Apply a Palliative Approach in Nursing Practice 

Explain, in no more than 100 words the principles of palliative care as listed in question:

  1. How will you ensure a holistic assessment to Ramesh who is on the end of life cancer care.

Ans: For ensuring the holistic assessment of Ramesh, he can be provided an important component of palliative care. It is multidisciplinary input in managing the disease that is linked with terminal illnesses. The whole emphasis in palliative care is to provide relief and minimize the physical, psychosocial and spiritual suffering of patients. It can be done by offering support systems such as family to cope with the illness and providing positivity while enhancing the quality of life(Centeno et al., 2014).

2.What is the pathophysiology of gastric carcinoma? Identify two needs of Ramesh in this scenario

Ans: The pathophysiology of gastric carcinoma is related to the invasion of the Helicobacter pylori infection in the intestine. This invasion initiates the chronic non atrophic gastritis to atrophic gastritis. This type of cancer is mainly related to the nutrition of the person. The two needs required by Ramesh are proper nutrition at all preoperative and postoperative levels. Special attention must be given during the postoperative levels where the body requires minerals for proper functioning(Rosania et al., 2016).

3.How will you assess this pain and current Pain management plan of Ramesh? Mention two strategies to reduce pain for Ramesh.

Ans: Assessing pain management in Ramesh’s case, it was observed that Ramesh did not eat anything from last night. The strategies included providing medication for reducing pains by opioids and analgesic ladder(Scarborough & Smith, 2018).The pain management given included:

  • Oxycodone 1mg / hour running in the syringe driver.
  • PRN morphine 1mg 4/24. The last given was at 6 am
  • Panadol Osteo 600mg TDS
  • Fentanyl patch 200 mcg/ 24 hrs

4.Ramesh has codeine induced constipation. How do you address medication-induced constipation in consultation with RN?

Ans: Codeine constipation occurs due to the absorption of the drug in the gastrointestinal tract. The medications that can be addressed in the constipation is Methylnaltrexone bromide. It is an analgesic that works against opioids. Polyethylene glycol is another way of controlling codeine induced constipation. These are stool softeners that help in regulating bowel movements(Sizar & Gupta, 2019).

5.Identify the following needs of this patient and explain how this can be respected by you as an EN.

Ans: The needs required by the patients were providing palliative care to lessen the pain that had occurred. He had no urge to eat food. To make sure that he eats, he must have been given some medications. He could have been provided with palliative chemotherapy.

6.a.Identify your role in this scenario and explain why it is important to work within the roles and responsibilities of an interdisciplinary team when planning palliative care?

Ans: Whole planning palliative care, it is important to look out for the holistic needs of the patients. Palliative care is about physical, emotional, and spiritual care. The palliative care provides support and acts as a caregiver to the person limiting the negativity produced by the ailments. It is important to abide by the rules because there may be chances when self-esteem and emotions of the patients can get hurt. Following rules might help to avoid such situations(Schroeder & Lorenz, 2017).

Explain the psychosocial impact of palliative care on Ramesh’s wife and family.

Ans: Palliative care is given to the patients and their family members in order to maintain the quality of life. The impact that is put up is coping up with the situations strongly and knowing and accepting the truth about the patient's condition. The care is also about coping up with the feeling of helplessness that occurs while the patient’s condition worsens. The understanding and acceptance of the loss that the family would face in and continue to live with that in the future(Carolan et al., 2015).

7.When Ramesh’s daughter approached you to discuss their spiritual and cultural issues and needs of Ramesh, as an EN how will you handle that situation.

Ans: As an EN, the spiritual needs and demands of the patients and his family have to be addressed in a positive way. They must be given the space to make the patient’s last few minutes of life as their own part. It helps in strengthening the spirits and would provide the family with the courage to face the last times of grief and sorrow. Moreover, the cultural and spiritual issues of the patient and his family must be understood by the healthcare workers at any level( (Kelley & Morrison, 2015).

  1. Identify two (2) effective communication techniques and two support services you may approach to provide a supportive environment and care to Ramesh and his family in this crucial moment of his life.
  2. Identify the signs of stages of dying in this scenario. Explain the importance of sharing accurate information with the family.

