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Decreased Appetite and Breathlessness: A Care Plan

Palliative care focuses on reducing pain and other related health problems due to life limiting diseases. For example, take the case of a cancer patient. The patient might have severe and unbearable physical pain and other symptoms. Here, palliative care takes care of the patient by helping to reduce the severity and provide comfort. “The term health needs ought to include at least social care, accommodation, health care, finance, education, employment, leisure and transport” (Asadi- Lari, Packham & Gray, 2003, ‘Health needs’ the ‘healthcare needs’, para.1).

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Principle of palliative care

“To provide health care that’s relevant to community needs, you need to understand the experiences, preferences and care requirements for people with life-limiting illnesses” (Module 1: principles of palliative care, n.d., p.1).

Concepts of Palliative care

Palliative care can be defined as a method of clinical care which is used to reduce the severity of symptoms of diseases rather than curing the disease. The ultimate aim is to cut short the degree of suffering by the patient and thus to improve the standards of life of people suffering from vital diseases. This system of patient caring is usually associated with hospitalisation and medications. There are some diseases such as cancer, leprosy for which palliative care is very much helpful to the patient to relieve from the serious and severe symptoms, to a large extent.

Clinical History

Herbert was diagnosed with mild class II heart failure before five years. At that time he felt difficulty in performing physical activities that resulted in fatigue and palpitation, feeling comfortable at rest. While he was spending his holidays in Northern Australia, he was noticed more tired and he felt difficulty in breathing and had lack of appetite. After spending his holidays, he was diagnosed as having heart failure of Class III, which is moderate. He is unable to perform any physical activity and “less than ordinary activity causes fatigue, palpitation or dyspnoea.” Herbert’s main clinical symptoms were shortness of breath, fatigue and lack of appetite. (Primary care quality and information services, 2008, p.8).

Social History

Self-funded retiree lives with wife, diagnosed with heart failure and type 2 diabetes before five years.

Health needs

“Shortness of breath at rest occurs mostly when people lie down because fluid seeps throughout the lung tissue.” (Symptoms, 2006, Causes, para.3).

The major indicators of breathlessness in a patient are the following

Blue colour in lips, fingers and “chest moving in an unusual way as the person breathes (may indicate an airway or chest injury)” (Breathing difficulties- first aid, 2006, Symptoms, para.2). Pain in the chest region is associated with breathlessness. “Light-headedness” is a temporary loss of consciousness due to a drop in blood flow to the brain. The episode is brief (lasting less than a couple of minutes) and is followed by rapid and complete recovery” (Fainting, 2009).

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Besides this, the patient may be suffering from cough, fever, and production of abnormal sounds while breathing. There is a set of care plan for the patients suffering from heart disease. Care plan concentrates on reducing and eliminating the feel of breathlessness. “Ensure rest & sleep” is the finest care to the patient. (Nursing care plan for MCI, 2007). “Morphine” is used to reduce the sensation of breathlessness. (Morrow, 2009).

Altering the environment and atmosphere in which patient lives, such as cooling air, making low humidity, making available fan, calm room and lightweight cloth will help the patient. Physical exercise like concentrating on deep breathing, relaxation techniques such as hearing music and using massage or other relaxing touch of the patient’s choice, and providing emotional support such as “listening closely to what the patient has to say and providing reassurance” are also some of the methods used in palliative care. (Morrow, 2009, Non-medical treatments, para.5).

Care plan for breathlessness

The patient was suffering from severe health problems such as extreme tiredness, limited physical activity, palpitation, breathlessness and decreased appetite. The ultimate goal of care plan is to alleviate or reduce the severity of these health problems and thus to acquire a comfortable physical state. In this context what the patient needs is a care plan involving both supporting and treatment approaches. The supporting approaches suggested are physical exercises, holistic methods, familial support and care, tension-free homely atmosphere etc. The treatment methods can be divided into two. They are pharmacological (using medicine) and non-pharmacological.

In pharmacological methods, medicines which can be used to treat the patient suffering from breathlessness are Parenteral, Opioids, Fentanyl, Methadone, Morphine, Oxycodone, Anti-cholinergics, Anti-tussives and Anxiolytics. Along with pharmacological treatment, for getting better result, non-pharmacological caring methods should be practiced because both these methods are complementary. Non-pharmacological treatment approaches include three methods, namely, “environmental, complementary treatments and psychosocial and interpersonal methods.” (Palliative care and symptom management resource, 2008, p.95).

Under environmental treatment approach these methods can be adopted by the patient.

