Download - Hospice Care Plan
-
7/28/2019 Hospice Care Plan
1/9
TCC Nursing Program
NURS 2543 Nursing Promotion for Quality of Life
Hospice Patient/Family Data Sheet
1. Past Medical History and reason for Hospice care
2. Family/Caregiver Structure
3. Describe Environment
-
7/28/2019 Hospice Care Plan
2/9
TCC Nursing ProgramNURS 2543 Nursing Promotion for Quality of Life
Functional Health PatternsSubjective and Objective Data
Health PerceptionHealth Management: The client was admitted and is
maintained on hospice due to the current diagnosis of rectal cancer
which is terminal. Patient is a 75 y/o African American female. Theclient also has a diagnosis of dementia. The patient youngest daughter is
her live in primary caregiver. The primary caregiver takes the patients to
all of her appointments in addition to ensuring that the patient gets hermedications as ordered. The patients caregiver stated that healthcare
providers have done as expected and she is currently happy with thelevel of care her mother receives.
CognitivePerceptual: pt. has PERRLA, was oriented to person and
place, patient does not use hearing air or glasses, wears dentures,
hearing is slightly diminished. Patient denies having pain; patient doesnot reveal any consciousness of memory changes but caregiver states
that there have been moderate memory changes in the last 6 months.
Patient demonstrated awareness of body parts. Education level was noaddressed.
NutritionMetabolic: Pt. caregiver statespt.s appetite is poor to fair.He patient stated that she does not have any problems with chewing or
swallowing. The patient does wear dentures and did not have them in
her mouth during the assessment. Mucous membranes are pink, moistand intact. Patient has recently been suffering from nausea but vomiting
has not presented itself at this time. Patients caregiver states that thepatient has lost at total of 7 pounds in the last 30 days. Oral temperature
97.9 degrees Fahrenheit. Skin was warm and dry with yellow
undertones. Skin was intact, no open sores noted. Heels of both feet
were spongy but intact. Patient takes Megace as an appetite stimulant.
Self-Perception -Self-Concept: Questions about the patients self andabilities were not answered by the patient for lack of time. Illness has
affected thepatients physical mobility and the ability to participate in
once meaningful interactions. The patient is limited to contact with theyoungest daughter with occasional visits from her other 7 children. Th
patient is no longer to independently shop for herself or prepare herown meals. The patient was relaxed and lying in bed, unguarded
behavior. Unable to assess geriatric depression using standard
measuring the tool due to the lack of time.
Activity-Exercise: Patient can move around fairly easy with mildassistant when first getting out of bed in the morning. Patient does not
smoke, and has mild shortness of breath on exertion, patient states that it
was tolerable and that she was not experiencing any shortness of breathat this time. Patient has a congestive heart failure; pt. states that she is
not currently having cardiac pain nor has she experienced any recently.Lungs were CTA; respiratory rate of 18 breaths per minute visually, no
cough present at this time. Apical heart rate 86 beats per minute and wasirregular in rate and rhythm. Edema present in lower extremities
bilaterally and was not pitting. Lower extremities were warm and dry
Role Relationship: The patient who is a mother of 8 grown children isnow being cared for by her youngest child. The youngest child is now
the primary caregiver. Patient was a homemaker. The patient is no
longer available to do things as independently as she did before thebeginning of the disease process and she is unable to live by or care fo
herself. The daughter seemed distant while hospice was with thepatient; she answered questions but appeared to be very tired. I
visualized no interaction between the daughter and the patient.
-
7/28/2019 Hospice Care Plan
3/9
with patches of hair present. Pedal pulses were present and palpable.
Blood pressure 193/89. Capillary refill less than 3 second in upper and
lower extremities. Negative Holmans sign, strength in upper and lowerextremities was equal bilaterally. Patient uses a rolling walker outside of
the home. Patients caregiver states that the patient easily tires whencompleting simple tasks and naps frequently.
