Essay On Patient With Life Limiting Illness

 

A life limiting illness can be defined as a disease that cannot be cured and will eventually result in the death of the patient. It can cause a significant negative impact on the quality of life of the patient. As the condition worsens, the care paradigm must shift from prolonging survival to alleviating symptoms and improving quality of life (Shrestha et al. 2019). This can be achieved by planning a holistic care plan for the patient that involves both pharmacological as well as non-pharmacological support to the patient. In this assignment, the case study of Ngarla Kngwarreye is studied to develop a care plan for a critically ill patient. Ngarla Kngwarreye is a 62-year-old woman who is suffering from end-stage Chronic Pulmonary Obstructive Disorder (COPD). Thus, in this paper, two key aspects of her health will be discussed with the help of one pharmacological intervention and one non-pharmacological intervention to relieve her symptoms.

 

From the PCOC assessment of Ngarla Kngwarreye, it is evident that she has significant difficulty in breathing. Thus, management of her breathlessness should be considered an important goal to improve her condition. The breathlessness may cause several other added psychological issues like distress and anxiety. Therefore, another important key area will be managing her anxiety and stress.

 

Dyspnea is often the most distressing symptom that COPD patients experience (O’Donnell et al. 2020). An effective pharmacological intervention for end-stage patients that can relieve Dyspnea is the administration of Morphine (Verberkt et al. 2021).

 

 

Morphine is an analgesic that can bind to delta, kappa as well as mu-opioid receptors. However, the maximum affinity of Morphine is for mu-opioid receptors that is present in the central nervous system (CNS) and the peripheral nervous system (PNS) (Murphy et al.  2021). Experiments suggest that it has the ability to reduce dyspnea by two possible mechanisms: Morphine can alter perception and reduce anxiety by acting directly on the central synapses or it can act on the medullary respiratory centres thereby reducing respiratory drive as well as associated corollary discharge (Soffler et al. 2017). This helps to reduce the mismatch between the motor drive and pulmonary afferent feedback.

 

Ngarla is in the deteriorating phase of COPD. Thus, the primary concern is to alleviate her symptoms thereby improving her quality of life. Studies have shown that administration of sustained-released Morphine in low doses can be effective in reducing breathing difficulties in palliative care patients with COPD (Ferreira et al. 2022). In the case study provided, it is visible that the PRN medication of Ngarla also mentions the use of Morphine twice daily. Morphine has a short half-life and thus can be easily absorbed in the gastrointestinal tract when consumed orally thereby producing a calming effect (Laycock and Bantel 2019). In addition, Ngarla is in the end stage of COPD thus, the use of Morphine will not affect her lifespan; instead, its use will alleviate breathlessness.

 

 

Ngarla is a First-nations person. Thus, Ngarla and her family’s health beliefs are based on traditional health beliefs of the First-nation peoples. They believe in supernatural custodians for their health issues and diseases (Senior et al. 2018). Thus, administering Morphine might not be acceptable to Ngarla and her family. Hence, it is important that the nurse provide adequate knowledge regarding the illness, the symptoms and the usefulness of the selected medicine or treatment without demeaning or being judgemental about their beliefs (Kaihlanen et al. 2019). Thus, before administering Morphine, Ngarla and her family members should be educated and their concerns must be cleared.

The common side effects observed in the administration of Morphine include nausea, vomiting, constipation and sedation (Murphy et al. 2021). An adverse side effect of Morphine administration is respiratory distress. Respiratory distress may occur because Morphine reduces respiratory rate and thereby increases the time involved in expiration (Oderda et al. 2019). Thus, the most prominent side effect of Morphine is respiratory distress because of the lowering of breathing rate. The chances of respiratory distress can be minimised if Morphine administration is mediated in small doses.

 

 As discussed, Ngarla and her family have different cultural beliefs and practices associated with their health. Thus, it is important that proper education is provided to them about the use and importance of Morphine. In addition, her family must also be informed about the dosage and route of administration of Morphine. Proper education and knowledge about their health issues and treatment plan help a patient better adhere to the intervention (Taibanguay et al. 2019).

