Care Study Fiona Draft
Assessment
Fiona is 76 years old retired school teacher. She had a past medical history of rheumatoid arthritis, hypertension and high cholesterol which left her in a stroke and is now wheelchair bound. Shortly after the death of her husband, Fiona started gaining weight and was later diagnosed of Type 2 Diabetics. A year ago, she was diagnosed with Ulcerative Colitis (UC) after she reported continuous loose stools, abdominal pain with blood in her bowels. She has been suffering with chronic abdominal pain sins her last diagnosis. On a Wednesday morning Maria called the Hospice team reporting that her mother had excruciating pain in her abdomen.
After her last diagnose doctors agreed to discuss Fiona’s case in a Multidisciplinary –Disciplinary Team meeting and agreed that she received palliative care, to which Fiona and her daughter consented. She has been receiving care at home and in the hospice for eleven months. Fiona lives alone but receives help from her daughter who leaves just ten minutes away from her.
Fiona is going through the end of life, the type of pain at this stage may differ from the type of pain that other patients experience (Lawrenson and Truglio-Londrigan, 2015). Pain measurement at the end-of-life care relies on accurate pain assessment (Banning, 2007). It is therefore important to question the patient carefully, and communication can also be a good means to obtain a full history of the type, area and how long the pain has been going on. Pain in patients suffering from uncreative colitis depends on the severity and the extent of mucosal involvement The disease is often treated mesalaniine product (five- amino salicylic acid) Steroids and amino salicylates suppress of symptoms (Nicholas and Hawkes-Frost 2012). Therefore, in identifying Fiona’s pain the team has used two types of tools (Standing, 2017). Numerical Pain Tool helps and the Palliative Care Outcome Scale (POS) is a source for palliative care practice, guidance and research. The tool helps with the organisation of advanced measurement in palliative care.
Planning
Huether and McCance, (2012) subsequently iHowever, it is known to be common amongst the white population and Northern Europeans. For the past five years, Fiona has been experiencing watery diarrhoea whose mucosa looked normal on proctoscopy. The plan for Fiona in this case is to make sure that her bowel movements are normalise. Also, to mantain adequate fluid balance which will be evidenced by the intake and output. Fiona will also be informed on how to take her new drugs.
Implementation
The golden treatment of uncreative colitis is to decrease inflammation and treat pain management with the aim of inducing and maintaining remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include five amino salicylic acid drugs, steroids, and immunosuppressant. Some patients can expect colectomy for medically refractory disease or treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is developing, and the number of medicines with new targets will rapidly increase in the coming years (Burns, 2015).
When aiming to offer excellent palliative care, nurses should consider the principles of good palliative care, which requires the health professionals involved to work following their competency standards. The NMC’s code of conduct (2018) explicitly states that every nurse should work within specific boundaries regarding their ability, and they should make a referral in time if they are any patient interests as nurses should be the patients advocate and have to prioritise the patient while maintaining the safety of their patients. This will help in promoting professionalism while practising effectively (Day, 2013). The doctors and palliative nurses advised Fiona about having surgery, but she decided not to have it as this may cause more complications. Therefore, she continues having pain treatment.
Evaluation
After a trial of series of drugs and making sure that Fiona maintains adequate hydration her pain was minimised and her diarrhoea is relieved. However, her preferred analgesia (Morphine) makes her feel tired and affects her vital signs.