Elimination (urinary/bowel): Patient stated that she has problemsurinating with a major complaint of pain in her lower back and some
hesitancy as well as a decrease in the amount of urine she passes.Functional incontinence with bowel and bladder. Caregiver states thatthe patient does not drink much because she is not thirsty. Last BM
9/18/12 which was soft, semi formed and dark brown. Patient does nottake any stool softeners or laxatives because she states that most of her
stools are soft or liquid. Abdomen was soft and non-tender, bowel
sounds were active in all quadrants, no pain or discomfort uponpalpation, no bulges or masses felt. Care giver states the use of briefs at
night and during the day due to the functional incontinence.
Sexuality-Reproductive: Patient is and presents herself as a female, shwears make up and wears dress clothes specific to a woman. Patient
gets yearly mammograms. All others sexual/reproductive patterns wernot addressed.
Sleep-Rest: Patient has no specific sleep patterns due to the variance
because of daytime sleepiness and frequent naps. Caregiver states thatthe patient lays down beginning at 10pm and rises from bed around
10am. Main factors that influence sleep are frequent daytime napping
and diarrhea during the night. Upon my assessment of the patient is
visibly clear that she was tired, eyes were swollen with dark circlesunderneath and was frequently yawning. Patients attention span wasshort.
Coping-Stress-Tolerance: Patient denies any use of alcohol or illegal
drugs. Support systems consist of children not all of which participatein her care. Lack of eye contact. Patient had a bright affect. Patient
denies having anxiety. No specific coping mechanisms or stressors
noted.
Value-Belief: Patients home was decorated with religious items, apicture of the last supper, a picture of Jesus, crosses, a crucifix on the
wall in the bedroom and a bible on the bedside table. Patient has a
DNR. Questions regarding specific religious beliefs were not askeddue to the lack of time.
-
7/28/2019 Hospice Care Plan
4/9
TCC Nursing ProgramNURS 2453 Nursing Promotion for Quality of Life
Hospice Medication List
Date
Started
Med/Route,
Frequency,
Dosage
Normal Dose
Range
1) Classification,
2) Action
3) Reason Rxd forTHIS Client
1) Nursing Precautions
2) Common Side Effects,
3) Nursing Implications
Clients Response toMedication
-
7/28/2019 Hospice Care Plan
5/9
TCC Nursing Program
NURS 2453 Nursing Promotion for Quality of Life
Working Copy
Nursing Diagnosis
Knowledge deficient
Supporting Data
Meds
Labs
Nursing Diagnosis
Ineffective health
maintenanceSupporting Data
Meds
Labs
Nursing Diagnosis
Risk for electrolyteimbalance
Supporting Data
Meds
Labs
Nursing Diagnosis
Risk for caregiver role
Strain (daughter)Supporting Data
Meds
Labs
Nursing Diagnosis:
decreased cardiac tissueperfusion
Supporting Data
Meds
Labs
Nursing Diagnosis
Chronic confusion
Supporting Data
Meds
Labs
Client/Family
75 y/o African American
female with a Hospicediagnosis of rectal cancer.
Daughter is primary
caregiver
Reason for Needing
Hospice:
Rectal Cancer
Key Assessments:
Key learning need (Hospice)
Management of hypertension
history of non-compliance
Nursing Diagnosis: risk
for ineffective GI tissueperfusion
Supporting Data
Meds
Labs
-
7/28/2019 Hospice Care Plan
6/9
TCC Nursing ProgramNURS 2453-Nursing Promotion for Quality of Life
Teaching PlanNursing Diagnosis
Goal ____________________________________________________________________________________
Content Reference: ____________________________________________________________________________
Learner Objectives Met Content TeachingStrategy
Caregiver will
demonstrateunderstanding of the
teaching content byverbalizing what blood
pressure is, why
compliance to themedication regime is
necessary and potentialcomplications to not
complying with
medication regime.