 

 

Morphine can be an effective medication for palliative care patients as it reduces pain and breathlessness. Studies have shown that low doses of oral sustained-release Morphine, in the range of 10 to 30 mg, produce effective results (Johnson and Currow 2020). In addition, Morphine does not cause hypercapnia or hypoxia while reducing the respiratory rate. In addition, it helps to provide relief by reducing pain at the end-of-life.

 

 

It is important for a nurse to provide psychological support to Ngarla so that the quality of her life can be improved. To reduce her anxiety it is important that her breathing difficulty be reduced. A non-pharmacological intervention to reduce breathing difficulties is teaching Ngarla breathing exercises.

Breathing exercises help COPD patients to increase the strength of the breathing muscles, receive increased amounts of oxygen, and reduce the effort required for breathing. Exercises like Diaphragmatic breathing, deep breathing and pursed-lip breathing can be effective exercises for reducing the shortness of breath (Mehandiratta and Gugnani 2020). Breathing exercises assist the accumulated air to get out of the lungs and increase the level of oxygen consumption. This helps in reducing stress from the pulmonary muscle through effective muscle relaxation (Ubolnuar et al. 2019). Apart from that, breathing exercises improve the overall psychological well-being of the patient by reducing the amount of stress and anxiety of the patient. In addition, it also helps the diaphragm to perform its function adequately. Teaching meditation will also help to relax Ngarla. These exercises will also help improve the quality of sleep (Chegeni et al. 2018).

 

 

Ngarla is in the end stage of COPD. Thus, it is important that all the interventions that are to be implemented focus on improving her quality of life without creating additional stress on her. Practicing these exercises is simple yet effective. They can be performed by staying in the bed, lying in the supine position. According to Johnson and Currow (2020), patients who have depression and anxiety do not receive the proper benefits of Morphine. Thus, it is important that Ngarla’s anxiety be reduced so that the pharmacological intervention can work effectively.

 

The exercises may cause fatigue initially. This is because it will require the patient to use extra effort to make their diaphragm and lungs use their full capacity. This can be difficult at first and thus may be tiring for Ngarla. Thus, a physiotherapist guidance and training will help reduce this fatigue through proper practice. In addition, the supine position may cause complications in performing these exercises (Chanif and Prastika 2019). To avoid that, patients can be repositioned in an upright position.

 

 

The use of effective breathing exercises will require proper training, practice and education. Training Ngarla is necessary so that she can understand the process and implement them effectively. Apart from that, Ngarla’s family members must be educated about how they can provide support and motivate Ngarla to practice these exercises. They must also be taught about the positioning requirements. In addition, the constant motivation and support of her family will help encourage Ngarla to implement the exercises more and thereby reduce her anxiety (Bombard et al. 2018). Thus, educating Ngarla about breathing techniques and its correct implementation will reduce her distress due to breathing difficulties.

 

Breathing exercises do not require any positioning or movement of the patient. However, if patients are repositioned in the semi-fowler position from the supine position at regular intervals, it will increase the effectiveness of the exercises. This position elevates the patient’s head at an angle of 30 to 45 degrees with the legs placed straight or bent in front (Maria and Hasaini 2019). This position is effective as it releases pressure and reduces the chances of pressure ulcer formation. In addition, the semi-fowler position also increases the effectiveness of the breathing exercises. According to Chanif and Prastika (2019), semi fowler position is the most effective position for effective breathing. Thus, regular repositioning can help achieve the successful implementation of breathing exercises.

 

Thus, from the above discussions, it can be concluded that a person suffering from a life-limiting illness requires both pharmacological as well as non-pharmacological support. However, their care provision should focus on improving the quality of their life as well as providing comfort and not on prolonging the lifespan of the patient. This paper presented two interventions that focus on reducing the breathing difficulties along with anxiety and distress because of troubled breathing in Ngarla Kngwarreye. Providing Morphine will help to reduce the respiratory drive and thus help with dyspnea. In addition, teaching her breathing techniques will also improve breathing along with reducing anxiety. It will also improve sleep quality and thereby reduce fatigue. Thus, implementing these two interventions will help to improve the quality of Ngarla’s life and help her have a peaceful death.

 

Bombard, Y., Baker, G.R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., Onate, K., Denis, J.L. and Pomey, M.P., 2018. Engaging patients to improve quality of care: a systematic review. Implementation Science, 13(1), pp.1-22.

