and emotional feelings (Lader, 2015). The patient is characterized with unexplainable worry, panic for no reason and fear of objects. Anxiety is caused by interaction of biophysical factors as a result of stress and trauma. For instance, the anxiety stems from the amygdala a cluster of neurons in the brain and it is responsible for the body actions. Since the amygdala stores memories, once it is triggered by the stimuli, it distributes the distress signals to other brain portions (Lissek et al., 2014).

Nursing diagnosis

Goals

Interventions

Rationaile

Evaluation

fluid deficit volume as a result of acute lymphoblastic leukaemia  

Remain with the patient nearly every time especially when there are high levels of panic. Develop a trustworthy relationship between the nurse and the patient by paying close attention.

Assess what the patient feels concerning the current situation within 24 hours verbally.

Assess what the patient feels concerning the current situation within 24 hours verbally.

The patient will be calm and attentive to the nurse within the next 24 hours. The patient will state in words his current situation before being discharged.

 
 
Reference List
Lader, M. (2015). Generalized anxiety disorder. In Encyclopedia of Psychopharmacology (pp. 699-702). Springer Berlin Heidelberg.
LeMone, Priscilla (2017). Medical-surgical nursing : critical thinking for person-centred care (Third edition). Melbourne, VIC Pearson Australia
Lissek, S., Kaczkurkin, A. N., Rabin, S., Geraci, M., Pine, D. S., & Grillon, C. (2014). Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biological psychiatry, 75(11), 909-915.
Mallat, J., Meddour, M., Durville, E., Lemyze, M., Pepy, F., Temime, J., …& Tavernier, B. (2015). Decrease in pulse pressure and stroke volume variations after mini-fluid challenge accurately predicts fluid responsiveness. British journal of anaesthesia, 115(3), 449-456.

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