hospice care plan

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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


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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.


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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.


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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


5/9

TCC Nursing Program


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


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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


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TCC Nursing Program


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


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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



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Grading Criteria for Hospice Teaching Project

Student ID# Date

Possible

Points

Earned Points

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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)

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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)

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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)

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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)

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