End-of-life care nursing care plan

phuretrotr · Jul 25, 2013

Just focus on what will give him the most comfort. Such as, does he have a dry mouth (drops for that), skin integrity (reposition q 2-4 hours or give a bath), if he has family visit, you can write something about coping... Remember, you are not trying to fix his diagnosis at this time, only make him as most comfortable as possible. You may want to write something about pain, because I would assume he is on some sort of pain medication since he is on palliative care.

Esme12, ASN, BSN, RN · Jul 26, 2013

Hey guys. I just need some clarification if possible. I went to clinical and I had to take care of a patient who's on palliative care, he's unconscious and nonresponsive. I have to write a care plan, but I am not sure what to focus on. Pain cannot be assessed because he's unconscious. He has respiratory failure so I picked as one of my diagnosis ineffective airway clearance and impaired spontaneous ventilation. He is on a nonrebreather mask, 100% O2. My question is, he is dying so I am not sure what to focus on. Thanks!!!

So you have a dying, comfort care patient who is unconscious .....tell me what you see....what does he NEED, what is your assessment...what is the physical assessment. Unconscious patients have pain and discomfort....is he restless what are the vital signs.

Care plans are all about the assessment....there isn't really enough information here to help you. How is his family....are they aware of the dying process....are they prepared?

Don't get caught up in the medical diagnosis.......LOOK at your patient....what does he NEED? Palliative care doesn't mean we ignore them because they are dying......they are dying so what can we do to make this as comfortable as possible and with as much dignity as we possibly can....we owe that to our patients.

If this was your Dad, grandpa, Uncle, husband ......tell me what would you want done for them to be sure they are not in pain and are well cared for......

chrisrn24 · Jul 26, 2013

Pain CAN be assessed. Look up the PAINAD scale.

nurseprnRN, BSN, RN · Jul 26, 2013

Remember too that the family or other significant people in his life are your patients in this situation, too.

If you pull out your NANDA-I 2012-2014, what do you find for nursing diagnoses that might apply in the sections in:

Comfort

Role

Coping/Stress

Life principles

I'll bet you will find many, many things that could potentially apply to this situation.

NANDA-I 2012-2014, the ONLY definitive book on nursing diagnosis- that's where they all come from. $29 at Amazon, free two-day delivery ($24 for your Kindle). Every student should have one for more reasons than I have time to write right now, but you can see my advice on this in other threads.

loveSBK · Jul 26, 2013

The patient's vital signs were normal and he was on morphine for pain. No one visited him therefore I could nit speak to his family members. All i could see was that he was unresponsive, he had a hard time breathing and he was on oxygen. When I talk to him, he barely opened his eyes. He had edema +3, and some pressure ulcers, we couldnt move the patient too much because it affected his breathing too much, he also had a lot of secretions.

Esme12, ASN, BSN, RN · Jul 26, 2013

The patient's vital signs were normal and he was on morphine for pain. No one visited him therefore I could nit speak to his family members. All i could see was that he was unresponsive, he had a hard time breathing and he was on oxygen. When I talk to him, he barely opened his eyes. (so he did respond) He had edema +3, and some pressure ulcers, we couldnt move the patient too much because it affected his breathing too much, he also had a lot of secretions.

What were his vitals signs...what was the O2 set at? what was his respiratory rate? What was the O2 Sat? What did his lungs sound like? Was he restless?

So looking at this....what would you be concerned about.

What semester are you? What care plan book do you use? What NANDA diagnosis do you have proof for?

Activity Intolerance

Ineffective Airway Clearance

Excess Fluid Volume

Impaired Skin Integrity

So what are the NANDA definitions for these diagnosis? What proof do you have in your assessment to support these diagnoses?

Attached is a student brain sheet from a beloved contributor Daytonite (RIP)

Critical Thinking Flow Sheet for Nursing Students(1).doc

loveSBK · Jul 27, 2013

Thank you so much for the flow sheet, its really helpful. The patient was on 100% O2, his respirations were 18, sat was 100, and his BP and Rate were normal. I already turned in my careplan but I just wanted some insight for next time. I used ineffective airway clearance seeing that that was the only thing we could help him with. His lung sounds were rhonchorous and he had a lot of secretions. I am in Fundamentals II and this is our first clinical rotation.

PATTYM1 · Jul 27, 2013

if your patient is on oxygen maybe impaired gas exchange. Also it does not matter if they are dying Pain is the main issue you want to make him comfortable at all the times . remember that skin integrity is a risk because they are not moving so turn your patient every 2 hours, oral cares, also morphine is used to help respiratory distress and u can use that as a data!!

Esme12, ASN, BSN, RN · Jul 27, 2013

Use that sheet for guidance on what information you need...to help you critically think. You actually have evidence for all of the diagnosis I listed. Come back with your assessment for your next care plan and we can help.