Ans: The signs in the scenario observed were at 12:00, the situation started to deteriorate. The patient became less responsive and started becoming less responsive. It was only seen as vocalizing and making abrupt noises while breathing. He started moving his limbs in all ways and the saliva was drooling without any control. Hiccups could be seen and he was becoming unconscious. The following symptoms must be accurately shared in order to inform them in future concerns and also abide by laws that state to provide all information related to the patients(Kelley & Morrison, 2015).

10.Describe the physiology of dying. Is it important to explain the same to Ramesh’s family or carer?

Ans: It is very important to inform the physiology of dying. The symptoms and the sighs help in assessing the diseases and it is useful for the family as well in future concerns. The physiology of dying was being unconscious, several hiccups, not able to breathe and making sounds while breathing, sudden uncontrolled movement of limbs.

11.Identify the signs of respiratory distress and swallowing difficulties in this scenario. What management strategies will you implement in accordance with Ramesh’s ACD?

Ans: The time when he was given water and he could not swallow it is the difficulty in swallowing. It can be assured that his food and windpipe were not capable of taking it that moment of fluctuations. He can be given fluids through the pipes and water line which is connected to the patient’s body.

  1. Note how you will manage the malignant wound of Ramesh in accordance with non-healing wound management strategies?

Ans: In the case of wound management which is malignant, the wound bed must be prepared in such a way that bacteria growth is stopped minimizing the odor and decreasing the risk of infection. The cleansing can be automatic or manual which can include cleaning the wound with saline or the enzymes(Sundaram et al., 2018).

  1. What are the signs of deterioration according to ACP or ACD guidelines? When and to whom should these signs be reported?

Ans: The signs of deterioration include dropping of vitals, fluctuation in speech, incontinence in urinary and bowel movements, and involuntary body movements. The signs must be reported to the doctors when the vitals deteriorate and the patients are not able to control the physiological processes of the body. It must be reported so that the patients can be survived and treated in the moment of time.

  1. How do you support the dignity of this person while providing care in their end-of-life-stages as well as after death?

Ans: The dignity of the person can be served by following the customs and rituals of his community. It can also be done by following his last wishes that he wants to be accomplished related to his family. The dignity can be maintained by not disclosing anything that defames his honor.

  1. Identify and reflect on the ethical issues in this scenario. Who is the appropriate person to discuss this issue according to organizational policies?

Ans: The ethical issue in this scenario is taking care of Ramesh's health and refusing the resuscitation if his health deteriorated. He further stated that he is just here for comfort and care. These are two ethical issues that are being addressed in the situation. The appropriate person to discuss about the organizational policies are the doctors who look after the case history of the patient.

  1. What are the legal responsibilities of an enrolled nurse when a patient dies who was under his/her care?

Ans: When a patient dies under a nurse's care, it is the duty of the nurse to take care of the physical assets of the patient until the last rites are performed. The actions must be taken to preserve the body from decomposition., The detail regarding the last vitals must be shared with the doctors to ensure transparency. The discharge process must be done quickly and properly to avoid any negligence in providing the body to the family members(Pesut et al., 2019).

  1. Explain the steps involved in death care/ care of the body after death in this scenario. Please include standard precautions, respect, dignity, and cultural, religious, spiritual, and individual customs in answering this question.

Ans: The nurse's role is important after the death of the patient. A nurse must follow the rules and regulations of the respective culture. It is her duty to provide emotional support to the family. She must also give her condolences to the family members. The cleaning of the boy has to be done. The sewing of the mouth and other openings has to be done. The last wish, if stated, of the person who died has to be delivered to the family(Pesut et al., 2019).

  1. Define bereavement care. Discuss the support needs of the family in this scenario. What are the resources available for those who require bereavement care?

Ans: Bereavement care is the emotional and psychological support given to the family by the nurses when their loved ones die. It is available at no cost. Bereavement care has an important role to play in palliative care. The traumatic death incidents in the family can affect the family members increasing the stress disorders. The family needed bereavement care as the eldest in the family passed away. The resources that are available are constant emotional support and communication related to counseling of the family members during the last official formalities are performed(Pattison et al., 2020).

