Assessment Task 2: Unit Outline Assessment Task 2 Details You are required to produce a Written Critique of a Practice Guideline to better improve patient care Students are to provide an 1700-word...

Assessment Task 2: Unit Outline Assessment Task 2 Details 
You are required to produce a Written Critique of a Practice Guideline to better improve patient care
Students are to provide an 1700-word critique of a guideline against relevant elements of the
• NSQHS and/o
• NMBA standards and/o
• National Palliative Care standards
FAQ's
Do we need to use all of these standards to do well?
· As the ru
ic states if you provide "Outstanding knowledge of themes and principles associated with palliative care" this will demonstrate an outstanding application of your knowledge to practice therefore using standards from more than one of the above and relating them together to uphold your critique of the patient care and support the clinical practice guideline selected will demonstrate excellent knowledge and understanding.  Using one standard from one of the above will not provide strong application of knowledge. However, a comparison of multiple standards that as registered nurses we are required to uphold will absolutely demonstrate very strong knowledge and understanding, if you link them together well with evidence-based practice (EBP)
· NSQHS
Eight National safety and Quality Health Service Standards to provide a nationally consistent level of care that can be expected by all consumers from all health organisations 
https:
www.safetyandquality.gov.au/standards/nsqhs-standards
· NMBA
Seven Standards that all Registered nurses must uphold to ensure that they maintain their registration and provide person centred and evidence-based preventative, curative, supportive, formative and palliative elements to their practice 
https:
www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards
egistered-nurse-standards-for-practice.aspx
· National Palliative Care Standards
Nine National palliative Care standards that you know well as they have formed the framework of NRSG374 and were fundamental for assessment task 1
https:
palliativecare.org.au/standards
How do I relate these standards to Frank's experiences as a patient?
This is where your critical thinking and application of theory to practice is required, we cannot tell you how to do this, as a final year nursing unit is essential that you are aware of how all of these standards, uphold and maintain, patient centred care, dignity, patient assessment and safety to name a few.  Spend some time reviewing these and map out the ones that you believe are important for your critique.
Purpose: Students are required to demonstrate an understanding of how theory translates into practical nursing care and how evidence underpins best practice. Each student will review and critique the care given in the Case Study provided according to their choice of ONLY ONE of the provided Clinical Practice Guidelines (CPG’s) best suited to the highlighted discussion.
Where will I find the CPG's that you want me to use?
· You are provided with CPG's for this task, you need to choose one of these only to demonstrate the area of care that you are providing a critique of.  You do NOT have to look for other CPG's to support your work, however evidence-based practice of peer reviewed journal publications are expected to further reinforce your critique.
Consider the Patient Situation
(Levett-Jones, 2018)
Fortunato (Frank) Rossi, is a 60 year old male who was born in Italy and Migrated to Australia with his wife in 1952, both he and his 58 year old wife Sofia have dual citizenship in Italy and Australia. Frank and his wife practice a strong catholic faith. Frank has worked as a Secondary School Science and Mathematics teacher at a local Catholic Secondary School for over 20 years and loves his job.  He is well respected by his colleagues and students with his very "quick wit and sharp mind with problem solving" that he prides himself on
Sofia has been a stay at home mother and carer for their 2 daughters:
· Eldest Daughter: Anna ma
ied Phillip have 2 daughters Bella (6) and Emily (3 months)
· Youngest Daughter: Ga
iella ma
ied Michael have 1 son (18 months old)
Together they have had a wonderful life, with supportive family visiting from Italy and the Rossi family themselves being able to go over to Italy for many family holidays.  Both Frank and Sofia are very excited and enjoying being grandparents, they are looking forward to Frank's decision for an early 'self-funded retirement' to enjoy more time with the family. Frank has a
anged with his school to be able to undertake a small amount of casual teaching if he and his family require some small income once he has retired, although he is very keen to work in his garden and spend time helping to raise the grandchildren and enjoy the many years of hard work that he and Sofia put in to support their family and the "good life" they have created in Australia.
Three months ago
Frank experienced some confusion at work and a seizure "of unknown origin" that was witnessed by his wife and grandchildren.  Sofia immediately called 000 and Frank was transported urgently under the care of paramedics to the emergency department (ED) of a major metropolitan hospital as they lived close to the city.