1. Provide the numeric value of the patient's BP and explain what it means (e.g.,
high, low, normal, borderline). Encourage patient to monitor BP at home and
instruct the patient to call health care provider if BP exceeds high or low limits setby health care provider. Normal BP
-
7/28/2019 Hospice Care Plan
7/9
TCC Nursing Program
NURS 2453 Nursing Promotion for Quality of Life
Evaluation of the Teaching
The chief learner in this teaching plan is the daughter who is the primary caregiver. Client has
poor health management due to non-compliance with hypertension medication regime, I believe
due to a knowledge deficit. I did not identify any readiness to learn from the caregiver but she
did act surprised when the blood pressure maintains a range in the 190s systolic and in the 90s
diastolic. Teaching would be held in an intimate and non-threatening part of the common such as
the family room. In this instance I would choose not to include the patient in the teaching lesson
simply due to the fact that the caregiver provides the daily medication to the patient. I would sit
across from the caregiver and maintain non-threatening eye contact. I would include basic
information regarding hypertension; material would be at a 6th
grade level or less. First I would
assess the knowledge of the caregiver on hypertension; judging by what she did or did not know
I would tell her that blood pressure is the force exerted by the blood against the walls of the
blood vessel. I would educate the caregiver that hypertension is more aggressive in African
Americans and results in more severe end-organ damage. (Lewis, 2011) I would inform her that
hypertension is known as the silent killer because it commonly presents with no signs and
symptoms and that while the patient states she is fine she still needs to continue taking the
prescribed medications. I would educate the caregiver to not to stop drugs abruptly because
withdrawal may cause a severe hypertensive reaction (rebound hypertension). (Lewis, 2011)
After the caregiver teaching was complete and throughout the teaching I would evaluate the
caregivers understanding of the information given. I would evaluate caregivers understanding by
-
7/28/2019 Hospice Care Plan
8/9
having her repeat the information learned. I would ask her if she understood the information
given and I would ask her if she had any questions or concerns. (Lewis, 2011)
Lewis, S. (2011).Medical Surgical Nursing. St. Louis: Elsevier Mosby.
TCC Nursing Program
NURS 2453 Nursing Promotion for Quality of Life
-
7/28/2019 Hospice Care Plan
9/9
Grading Criteria for Hospice Teaching Project
Student ID# Date
Possible
Points
Earned Points
22
AssessmentA. Provides a comprehensive patient history and describes the client clearly. (4)B. Systematically organizes comprehensive data using functional health patterns.
(4)C. Completes and documents pertinent focused assessment data relevant to
clients medical condition. (4)D. Provides research about clients acute/chronic conditions and treatment,
including end-of-life considerations. (4)E. Documents research of indications for and effects of prescribed medications.
(4)F. Describe laboratory and diagnostic work, including significance of abnormal
results. (2)
28
DiagnosisA. Clusters data from functional health patterns (4)B. Applies appropriate nursing diagnoses. (4)C. Prioritizes client problems (4)D. Chooses priority learning need (4)E. Selects NANDA-approved nursing diagnosis and etiology related to
learning need (6)F. Teaching need is appropriate for the client (6)
30
PlanningA. Develops an overall learner goal. (6)B. Develops measurable learner-centered objectives. (6)C. Specific content is outlined and referenced. (6)D. Teaching strategies are selective and appropriate to the content and the
learner. (6)E. Learning activity is directly related to clients interests, resources, and daily
living patterns. (6)
14
Implementation/EvaluationProcess EvaluationA. Addresses client behaviors indicating readiness to learn (2)B. Physical/psychological barriers to learning are identified (2)C. The environment during teaching is described, include who is present (2)D. Learner reactions to presentation of content are identified, including
questions, comments, and nonverbal behaviors (2)E. The level of achievement of each stated learner objective is evaluated (2)F. Addresses overall progress toward stated goal. (2)G. Describes changes student would make if experience were repeated (2)
6Form and FormatA. References cited using APA format (3)B. Grammar and spelling correct, document is legible (3)
100Total