  1. Sit in an upright position with the help of pillows.
  2. Provide increased air circulation through fan or opening windows.
  3. Practice relaxation methods
  4. Stay away from dust and irritants

The patient is suggested to practice complementary methods such as acupuncture and acupressure. Psychosocial and interpersonal methods could be used to minimize shortness of breath. The patient should identify the goals of treatment. Mechanical, non-invasive ventilation and oxygen therapy are also practicable. Fulfilling the various needs of the patient would be helpful in the treatment course (Palliative care and symptom management resource, 2008).

Care plan for decreased appetite

There are two mutually supported care plans to face the health problem of decreased appetite. They are intake of drugs and home care. Drugs include “Amphetamines, Antibiotics, Chemotherapy drugs, Codeine, Digitalis, Demerol, Morphine and Sympathomimetics,” (Appetite- decreased, 2009). Home care includes intake of nutritious and high calorie food in small amounts several times a day. Additionally, liquid protein intake is recommended. Family members are advised to provide the favorite food of the patient (Appetite- decreased, 2009).

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When you feel hungry take food and do not wait for meal time.

Try to make the meal a happy event rather than a battle.

Monitoring and evaluation

In the case of Herbert, shortness of breath and decreased appetite are major symptoms that he is suffering from. Two approaches are suggested to get rid of shortness of breath and decreased appetite. The patient has to follow pharmacological method along with non-pharmacological method. When the patient follows pharmacological method, while monitoring one should ensure that the patient takes medicines of prescribed dosage, schedule, duration and manner.

Non- pharmacological method supports the patient from the surroundings. While monitoring, one should be alert on whether the patient follows the instructions regarding the positioning of the body while sitting, practicing relaxation methods and its intensity and duration. In addition to this, the physical atmosphere of the patient’s residence should be examined and if needed, appropriate steps should be taken to make it dust free and airy.

Two methods are suggested to come out of decreased appetite — pharmacological method and home care. Family members should ensure that the patient takes the medicine in time and he has access to his favourite food. Intake of medicine alone may cause side effects. Home care is the best method to increase the appetite of the patient. Herbert felt tiredness because of the two symptoms — decreased appetite and shortness of breath. If he follows the different approaches given above, he can get relief from tiredness.

Evaluation consists of raising some questions like whether the goals are achieved, in what way this care plan is executed, were there any problem which hindered execution, were there alternatives, the responses from the patient and stake holders, what is the outcome and its impact on the patient. While considering this particular case, one should cross-check whether the care plan was successful in alleviating the health problem of the patient.

Then comparison between the health condition before and after the execution of care plan is necessary to understand and calculate the magnitude of the change that has happened. The roles of different persons involved are estimated while evaluating this care plan. If the care plan is a failure, alternatives should be chosen according to client preference. Support from the family members is a factor that leads to the success in the implementation of the care plan. Strategies to ensure support from the family members are inevitable. The problem and difficulties faced by the family members while taking care of the patient’s wellness also should be considered.

Conclusion

This paper presents a ‘care plan’ for the reduction of two symptoms — lack of appetite and breathlessness due to heart failure. This paper is relevant because heart disease is one of the major diseases. Palliative care focuses on the cutting down of the severity of the health problem. Finally, evaluation and monitoring of the care plan is presented.

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Reference List

Appetite- decreased: Causes. (2009). Medline Plus: Trusted Health Information for You. Web.

Appetite- decreased. (2009). Medline Plus: Trusted Health Information for You. Web.

Asadi- Lari, M., Packham, C., & Gay, D. (2003). Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services: ‘Health needs’ the ‘healthcare needs’. Health and Quality of Life Outcomes. 1(26). Pub Med Central Journal. Web.

Breathing difficulties- first aid: Symptoms. (2009). Medline Plus. Web.

Fainting. (2009). Medline Plus. Web.

Module 1: principles of palliative care. (n.d.). PCC4U: Palliative care for Undergraduates (PCC4U): A Learning Resource for Health Care Students. 1. Web.

Morrow, A. (2009). Dismiss the dyspnea: Managing shortness of breath: Medical treatments. About.: Palliative care. Web.

Morrow, A. (2009). Dismiss the Dyspnea: Managing shortness of breath: Non-medical treatments. About.com: Palliative Care. Web.

Nursing care plan for MCI. (2007). Nursing and Medicine. Web.

Palliative care and symptom management resource. (2008). American Association of Critical- Care Nurses. Web.

Palliative care and symptom management resource: Are there any non-pharmacologic management strategies used for managing dyspnea. (2008). American Association of Critical- Care Nurses. Web.

Primary care quality and information service. (2008). Chronic heart failure: Quality improvement toolkit: Appendix A- New York heart association: Class III (moderate). 8. Web.

Symptoms: Causes. (2006). The Merck Manuals: Online Medical Library. Web.

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