A. Our client, Mrs.. Thomas has been given the unfortunate diagnosis of metastasis breast cancer. When considering the current and future needs of this client, significant thought and planning must be directed toward the client's level of well being. In the case off terminally ill patient, it is important to help facilitate a high quality of life that encompasses both physical and psychological health. I would recommend initiating palliative care for Mrs.. Thomas.
Palliative care would allow the client to receive a combined and holistic approach for medications, equipment, unseeing, and symptom treatment all fascinated through one program. The community health nurse needs to be careful not to impose ones own perception about quality of life upon the client. With the experience of having helped both of my parents through the dying process, I know that it is important to separate my own experience and perceptions from those of my client. Just as each person takes on life with a different philosophy, so it goes with the dying process.
The nurse must not assume that the patient's priorities are the same as his or hers. Open communication regarding the patient's wants and needs must be initiated. Though not all patients have had the time or skills to know how to deal with a terminal illness, one of the most important Jobs of the nurse is to connect the patient to the proper resources needed for navigating through the various aspects and stages of their disease process, and to do so without Judgment or bias. B. Many terminally ill patients begin to navigate through the stages of grief as outlined by Elisabeth Kibble-Ross.
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While caring for this client with a lingering terminal illness such as cancer, my first strategy would be to keep the lines of communication open, managing the patient's emotional and spiritual needs and outlining the stages of grief as the client progresses through them. By initiating a good line of communication, one can recognize and guide both Mr.. And Mrs.. Thomas through denial, anger, bargaining, depression and acceptance (Kibble-Ross). It will be easier to better manage Mrs.. Thomas' physical needs if her psychological social needs have been addressed.
My second strategy in helping to improve the quality of life for Mrs.. Thomas and her husband would be to manage Mrs.; Thomas' comfort. Working carefully with a palliative or hospice team to manage the physical discomforts of the tangent's illness, can greatly increase quality of life. This is often a critical area of educating the patient on pain control. Patients are often afraid to take pain medications, and therapeutic communication is likely to be necessary. Monsoon). My third strategy would be to set up an interdisciplinary palliative care team to to manage the health of Mrs..
Thomas. Terminal illness can be overwhelming for a family, where likely there are other factors - be it financial, familial, psychological, and no one person can manage it all. By working with the family to institute a good team or care, the burden can be lifted off the family and this will ideally allow them to care for their loved one without becoming burdened or overwhelmed. It is important to consult the family regarding any spiritual support that they would feel comforting. Is there a minister or spiritual guide currently in their life?
If not, would they be open too visit from someone that is akin to their spiritual values? These are questions that should be carefully addressed. C. Nursing Care Plan for Mrs.. Thomas Assessment: Mrs.. Thomas is a 56 year-old female with a history of breast cancer. Mrs.. Thomas is aired with two grown sons, aged 28 and 30 both of which live out of state. Mrs.. Thomas has a strong familial history of braes cancer and one year ago, was treated for a malignant mass in her right breast.
After a right mastectomy, chemotherapy and radiation six months ago, the cancer has now returned with subsequent right sided mastectomy, chemotherapy and radiation. The cancer has now metastasis's to the lungs and the prognosis is now deemed to be "poor" with "palliative care now being recommended". (Task 2). Diagnosis Number One: Acute Pain related to incision secondary to surgical intervention as evidenced by tangent's visible discomfort/crying in bed, pallor, respirations, blood pressure and a report of 8/10 pain. Goal 1.
Patient will verbalize a pain rating of 4 or less on a scale of 10 with each assessment. 2. Pain control as evidenced by patient demonstrating ability to use analgesics appropriately, use alternative non-analgesic relief, reported pain to be mild, relaxed body language, vital signs returning to normal Plan 1. Analgesic pain medication as prescribed by physician (Swearing) 2. Use of diversionary and or strategies to assist with pain (SHE Nursing Care Plan Guide) 3. Assist patient with positioning for comfort Implement .
Evaluated effect of medication, utilize pain scale 2. Assessed effectiveness of diversionary strategies (SHE Nursing Care Plan Guide) 3. Assisted with position changes Diagnosis Number Two: Activity Intolerance related to generalized weakness as evidenced by increasing fatigue Goal 1. The nurse will help fascinate a physical therapist to help with mobility 2.. Will ambulate IX around block daily Patient 3.. Patient will fully participate in Tall's within physical limitations without dizziness or change in vital signs by 8/1/14 1 .
