Case presentation template
Client General Information
Age:73 years, 2 months Gender (Circle): Male/ Female / Not mentioned Resuscitation
status: Not recorded
Is the client culturally and linguistically diverse (CALD)? (Circle): Yes / No
Is the client Aboriginal and/or Torres Strait Islander? (Circle): Yes / No
Client Health History
Reason for current admission (brief statement):
Fracture of vertebra and thoracic bony structures; superficial hip injury (abrasion, blister, contusion).
Past Medical/ surgical history: (include duration or year of occurrence if available):
● Glioblastoma (fast-progressing brain tumour)
● COPD
● Obstructive Sleep Apnea (OSA) – severe
● Hypertension
● Smoker (history)
Psychosocial history:
● Past head trauma
● Cognitive difficulties
● Physical symptoms: headache, fatigue, balance issues, dizziness
Applied anatomy, Aetiology and Pathophysiology (relevant to this client)
The client’s condition is the result of many diseases that strongly affect both her abilities and overall well-being.
The brain tumor known as glioblastoma multiforme (GBM) is a grade IV astrocytoma, starting in the frontal or
temporal lobes. This condition interferes with normal brain functions by causing some brain cells to die, with
swelling and by raising pressure in the skull, resulting in seizures, mental changes and losing balance (McKinnon et
al., 2021).
The presence of COPD affects breathing and leads to hypoxia and hypercapnia, reducing how much exercise a
person can do (Bubu et al., 2020). When combined with OSA, a disorder that causes frequent nighttime pauses in
oxygen and broken sleep, the client feels tired during the day, has trouble with thinking and their heart works
under more stress (Cousins et al., 2020).
A vertebral fracture involving the thoracic spine can press on nerves, causing soreness, less movement and a
higher risk of pneumonia or becoming deconditioned (Zanatta et al., 2020). Furthermore, hypertension can
worsen changes in brain blood flow which is extremely dangerous for a patient with a brain tumor (Zanatta et al.,
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Case presentation template
2020).
Ultimately, the client’s injuries are likely caused by a fall which occurs due to being frail, having balance problems
and neurological problems. Being frail raises the risk of minor injuries and deterioration in older adults is related
to their total number of conditions and brain function (Flyum et al., 2022; Albasha et al., 2023).
Client Health Status and Plan of care advised
Client Health Status and Plan of Care on Admission:
After being admitted, the client reported localized pain to the hip, head and rib which were related to confirmed
injuries to the vertebral bone and hip following a suspected fall. Even though the vital sign measurements were
not recorded, the clinical assessment points to her being stable. As the assessment took place at the moment, no
blood tests were present. The X-ray showed the full severity of the broken bones.
Immediately, the client’s care approach was tailored to comfort care, considering glioblastoma’s symptoms and
the weakness it caused. She was given 2L oxygen through her nose and was prescribed medications taken by
mouth to help with her symptoms. IV fluids were not required for this patient.
Nurses initially took care of the patient’s comfort and safety.
The patient was moved twice a day in bed using SATH and a sling hoist when required.
The client scored 18 for high falls risk which required them to sleep in a low bed, have the floor clear and access a
call bell.
They are in line with well-established strategies that include making changes to the environment and supplying
equipment to minimize the consequences of falls.
Progress during care:
There were no specific patterns found in vital signs over the course of care, so it is difficult to assess the client’s
physiological state. In palliative health care, watching vital signs regularly helps palliative teams discover sudden
changes and treat these patients comfortably (Sjöberg et al., 2021). Due to the client’s approaching last days,
health care professionals may have chosen to limit their attention to avoid making the client uncomfortable.
There were no new blood tests or examinations needed during the client’s stay which further showed that
treatment was shifting toward palliative care. This goes along with the person-centred approach, in which
minimal care is provided in the end to protect the patient from being overburdened (NMBA, 2023).
The care team revised the plan, as the client’s health was declining: every medication was stopped, possibly due
to their limited use or negative side effects, as advised by current palliative care guidelines (Zanatta et al., 2020).
Patients were given a greater emphasis on non-drug pain treatments.
Instead of manually lifting the patient, the nurses now use a sling hoist for all transfers. It became necessary as
the patient’s muscles weakened and they needed more physical assistance which is often seen in glioblastoma
patients (McKinnon et al., 2021).
They highlight proper actions that value dignity, ensure safety and provide comfort during the end of life.
Observations and Investigations Analysis:
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Abnormal findings became evident in the client at both the time of admission and during subsequent observation.
These included a high fall risk score (18), suggesting that the person has major issues with moving and is at danger
in the environment. Meanwhile, indications of mental decline connected to her glioblastoma and previous head
injuries became evident. She also showed signs of physical problems, as she complained about pain in her hips
and ribs due to a fall.
Her reported pain and inability to walk were confirmed by X-rays of her backbone which showed fractures. The
patient was kept comfortable, so no additional tests or labs were necessary according to palliative care. Her
limited ability to walk and stand stably is probably due to the tumor disrupting the brain’s functions (McKinnon et
al., 2021).
It is common for older adults to experience these symptoms, so it is necessary to blend medical data with the
clinical picture for the right treatment (Fuller et al., 2021; Flyum et al., 2022).
Rationale for Changes and Interventions:
The client’s support team put various measures in place to manage the client’s getting worse. Due to decreased
neurological and muscular function, the use of a sling hoist for moving the person was required since manual help
was no longer practical or safe (Flyum et al., 2022).
By stopping the medications, palliative care teams made it clear that active treatment was over and comfort was
now the priority. It follows the concepts of end-of-life care by focusing on symptom management, avoiding
additional complications and reducing the use of difficult interventions (Sjöberg et al., 2021; Zanatta et al., 2020).
