Careplanning for Comorbidities?????HELP?????

Whispera, MSN, RN · Jun 19, 2012

What's aftt?

If it's a requirement, you need to do it. I think since the patient has a hx of hypertension and now is hypotensive, you need to include some measures that address that....such as monitoring bp and medicating according to orders as well as alerting the doc when there are changes.

Hypotension is a problem too. While the person is in hospice and vitals aren't taken so much in hospice, ya gotta do what ya gotta do...

Double-Helix, BSN, RN · Jun 19, 2012

There really isn't a "right" way to do it. The right way is the way that your facility/company wants it done. So if they are saying to care plan for the patient's history, then that's the way you should be doing it.

Typically, especially in inpatient care, the care plans reflect the current problems and can be modified as the patient's condition changes. But since you're working in hospice (since this is posted in the hospice forum) it's possible that your facility may want you to do a more complete care plan up front so that all staff are on the same page and there is no need to go back and modify the care plan as the patient's condition changes. That way, if the patient is hypertensive one day, no matter who is taking care of the patient, the staff member can look at the care plan and know what should be done.

It does sound like a little bit of overkill, but if that's the way your facility wants it done, that's the way to do it.

Esme12, ASN, BSN, RN · Jun 19, 2012

If a patient has a history of HTN and they are now hypotensive that is a problem....right? If they are admitted with an Acute MI and they are diabetic....we know that diabetes can lead to heart disease and elevate blood sugars which further complicates recovery. That is a co morbidity and is a present problem.

They all need to be addressed

AtlantaRN, RN · Jun 19, 2012

I guess my issue is, this is hospice and there is NO real recovery....just symptom management. Narcotics cause gi sluggishness, so of course i'm gonna open a gi care plan and add senna to the patients routine scheduled medications.

Hypotension treatment outside of hospice is ivf and stopping meds that would cause hypotension. usually hospice doesn't do ivf because its considered aggressive treatment and hospice is all about nature taking its course.

AFTT is adult failure to thrive, which is a blanket diagnosis that no one likes because essentially you say they are dying, but you don't know exactly what is killing them.

I would feel better if careplanning for comorbidities was brought to the attention of all nurses at this location, and not just one particular case manager. I don't know, maybe there will be a note in my box when i go to work friday. Im just confused.

Thank you all for your comments. Brainstorming helps.

Whispera, MSN, RN · Jun 19, 2012

I was the QI person for a hospice program for awhile. While we provide comfort measures for the reason the patient is in hospice, we also take care of the whole person, right? So, if the person has a history of hypertension that is decreased to hypotension, it still needs to be monitored because it's there and can cause problems. That doesn't mean you treat it medically. It just means the careplan makes everyone aware so they will be sure to monitor and let the doctor know what's happening. When the power-that-be audit things (Joint Commission, accrediting agencies, Medicare, Medicaid), they look to be sure things other than the reason-for-hospice are addressed. It would be a big omission if they found that the patient has a history of hypertension and nothing is in the care plan about it...

tewdles, RN · Jun 23, 2012

interesting...

so we just admitted a pt with a co-morb of htn, well controlled and asymptomatic. we did not include that in the poc. whispera, I have worked for several hospices and we were never required to include things like that in the poc unless they were a problem that affected the goals of hospice...like quality of life, comfort, or environment of death, etc.

hhhhmmm