Palliative care case scenario Patient name: Robert Miller Handover report to Ward 8E Oncology Palliative care unit Date

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Palliative care case scenario Patient name: Robert Miller
Handover report to Ward 8E Oncology Palliative care unit Date of
handover report: 5 th September 2021 at 15.00 hours MRN: 968 644
DOB: 27.05.1953 Weight: 53kg Height: 170cm BMI: 18.3 kg/m2
(underweight) Introduction Robert Miller a 68 year old male
presented to the Oncology ward three days ago following
deterioration over the last week. Patient is in the terminal phase
of cancer and is experiencing severe pain. Robert and his family
are not comfortable attending to end-of-life requirements at home.
The patient wife and two children have accompanied the patient to
the hospital for end of life care. The patient wife informs the
nurse that the patient has not been sleeping well for the past week
due to experiencing severe pain. Situation The patient is becoming
less conscious and is no longer verbalising but opens eyes to pain.
Vital signs prn have remained stable for the past three days. The
patient is receiving regular subcutaneous morphine and hyoscine via
an abdominal subcutaneous butterfly. The patient is NBM. Mouth care
has been attended and Colostomy has minimal output. Background
Robert has a four year history of Colorectal Cancer and has a
Colostomy insitu following bowel resection surgery four years ago.
Robert developed terminal metastases in his lungs and brain three
months ago. The patient medical notes contain the required
documentation for an Advanced Care Directive (ACD) which includes a
do-not-resuscitate order and no other acute medical response or
treatment. Medical staff discussed advanced care planning with the
patient and family during a previous medical admission for
radiotherapy six weeks ago. Robert lives with his wife and has two
children with families of their own. 2 Assessment Observations
taken at 10am this morning: BP: 105 / 72 mmHg HR: 64 beats per
minute SpO2: 94% R/A RR: 12 breaths per minute On Auscultation:
Fine crackles–bilateral lower lung fields Cool lower limbs Temp:
36.4 OC (oral) Glasgo Coma Scale (GCS): 10/15 (Eye = 2, Verbal = 3,
Motor = 5) Pain score: 8/10 BGL: 4.8 mmol/L Recommendations
Continue with end of life care and PRN subcutaneous morphine and
hyoscin
q- What are the three patient issues that nurses can address
within their scope of practice as per Australia?