Keeping the client on 2L oxygen was valuable as she struggled with chronic obstructive pulmonary disease and
severe obstructive sleep apnea. Oxygenation therapy was not given to treat hypoxia, but rather to relieve her
shortness of breath and anxiety, as directed by the best palliative care guidelines (Cousins et al., 2020; NMBA,
2023).
Applying these techniques highlights why ensuring dignity, safety and comfort matters at this time.
Nursing Goals and Interventions:
Goal 1: Guide patients to avoid additional harm
Intervention 1: Place the client in a low-low bed and lay down floor mats to decrease chances of injury from
falling.
Intervention 2: Regularly check neurological and movement improvements so early action can be taken.
Intervention 3: Remind the client to push the call bell for their needs, as this ensures they can be looked after and
remain safe.
Such recommendations are consistent with how falls are prevented in long-term care settings (Albasha et al.,
2023).
Goal 2: Ensure Comfort and Relief From Pain
Intervention 1: Administration of analgesics, on orders, helps relieve pain caused by fractures and tumours.
Intervention 2: Use an assessment tool for pain often to guide changes in the treatment routine.
Intervention 3: Try to make non-medical strategies such as re-arranging, using supports and reassuring words
available to the patient.
The tactics are in line with the ideas of person-centered, symptom-responsive palliative care (Sjöberg et al., 2021).
Goal 3: Improve the Amount of Oxygen and Relieve Shortness of Breath
Intervention 1: Give the planned nasal oxygen to the patient through the nose to reduce their shortness of breath
and ease their anxiety.
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Intervention 2: Help the patient sit with correct posture to give the lungs room to expand.
Intervention 3: Regularly measure respiration and blood oxygen levels to ensure patients remain safe and to
identify any changes for the worse.
These interventions rely on the best methods for handling palliative pulmonary symptoms (Cousins et al., 2020).
Care Plan review
Review the nursing care plan of the client from admission to current status. Analyse if the interventions
carried out were effective or how the team could change them and explain briefly in the space given below.
Discuss within a group/ or with your supervisor.
The efforts and strategies used have addressed the client’s palliative needs reasonably well. Moving from
partial support transfers to a sling hoist is a sensible way to support mobility planning. Discontinuing active
drugs suggests moving toward providing comfort care as suggested by guidelines for end-of-life care
(Zanatta et al., 2020). Yet, early documentation of vital signs can help guide decisions and it is important to
include comfort devices such as pressure-relief devices promptly. Teamwork from different fields is vital to
keep up with new challenges. Services for patients are based on national standards such as the NSQHS
Comprehensive Care Standard (ACSQHC, 2021).
References
McKinnon, C., Nandhabalan, M., Murray, S. A., & Plaha, P. (2021). Glioblastoma: clinical presentation, diagnosis,
and management. Bmj, 374. Doi: https://doi.org/10.1136/bmj.n1560
Flyum, I. R., Gjevjon, E. R., Josse-Eklund, A., Lærum-Onsager, E., & Borglin, G. (2022). Nursing, frailty, functional
decline and models of care in relation to older people receiving long-term care: a scoping review protocol. BMJ
open, 12(8), e061303. Doi: https://doi.org/10.1136/bmjopen-2022-061303
Bubu, O. M., Andrade, A. G., Umasabor-Bubu, O. Q., Hogan, M. M., Turner, A. D., de Leon, M. J., ... & Osorio, R. S.
(2020). Obstructive sleep apnea, cognition and Alzheimer's disease: a systematic review integrating three decades
of multidisciplinary research. Sleep medicine reviews, 50, 101250. Doi:
https://doi.org/10.1016/j.smrv.2019.101250
Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, S. (2023).
Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a
systematic review. BMC geriatrics, 23(1), 47. Doi: https://doi.org/10.1186/s12877-023-03738-z
Australian Health Practitioner Regulation Agency (AHPRA). (2023). National safety and quality health service
standards (2nd ed.). Available at:
https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_ns
qhs_standards_second_edition_-_updated_may_2021.pdf
Zanatta, F., Maffoni, M., & Giardini, A. (2020). Resilience in palliative healthcare professionals: a systematic
review. Supportive Care in Cancer, 28, 971-978. Doi: https://doi.org/10.1007/s00520-019-05194-1
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Fuller, G., Pandor, A., Essat, M., Sabir, L., Buckley-Woods, H., Chatha, H., ... & Turner, J. (2021). Diagnostic
accuracy of prehospital triage tools for identifying major trauma in elderly injured patients: a systematic review.
Journal of Trauma and Acute Care Surgery, 90(2), 403-412. Doi: https://doi.org/10.1097/ta.0000000000003039
Sjöberg, M., Edberg, A. K., Rasmussen, B. H., & Beck, I. (2021). Documentation of older people’s end-of-life care in
the context of specialised palliative care: a retrospective review of patient records. BMC palliative care, 20(1), 91.
Doi: https://doi.org/10.1186/s12904-021-00771-w
Cousins, J. L., Wark, P. A., Hiles, S. A., & McDonald, V. M. (2020). Understanding clinicians’ perceived barriers and
facilitators to optimal use of acute oxygen therapy in adults. International Journal of Chronic Obstructive
Pulmonary Disease, 2275-2287. Doi: https://doi.org/10.2147/COPD.S263696
Nursing and Midwifery Board of Australia (NMBA). (2023). Professional standards for practice for registered
nurses. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx
Australian Commission on Safety and Quality in Health Care. (2021). Comprehensive care standard.
https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard
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