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Nursing Diagnosis for terminal patient (odd case)

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Okay...I usually don't have many issues coming up with a nursing diagnosis...however, this one has me stumped.

Patient has Cerebal Palsy, Mentally Handicaped (moderate to severe), Hx of seizures and blind since birth (O2 retinopathy). She has a bilateral ganglioma with encephalitis. Protein in CSF is 376. Patient was not able to care for herself (needed help with all her ADLs) and lived in a group home prior to hospitilization. She has been in the hospital for 4 days (sedated the entire time due to seizures and fighting the ventilator).

The discussion with the Drs today was about how much farther the family wants to take the care (family was not there, this was a pre-meeting discussion with the staff) as there is not much they can do and quality of life issues.

I wanted to focus on the stress of the family having to make end of life decisions (pt is 36). Not really sure how to word it since all the references in my books are about the patient having fear, anxiety, etc.

Help? Thanks!

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Any of these can apply to the caregivers or family making decisions when met with the finality of the situation.

Anxiety

NANDA-I Definition: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat

Interrupted Family Processes

NANDA-I Definition: Change in family relationships and/or functioning

Interrupted family processes occur as a result of the inability of one or more members of the family to adjust or perform, resulting in family dysfunction and interruption or prevention of development of the family. Family development is closely related to the developmental changes experienced by adult members. Over time, families must adjust to change within the family structure brought on by both expected and unexpected events, including illness or death of a member,

Caregiver Role Strain

NANDA-I Definition: Difficulty in performing family caregiver role

Ineffective Coping

NANDA-I Definition: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources

Complicated Grieving

NANDA-I Definition: A disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative

expectations and manifests in functional impairment

Grieving

NANDA-I Definition: A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives

Powerlessness

NANDA-I Definition: Perception that one's own action will not significantly affect an outcome; a perceived lack of control over a current situation or immediate happening

Spiritual Distress

NANDA-I Definition: Impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself

Gulanick: Nursing Care Plans, 7th Edition

I hope these helped. :)

Any of these can apply to the caregivers or family making decisions when met with the finality of the situation.

Anxiety

NANDA-I Definition: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat

Interrupted Family Processes

NANDA-I Definition: Change in family relationships and/or functioning

Interrupted family processes occur as a result of the inability of one or more members of the family to adjust or perform, resulting in family dysfunction and interruption or prevention of development of the family. Family development is closely related to the developmental changes experienced by adult members. Over time, families must adjust to change within the family structure brought on by both expected and unexpected events, including illness or death of a member,

Caregiver Role Strain

NANDA-I Definition: Difficulty in performing family caregiver role

Ineffective Coping

NANDA-I Definition: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources

Complicated Grieving

NANDA-I Definition: A disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative

expectations and manifests in functional impairment

Grieving

NANDA-I Definition: A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives

Powerlessness

NANDA-I Definition: Perception that one's own action will not significantly affect an outcome; a perceived lack of control over a current situation or immediate happening

Spiritual Distress

NANDA-I Definition: Impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself

Gulanick: Nursing Care Plans, 7th Edition

I hope these helped. :)

Thank you. Those were along the lines of what I was trying to get at. I think the anxiety/grieving is going to trump out due to the fact that the family is not taking care of the patient themselves, but is allowing someone else to do it in a group home...that in itself can cause guilt (I have seen it in families before) and increase anger/fear/depression etc.

Thank you so much!

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Agreed.....but they are still the "caregiver" when it come to decisions about the patients care and to end life support or decisde that no further interventions are necessary. You are right the "guilt" can be very destracting to the decision making for they have never dealt with their feelings of guilt for having to admit they could no longer care for their child.

You're welcome.

it was kind of my friend esme to give you so many answers! if you have the nanda-i 2012-2014 book, you would find these if you turn to the sections on role (domain 7), coping (9), and also consider safety (11).

however, i strongly recommend you also look in on domain 10, life principles, especially class 3, value/belief/action congruence. (and i'm gonna make you find them on your own :nurse:). there are some very applicable possibilities here which could become critically important when considering interaction with the family. as a hint, you could also look up a little bit of explanatory information on "substituted judgment."

let us know what you think.