Care Plan for Unresponsive Palliative Care Pt

[Tooimpatient]

Hi everyone! I'm having a little trouble with my care plan this week.

Patient actually died on my shift, she was a lady in her 90's with multiple health problems at the hospital for palliative care basically.

With her being non responsive and therefore immobile, I was thinking along the lines of "impaired skin integrity related to immobility" but then again I wasn't sure I was on the right track with that since she was expected to die that day. Not to sound harsh but that just doesn't seem to be the major concern in one's last few hours.

Her reason for being hospitalized was cervical edema and sub mandibular abscess but she had many other problems such as chronic kidney disease, CHF, MI, breast cancer, etc. I am not great with care plans anyways, I am in my 2nd semester but I guess I am trying to pick one of her issues here and say she has pain related to _____.....Because she was believed to be in pain, she had sky high bp and we were giving her morphine.

Any advice? If I do decide to base my diagnosis on Pain is there a right or wrong way to start it out? Or is it okay to just say "Pain related to ____" or maybe "Risk for pain related to ____"?

[Tooimpatient]

Anyone?

[MelissaLPN, ASN, LPN, RN]

If she is immobile I would be...

turning her q 2 hours or hourly depending on if she has existing wounds. ( this would be a comfort measure, its painful to lay in one position!)

Mouth care, as needed.

Monitor for s/s of resp distress, pain.

Keep HOB elevated for cervical edema.

Oxygen for comfort measures.

provide suctioning if patient is unable to swallow secretions

I don't know if it would help but I would provide a calm environment, music, silence, prayer sermons ( if that's what the family thinks she would want). Provide psychosocial support to family.

Impaired health maintenance due to care giver strain( make sure family is taking adequete care of themselves, children of this patient are bound to be elderly as well).

Also you could do "knowledge deficit concerning death/dying/diagnosis." This sounds straightforward but making sure family is aware of the fact that the MD feels death is imminent.

Also this would be a great time to explain to family what palliative care is. The family may feel like they are being ignored if the pct no longer comes in every 4 hours for vs or mama no longer gets blood glucose checks 4 times a day. Explain to the family that this is not "withdrawing" care but eliminating unnecessary and painful procedures that do not benefit the patient.

This is all I can think of for now. I always look at a careplan like a map to give a lay person to do my nursing job. I as the nurse would make sure all these things are done but instead of assuming it is second nature we " careplan" it so that everyone is on the same page.