last week my patient was an 83 year old male brought into the hospital for what the family thought was a bowel obstruction or impaction. the pt has alzheimer's and is unable to comminicate or even understand very much. the patient had an ng tube which the patient kept pulling out so the hospital put in a j-tube which he also keeps trying to pull out. after getting the results of an upper gi series we come to find out that the patient has advanced pancreatic cancer and the tumor is actually pushing into the duodenum which is causing his small bowel obstruction symptoms. patient also has prostate ca and a bladder tumor. all of these together, the hospital gave him about a week to live. at this point he is npo due to risk for aspiration. the son is in total denial telling the rn's that they are not to follow dr.'s orders of npo but to follow his orders since it's his father and he wants us to feed him coffee and ice cream since that is what his father loves. my rn stated all of the reasons she would not be doing this and of course the son was angry, so we got him in touch with a social worker and gave him pamphlets on the dying process and all that good stuff. the sone and his siblings had just found otu the day before that their father would be gone in a weeks time. towards the end of the day he started to seem like he was realizing that his father was dying.
so, after a brief story of my pt, i need some help with my care plan. i need 3 nursing dx/goals.
1) risk for aspiration r/t duodenal stenosis/goal: pt remains free of aspirations while trying to teach the family the importance of patient being npo/intervention
2) risk for fall r/t pt weakened state while in the dying process/goal: patient remain bedbound and free of falls/intervention: patient has sitter in the room 24/7 and is free of falls thus far
3) this is the one i'm most stuck on, i wanted to use: readiness for enhanced family coping but am not sure about the goals and intervention? any suggestions???
any help is appreciated!!!!