Readiness for enhanced family coping

[schooltake2]

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!!!!

[Daytonite, BSN, RN]

why are you using all these potential problem diagnoses when this patient has some real and actual nursing problems such as nutrition, comfort and help with all his adls? how do you plan to address those? your goals on your "risk for" diagnoses are too complicated as well. interventions for "risk for" diagnoses can only be:

• strategies to prevent the problem from happening in the first place
  
• monitoring for the specific signs and symptoms of this problem
  
• reporting any symptoms that do occur to the doctor or other concerned professional
  

goals for the "readiness for enhanced" diagnoses are always that the patient or family is going to perform the behavior that the diagnosis lists. in this case, they will effectively cope with whatever it is you are wanting them to cope with. interventions need to match with and work toward these goals. since this is a psychosocial diagnosis then behavior is the focus of the interventions as well as the goals.

goal statements have four components:

1. a behavior
   
   • this is the desired patient response/action you expect to see/hear as a direct result of your nursing interventions.
     
   • you must be able to observe the behavior
     

[*]it is measurable

• criteria that identifies exactly what you are measuring in terms of
  
  • how much
    
  • how long
    
  • how far
    
  • on what scale you are using
    

[*]sets the conditions under which the behavior should occur

• such conditions as
  
  • when
    
  • how frequently
    

  [*]take into account the patient's overall state of health (this requires knowing the pathophysiology of their disease process)

  [*]take into account the patient's ability to meet the goals you are recommending

  [*]it is a good idea to get the patient's agreement to meet the intended goal so both the nurse and the patient are working toward the same goal

[*]have a realistic time frame for completing the goal

• long-term goals usually take weeks or months
  
• short-term goals can take as little time as a day
  
• it all depends on knowing what your nursing interventions are designed to do and what you believe your patient is capable of doing.