What are NDs related to comfort care?

[cminmd]

I have a pt with end stage liver and kidney failure. During the week they changed his treatment plan to that of comfort measures only. They pulled the NG Tube, stopped all meds other than for pain and stopped all blood tests. I have to do my concept map- what types of ND's would show that change?

[Daytonite, BSN, RN]

Assess the patient, particularly their ability to perform ADLs. Remember, I told you yesterday that nursing diagnoses are based upon abnormal assessment data.

[cminmd]

Can "dying" be an abnormal "assessment?

I am really confused because when he reviewed my concept map he made it sound like comfort care/ hospice was an actual ND. So I went home with my NANDA and nothing. My patient is mentally altered by the HEncephalopathy so I don't think I can put Grieving, Impaired spirtuality, of Ineffective coping. I was thinking "Disabled family coping" but I have pretty thin evidence to support it. All I have as a D-i-L coming by to say that her husband was really sensitive and she wanted to come by to see how her F-i-L looked before she would bring the older grandchild to see him. I asked her if she wanted to speak with a physician or a minister (at an Adventist hospital) and she declined both, but I don't know if that relates to any spirituality issues or she just was in a hurry with a toddler in tow.

Any suggestions?

[Daytonite, BSN, RN]

psychosocial diagnoses are not easy to work with when psychology is not one's background.

stay focused on the patient and what the patient is doing.

dil coming by to say that her husband was really sensitive

dil wanted to come by to see how her fil looked before she would bring the older grandchild to see him

these are abnormal data items. the dil is protecting

her

immediate family members from the trauma of seeing the patient, but

depriving the patient of family contact

. focus back on the patient. the problem is the patient isn't getting to see and visit with family. is this a problem to the patient? you're the nurse who saw what was going on, so you must decide. does the patient want to see her husband or the older grandchild? if so, then this dil is interfering and this is

compromised family coping r/t terminal disease aeb dil being protective of her own family

over the needs of the patient

as evidenced by her visits to check the patient's condition first to see if her husband and grandchild would be able to tolerate seeing him

. if not, then there is no problem.

i asked her if she wanted to speak with a physician or a minister (at an adventist hospital) and she declined both.

this would be an intervention under the above diagnosis for the aeb listed--if this was a patient problem. if not, then it was just a nice humanitarian gesture on your part.

regarding dying: think this through. where on a head-to-toe assessment form or a systems assessment form is there a section labeled "dying". there isn't. "dying" is a decision someone has made. someone else might tell you that we are all dying a little bit every day that we are alive. that's an opinion as well. if you thought someone was at death's door, how would you know? there are physical, observable signs of death. this is why you have to focus on facts you can see, hear, touch. hospice books discuss impending death. again, you would assess the symptoms the patient is displaying and diagnose based on those symptoms.

• end of life care http://www.cme.utoronto.ca/endoflife/modules.htm
  end of life care subjects http://www.eperc.mcw.edu/ff_index.htm