 

 

Chanif, C. and Prastika, D., 2019. Position of Fowler and Semi-fowler to Reduce of Shortness of Breath (Dyspnea) Level While Undergoing Nebulizer Therapy. South East Asia Nursing Research, 1(1), p.14.

 

 

Chegeni, P.S., Gholami, M., Azargoon, A., Pour, A.H.H., Birjandi, M. and Norollahi, H., 2018. The effect of progressive muscle relaxation on the management of fatigue and quality of sleep in patients with chronic obstructive pulmonary disease: A randomized controlled clinical trial. Complementary therapies in clinical practice, 31, pp.64-70.

 

 

Ferreira, D., Kochovska, S., Honson, A., Phillips, J. and Currow, D., 2022. Patients’ and their caregivers’ experiences with regular, low-dose, sustained-release morphine for chronic breathlessness associated with COPD: a qualitative study. BMJ Open Respiratory Research, 9(1), p.e001210.

 

 

Johnson, M.J. and Currow, D.C., 2020. Opioids for breathlessness: a narrative review. BMJ supportive & palliative care, 10(3), pp.287-295.

 

 

Kaihlanen, A.M., Hietapakka, L. and Heponiemi, T., 2019. Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC nursing, 18(1), pp.1-9.

 

 

Laycock, H. and Bantel, C., 2019. Opioid mechanisms and opioid drugs. Anaesthesia & Intensive Care Medicine, 20(8), pp.450-455.

 

 

Maria, I. and Hasaini, A., 2019, October. The effect of semi fowler position on the stability of breathing among asthma patients at ratu Zalecha hospital martapura. In Third International Conference on Sustainable Innovation 2019–Health Science and Nursing (IcoSIHSN 2019) (pp. 242-245). Atlantis Press.

 

 

Mehandiratta, C. and Gugnani, A., 2020. Effect of Diaphragmatic Breathing and Pursed Lip Breathing In Improving Dyspnea-A Review Study. European Journal of Molecular & Clinical Medicine, 7(06), p.2020.

 

 

Murphy, P.B., Bechmann, S. and Barrett, M.J., 2021. Morphine. In StatPearls [Internet]. StatPearls Publishing.

 

 

O’Donnell, D.E., Milne, K.M., James, M.D., de Torres, J.P. and Neder, J.A., 2020. Dyspnea in COPD: new mechanistic insights and management implications. Advances in

therapy, 37(1), pp.41-60.

 

 

Oderda, G.M., Senagore, A.J., Morland, K., Iqbal, S.U., Kugel, M., Liu, S. and Habib, A.S., 2019. Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden. Journal of Pain & Palliative Care Pharmacotherapy, 33(3-4), pp.82-97.

 

 

Senior, K., Chenhall, R., Hall, J. and Daniels, D., 2018. Re-thinking the health benefits of outstations in remote Indigenous Australia. Health & Place, 52, pp.1-7.

 

 

Shrestha, A., Martin, C., Burton, M., Walters, S., Collins, K. and Wyld, L., 2019. Quality of life versus length of life considerations in cancer patients: a systematic literature review. Psycho‐oncology, 28(7), pp.1367-1380.

 

 

Soffler, M.I., Rose, A., Hayes, M.M., Banzett, R. and Schwartzstein, R.M., 2017. Treatment of acute dyspnea with morphine to avert respiratory failure. Annals of the American Thoracic Society, 14(4), pp.584-588.

 

 

Taibanguay, N., Chaiamnuay, S., Asavatanabodee, P. and Narongroeknawin, P., 2019. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient preference and adherence, 13, p.119.

 

 

Ubolnuar, N., Tantisuwat, A., Thaveeratitham, P., Lertmaharit, S., Kruapanich, C. and Mathiyakom, W., 2019. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Annals of rehabilitation medicine, 43(4), pp.509-523.

 

 

Verberkt, C.A., van den Beuken-van, M.H., Dirksen, C.D., Schols, J.M., Wouters, E.F. and Janssen, D.J., 2021. Cost-effectiveness of sustained-release morphine for refractory breathlessness in COPD: A randomized clinical trial. Respiratory Medicine, 179, p.106330.