Assess patient's level of mobility, educate within patient's capability 2. Assess nutritional status. Adequate energy reserves are required for activity. (Swearing) 3. Ambulate patient XX a day 1. Educated patient on benefits of mobility and the proper body mechanics for mobility 2. Encourage nutrition prior to activity and the proper body mechanics for mobility Monsoon) 3. Ambulated patient XX daily Diagnosis Number 3: Ineffective Coping related to financial burden and emotional impact of diagnosis on family as evidenced by patient's increasing isolation 1.
Set up a quality interdisciplinary team incorporating counseling services for the family 2. Patient will demonstrate problem solving techniques Monsoon) 3. Patient ill verbalize acceptance of diagnosis 1. Patient will utilize available support systems and work with counselor for socio psych issues 2. Assist client to identify priorities and attainable goals as he/she starts to plan for necessary lifestyle and role changes 3. Perform actions to facilitate the grieving process (Elsevier) 1. Patient met with counseling services 2. Patient identified priorities and set goals 3.
Patient demonstrated knowledge of the 5 stages of grief and how to work through them In order to optimize Mrs.. Thomas functional ability, the care team should strive for all three of the goals in her plan of care to be met. First of all, her pain needs to be managed so that manipulation can be successful, without discomfort. It is quite common for patients to be concerned about becoming addicted to pain medication as in the case of Mrs.. Thomas. Addiction is "psychological dependence" on a drug and is not the same as tolerance or physical dependence, according to Oncologist, Dry.
Gary Johansson who states that "In fact, addiction is rare when avoids are used for pain relief". With proper education and regularly scheduled pain medication, Mrs.. Thomas should be much more comfortable and able to manage other areas of her life more successfully. Once Mrs.. Thomas' pain is under control, she will be able to work through many of the stresses that have mounted since her diagnosis. As Mrs.. Thomas disease progresses, there will come a time when she will no longer be able to care for herself. A new Plan of Care should be created and ready to transition to at that time.
At this time the interdisciplinary team should consist of a hospice care which is generally implemented when a patient has less than 6 months to live. When hospice is begun, all care is transferred to the hospice team. New orders for care, medication, equipment will be set up and time is given to the family or supporting both the patient and their loved ones. Care will focus on making the most out of the time they have left, "without some of the negative side-effects that life prolonging treatments can have". Monsoon).
Most hospice patients can attain a level of comfort that allows them to "concentrate on the emotional and practical issues of dying". Willet-Legislations). Mr.. Thomas is carrying a big physical and emotional burden during his wife's terminal illness. The Thomas family's case is complicated by Mr.. Thomas' chronic depression and high stress occupation. As Mrs.. Thomas' needs escalate and change, so do the needs of the Mr.. Thomas. By facilitating psychological help for Mr.. Thomas, the care team is in turn helping Mrs.. Thomas by easing her worries about her spouse.
Patients and families need support, guidance, and encouragement to begin planning for many decisions. Many spouses are weighted with concern about the patients' comfort and impending death as well as every day problems. "This is an emotionally intense, exhausting, and singular experience, set in a world apart from everyday life patterns". (Siegel). Mr.. Thomas needs to be reminded that in order to help care and be emotionally supportive to his wife, he needs to take care of himself. Medication reminders and grief support should be set up for Mr.. Thomas.
Therapeutic conversation and guidance can make all the difference for the significant other off terminal patient. In addition, Mr.. Thomas needs respite care so that he can be fully present while caring for his wife. Mr.. Thomas should be encouraged to take a walk, a nap, or a restorative A care plan for Mr.. Thomas could be initiated with a nursing diagnosis of: Risk for Caregiver Role Strain. (SHE). Goal: Spouse will report low or no feelings of burden or distress by 8/01/14, measured by relief stated by spouse. Plan: Encourage the caregiver to talk about feelings, concerns, uncertainties, and fears.
Acknowledge the frustration associated with caregiver responsibilities. Initiate counseling. 2. Help the caregiver problem solve to meet his needs. 3. Set up medication reminders for psychological medications. Implement: 1. Patient openly discusses concerns, uncertainties and fears (SHE). Patient acknowledges frustrations associated with his caregiver responsibilities. Patient attends counseling. 2. Patient participates in problem solving to meet his needs. 3. Patient follows medication reminders and takes medications for his depression.
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