  1. What sort of emotional support will you provide to Ramesh's family in relation to grief, loss, and bereavement?

Ans: the emotional support that can be given is providing constant hope and courage to deal with the situation and understanding their spiritual needs in order to ensure that the community-based requirements and not disrespected. The utmost priority must be to understand the need of the hour that the family requires emotional and mental support(Pesut et al., 2019).

  1. As an EN, identify your own needs for self-care and support. Explain how you will implement effective strategies to sustain your social and emotional wellbeing.

Ans: In order to provide self-care and support as an EN, one must follow a healthy lifestyle. The EN must follow exercises and do mediation to take care of their mental health. The proper form of food and having that time is also very important to cope up with the stress that is followed in the profession(Ross et al., 2017).

  1. Identify two (2) ethical implications of Advanced care planning and advance care directives. Explain how those implications can be addressed?

Ans: The two ethical implications are the power of attorney and decision regarding refusing to take treatment or withdrawing treatment. The implications can be addressed by proper planning and proper communication with the family members of the patients(Jimenez et al., 2018).

22.How will you encourage Carolyn in this scenario? Explain the importance of professional debriefings in the workplace.

Ans: Carolyn can be encouraged to take care of her health and provide herself space where she can relax and alter her mind in other things. There are many things she can learn for the future as well. The professional debriefings help in managing the situation in the professional environment. The debriefings also help as instructions to the junior nurses who assist the senior ones. The debriefings also help the doctors to study the symptoms and provide the nurses with extra information related to the disease(Allen, 2017).

References for Palliative Approach in Nursing

Allen, M. (2017). The SAGE Encyclopedia of Communication Research Methods. Retrieved from:

Carolan, C. M., Smith, A., & Forbat, L. (2015). Conceptualizing psychological distress in families in palliative care: Findings from a systematic review. Palliative Medicine, 29(7), 605–632.Retrieved from:

‌Centeno, C., Ballesteros, M., Carrasco, J. M., & Arantzamendi, M. (2014). Does palliative care education matter to medical students? The experience of attending an undergraduate course in palliative care. BMJ Supportive & Palliative Care, 6(1), 128–134. Retrieved from:

Jimenez, G., Tan, W. S., Virk, A. K., Low, C. K., Car, J., & Ho, A. H. Y. (2018). Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. Journal of Pain and Symptom Management, 56(3), 436-459.e25. Retrieved from:

‌Kelley, A. S., & Morrison, R. S. (2015). Palliative Care for the Seriously Ill. New England Journal of Medicine, 373(8), 747–755. Retrieved from:

Omeed Sizar, & Mohit Gupta. (2019, June 4). Opioid Induced Constipation. Nih.Gov; StatPearls Publishing. Retrieved from:

Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R., & Vis-Dunbar, M. (2019). Ethical, Policy, and Practice Implications of Nursesʼ Experiences With Assisted Death. Advances in Nursing Science, 42(3), 216–230.Retrieved from:

Pattison, N. A., White, C., & Lone, N. I. (2020). Bereavement in critical care: A narrative review and practice exploration of the current provision of support services and future challenges. Journal of the Intensive Care Society, 175114372092889. Retrieved from

‌‌‌Rosania, R., Chiapponi, C., Malfertheiner, P., & Venerito, M. (2016). Nutrition in Patients with Gastric Cancer: An Update. Gastrointestinal Tumors, 2(4), 178–187. Retrieved from:

Ross, A., Bevans, M., Brooks, A. T., Gibbons, S., & Wallen, G. R. (2017). Nurses and Health-Promoting Behaviors: Knowledge May Not Translate Into Self-Care. AORN Journal, 105(3), 267–275.Retrieved from:

‌‌Scarborough, B. M., & Smith, C. B. (2018). Optimal pain management for patients with cancer in the modern era. CA: A Cancer Journal for Clinicians, 68(3), 182–196. Retrieved from:

‌Schroeder, K., & Lorenz, K. (2017). Nursing and the future of palliative care. Asia-Pacific Journal of Oncology Nursing, 0(0), 0.Retrieved from:

Sundaram, G. M., Quah, S., & Sampath, P. (2018). Cancer: the dark side of wound healing. The FEBS Journal, 285(24), 4516–4534. Retrieved from:

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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