Collect Cues and Information
Past Medical Hx
· Tonsillectomy as a child
· Ex smoker (quit smoking 25 years ago was a packet a day smoker)
· Diet Controlled type 2 Diabetes
Cu
ent History
· Seizures of unknown origin
· Confusion
· Headache
· Blu
ed vision
· Difficulties with problem solving and decision making
· Gradual onset of speech distu
ance
· Muscle Weakness
· Behaviour Changes
· Vomiting
· Sleepiness
· sluggish pupil response to light
Gathering new Information 
Frank's vital signs upon admission to medical ward 
RR : 18
HR: 84 bpm
BP: 185/95
SaO2: 96% on 3Lmin via N/P (For Comfort measures)
Raised Intracranial Pressure (ICP) - constant headache
GCS - 9/15 (eyes open to painful stimuli 2 / confused and disorientated ve
al response 4 / Abnormal Flexion from painful stimuli 3)
Intermittent Patient Notes
"Patient transfe
ed to medical ward following observed seizure of unknown origin by wife and grandchildren who called 000 for paramedic support. In ED patient's conscious state was altered with confusion and inability to recognise wife"
"Pupil size of both eyes was equal however pupillary light reflex is sluggish, positive babinski sign response bilaterally, renal function normal, patient experiencing double incontinence, normal FBE and U&E"
"Initial MRI clearly showed abnormalities in the frontal and temporal regions, with a differential diagnosis of metastatic tumors in the
ain from an unknown primary"
Frank was experiencing Increased Intracranial Pressure likely from
ain lesions and possible Diagnosis of a Glioblastoma Multiforme (GBM)
Differential Diagnoses had not yet been ruled out 
"Patient was administered mannitol every 12/24 over 16 days to reduce Intra Cranial Pressure (ICP,) Lyrica 150mg BD for seizure activity, and Diazepam 10mg PRN XXXXXXXXXXdays post initial seizure pt woke with normal cognitive responses and recognition of family members once ICP had begun to reduce. Progressively pt's ability to walk without deficit returned. Pt was fully continent, had good long-term memory recollection, however short term memory was impacted"
"Pt's oral mucosa had multiple a
asions and thrush evident from possible injury during seizure, patient complained of mouth and throat pain, often refusing to eat and drink"
"Differential Diagnoses of ?Infection, ?metastaic cere
al tumors were discussed however following lumbar puncture for collection of cere
o-spinal fluid (CSF) specimen, and  further MRI results  showing rapid tumor growth particularly in Frank's frontal lobe just 18 days after his initial ED presentation, the diagnosis was highly indicative of a GBM"
"Patient and wife agreed to surgical tumor resection as a palliative measure with the knowledge that this was not a cure. Histopathology post surgical resection clearly identified a rapidly growing GBM with temporal lobe metastases as the definitive diagnosis. A family meeting was a
anged with the neurosurgeon, oncologist, palliative consultant, social worker, nurse unit manager, Frank and his family to discuss options"
Confirmed Diagnosis, medical imaging, and histopathology results
Following  CT Brain and MRI it was concluded that Frank had a Glioblastoma Multiforme (GBM) in his frontal lobe which had likely metastasized in both temporal lobes, thus his prognosis was devastatingly a Stage IV GBM with a likely survival of 2 - 3 months without surgical resection and/or palliative radiation therapy.
"Family advised to discuss and complete an Advanced Care Directive whilst Frank was competent with the knowledge that his ICP was likely to increase again, and a decision on how to proceed with interventions was needed.  Palliative radiotherapy was offered to Frank, he and his wife refused and decided to be transfe
ed to an inpatient palliative care unit closer to their family where he could go home on day visits and also spend more time with his family at the palliative care unit, rather than in a busy medical ward" 
Whilst on Day leave Frank had another seizure and was transfe
ed back to the General Ward for review …..Frank has now spent some time in a general medical ward at the Tertiary Level City Hospital that he was originally transfe
ed to by ambulance 2 weeks ago following another seizure whilst he was at home during a visit there from the palliative care unit.  During his re-admission the following cues and information were collected, and a diagnosis made. Prior to his transfer and re- admission back to the palliative care unit in an outer city hospital closer to his family home
 
Processing Information
A
ival and Admission to the Palliative Care Unit
Frank expressed some personal family history and wishes for his disease progression 
"Frank informed medical and nursing staff that his father had died from a GBM, restless, undignified crawling on the floor from terminal restlessness and his only desire was to not die like his father had"
"Nil Advanced Care Directive had been completed with Frank and Sofia as they thought they still had plenty of time when informed about an ACD on the Medical Ward. However, with Frank's fluctuating ICP and disorientation he is now deemed incompetent for any legal decisions or changes to his Will"
"Sofia was Frank's medical Power of Attorney, presenting paperwork to support this to the admitting palliative Care Team"
"Sofia stayed with Frank during his admission and together they communicated that they wanted him to be comfortable and dignified"
Medications Commenced once reviewed by Palliative Care Team
· Dexamethasone: 8mg BD oral or S/C (0800 and XXXXXXXXXXTo aid in reduction of ICP and Pain Relief from headache (Consider side effects and behavioural changes from dexamethasone - How can these be managed?)
· Lyrica: 75mg BD Oral (0800 and 2000) -  To manage seizure activity (consider side effects of Lyrica, are there other options that could be considered for Frank?)
· MS Contin 10mg BD Oral (0800 and 2000hrs) - Analgesia
PRN Medications
· Morphine 5-10mg S/C
· Midazolam 2.5-5mg s/c
· Ondansetron 8mg wafer (maximum dose of 16mg in 24 hours) for nausea and vomiting
Upon a
ival and admission to the palliative care unit the following refe
als were made 
·  Physiotherapist review for assessment of walking aid due to increasing paraesthesia and weakness in Frank's legs
· OT home assessment and equipment for home visits
· Dietician to review loss of appetite, cachexia and anorexia
· Pastoral care 
· Catholic Priest visits and wish to be anointed ASAP
Identifying problems/issues
Considerations for the Palliative Care Setting
Frank a
ived on the Palliative Care unit late on a Sunday afternoon at 2pm, he was welcomed by his RN who undertook the following assessments and discussions between him, his wife and two daughters:
· Welcome and orientation to the ward
· Falls Risk Assessment 
· Braden Pressure Risk Assessment
· Pain Assessment 
· Allied Health Refe
als made
· NOK contact details
·