Question

At 80, Meena had been in a nursing home for 2 years after a stroke, when her health declined, and she was no longer able to communicate her wishes. Meena's physician, Dr. Torres, told her family she was dying. She said that medical tests, physical therapy, and intravenous treatments were no longer really needed and should be stopped because they might be causing Meena discomfort.
Dr. Torres also said that checking vital signs (pulse, blood pressure, temperature, and breathing rate) was interrupting her rest and would no longer be done regularly.

1. From the above situation, develop a nursing care plan (NCP) designed to maintain the patient’s dignity
and achieve a peaceful death.

Then, Meena developed pneumonia. Her family asked about moving her to the hospital. Dr. Torres explained that Meena could get the same care in the familiar surroundings of her nursing home. Besides, the doctor said, a move could disturb and confuse her. The family agreed to leave Meena in the nursing home, and she died 2 days later surrounded by those close to her.

Answer 1

Nursing care is important in patient during their end of life, not only for the patient but also for the family members to cope up with the situation. Nursing care plan includes

1.Compromised family coping

2.activity intolerance

3.anticipatory grieving

1.Compromised Family Coping related to Temporary family disorganization and role changes; feel that caregiving interferes with other important roles in their lives as evidenced by Inability to complete caregiving tasks; altered caregiver health status

Desired Outcomes

•Identify resources within themselves to deal with situation.
•Visit regularly and participate positively in care of patient, within limits of abilities.
•Express more realistic understanding and expectations of patient.
•Provide opportunity for patient to deal with situation in own way.

Intervention

rationale

Assess level of anxiety present in family and/or SO. Establish rapport and acknowledge difficulty of the situation for the family. Determine the level of impairment of perceptual, cognitive, and/or physical abilities. Evaluate illness and current behaviors that are interfering with the care of the patient. Note patient’s emotional and behavioral responses resulting from increasing weakness and dependency. Determine current knowledge and/or perception of the situation. Include all family members as appropriate in discussions. Provide and/or reinforce information about terminal illness and/or death and future family needs.

Anxiety level needs to be dealt with before problem solving can begin. May assist SO to accept what is happening and be willing to share problems with staff. Information about family problems will be helpful in determining options and developing an appropriate plan of care. Approaching death is most stressful when patient and/or family coping responses are strained, resulting in increased frustration, guilt, and anguish. Provides information on which to begin planning care and make informed decisions. Information can reduce feelings of helplessness and uselessness. Helping a patient or family find comfort is often more important than adhering to strict routines. However, family caregivers need to feel confident with specific care activities and equipment.

2.activity intolerance related to Bedrest or immobility; progressive disease state/debilitating condition

Outcomes

•Maintain or achieve slight increase in activity tolerance evidenced by acceptable level of fatigue/weakness.
•Remain free of preventable discomfort and/or complications

Nursing intervention

ratioale

Assess sleep patterns and note changes in thought processes behaviors. Recommend scheduling activities for periods when patient has most energy. Adjust activities as necessary Encourage patient to do whatever possible: self-care. Demonstrate proper performance of ADLs, ambulation or position changes. Identify safety issues: use of assistive devices. Encourage nutritional intake and use of supplements as appropriate. Monitor breath sounds. Note feelings of panic or air hunger. Provide supplemental oxygen as indicated and monitor response.

Multiple factors can aggravate fatigue, including sleep deprivation, emotional distress, side effects of medication, and progression of disease process. Prevents overexertion, allows for some activity within patient ability. Provides for sense of control and feeling of accomplishment. Protects patient or caregiver from injury during activities. Can provide guidelines for participation in activities. Hypoxemia increases sense of fatigue, impairs ability to function. Increases oxygenation. Evaluates effectiveness of therapy.