•Clinical Practice Guidelines (CPG's) for task 2
Please selectONLYONE CPGto critique and discuss the care provided to Frank in the Case Scenario found in the Green Booklet above ◦Read the Unit Outline...

FACULTY OF HEALTH SCIENCES
School of NURSING
National
SEMESTER 2, 2020
NRSG374: Principles of Nursing: A Palliative Approach
Assessment Task 2
Topic – Written Critique of a Practice Guideline
Name of Student –
Name of Tutor –
Word Count – 1853
Introduction
This critique is about a case study and the standards of care used by the staff at various points of care. The patient under discussion is Frank who had been diagnosed with GBM which is a deadly tumor and he decided to manage it with palliative care. The CPG or Clinical Practice Guidelines selected for this case study are the Care of a dying patient guidelines. These guidelines would allow the assessment whether the right and appropriate palliative care was provided to the patient or the staff could have done better. The trajectory of the illness and the limitations of care would also be discussed.
Patient Details
This case study is about Mr. Fortunato (Frank) Rossi, 60/M, who is in an Italian citizen and lives in Australia with his wife Sofia since 1952. They both have dual citizenship of Italy and Australia and practice strong catholic faith. Frank is a secondary school teacher who had been working at a school for over 20 years and teaches science as well as mathematics. His wife Sofia has been a home maker and took care of their two daughters who are now ma
ied and settled. Frank recently decided to take voluntary retirement from his job and take up some casual teaching so that he can give time at home as well as earn some small amount of money. Three months back Frank experienced a seizure that his family witnessed and he was taken to the Emergency Department of the Metropolitan hospital.
Important Patient Information
Frank was transfe
ed to a tertiary care hospital after he had another seizure and stayed for some time in the general ward. After the assessment and diagnosis, he was transfe
ed to a palliative care facility near his home. His medical history included tonsillectomy as a child, ex-smoker and diet controlled type 2 Diabetes. The cu
ent history included seizures, confusion, headache, blu
ed vision, muscle weakness, cognitive issues, vomiting, sleepiness, sluggish pupil response to light.
It was also noted that increased intracranial pressure of the patient was the most probable reason for his constant headaches. The MRI reports showed that there were abnormalities in the frontal and temporal regions. The doctors gave a differential diagnosis of metastatic tumors in the
ain. The
ain lesions and increased intracranial pressure give an indication of Glioblastoma Multiforme (GBM) as described by Anjum (2017) but differential diagnosis could not be ruled out.
Frank was given Mannitol to reduce the intracranial pressure, Lyrica for seizure activity and diazepam as per need as also discussed by Halani (2017). The patient responded well and was showing normal cognitive function after 5 days of medications. Though patient had good long term memory recollection but some short term memories were impacted. Patient had multiple a
asions and thrush in the oral cavity which were evident of seizures as also mentioned by Li (2018). After CSF examination and MRI, it was observed that there was rapid tumor growth in Frank’s frontal lobe within 18 days of his first attack which was highly suggestive of GBM.
The couple decided to have surgical tumor resection as the palliative measure. The histopathology results post-surgery identified a rapidly growing GBM which had metastasized in the temporal lobe. An interdisciplinary meeting with family members and healthcare workers was a
anged which concluded with the information that Frank had Stage IV GBM and might live for 3-4 months without surgery and radiation therapy as also noted by Maher (2020). Frank and his wife decided they would go to an inpatient palliative care facility close to their home so that they are close to their family.
Palliative Care Facility Treatment
Frank told his family history and his desires for his last few months when he was addressed at the facility. Frank told the medical and nursing staff that his father had died a ho
ific death from GBM and he did not want the same for himself. Frank had become disoriented and was constantly experiencing intracranial pressure. Thus, he was no longer competent for any legal decisions and his wife had the medical Power of Attorney.
The care team, patient and his family decided that they want the patient care to be comfortable and dignified as also discussed by Marsh (2017). Along with the medication management, the palliative care unit took care of certain refe
als like physiotherapist, OT home assessment, dietician, catholic priest which works as an interdisciplinary team described Liu (2020).
Care...