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Hospice Care

I. Interpretation of Data

Physical: Stage 4 or End stage of Cancer, malignant cells metastasized already to other
parts of the body. Possible characteristics of end-stage cancer are pain, easy “fatigueability”,
shortness of breath, weakness, problem sleeping, anorexia, etc.

Moreover, Mrs. Flores already underwent two surgery to control cancer.

Cognitive: Mrs. Flores shows subjective manifestation of confusion and disbelief


mechanism. She verbalized, “I am losing everything and everyone I ever loved. There is no
meaning in life, no purpose of living. May show preoccupation with the image of her husband
who died just recently.

Emotional: Patient exhibits anger specifically to god. She spoke and cried angrily,
“God! God!”. She also manifest guilt and shame, as verbalized “I am ashamed of myself. My
grandchildren still need me. I can’t abandon them.”

Other emotional characteristic she used in her responses are sadness and
yearning, possibly directed to her family. She lost her husband recently and her daughter died
in a car accident. Her son, who is the only non-minor member of their family, is busy working
abroad with his business. She believes that he doesn’t know what is happening right now to
his family here. This may have caused her say, “I’m like an orphan.”

Behavioral: She spends most time crying especially when verbalizing her hostile
feelings. Possible behavioral responses she may have performed are restlessness, eating
disturbance, and disrupted activities of daily living.

Spiritual: She expresses hostility toward god. She cried “God! God!” angrily. She
continued by saying “What God? I don’t want to talk about God. There is no God, can’t you see
that?” She spoke in a mad voice. Possible blaming God for doing this to her or forgetting
about her.

Family perspective: Mrs. Flores has granddaughters that are school aged. They
determined that the kids may need support for the impending death of their grandmother.
Possible non-caring impression to her son who is working abroad.

Grieving Process: Kubler-Ross’s: Patient is most likely under the Anger stage. The
patient directs main anger feelings to God. Her speaking tone is characterize with angry mood.
Grieving Process: Engel’s: Mrs. Flores may be under the Developing Awareness stage,
which is characterized by anger directed to agency, nurses, or others. The reality of loss is felt
both emotionally and intellectually.

Notes: Goals and Plans are usually long termed, as to the fact that you cannot address hostility
in a minute. Proper flow through the stages should be supported with the utmost empathy,
patience, and care of the nurses and other health care provider.

II. NEEDS III. PLAN (per aspect) IV. Nsg ACTIVITY V.EVALUATION
Physical: -Maintaining -The Patient
1. Pain Control physical dignity of a. Assess pain using pain maintained his
the patients. assessment tools. physical
-Maintaining b. For mild to moderate pain, dignity, as
physiologic and nonopiod drug like verbalized per
psychologic comfort, acetaminophen and aspirin se.
as much as possible. can be given. -Comfort
-Relieve or control c. For persisting and increasing physically and
Pain symptoms. pain, add mild opiod to psychologically
-Maintain normal acetaminophen. is maintain, as
body processes d. For severe pain, a stronger pain and
speed and opiod like morphine sulfate hygiene is
homeostatic balance. should be given. addressed.
e. Promote nonpharmacologic -Normal body
intervention like process is
aromatherapy, gentle promoted by
massage, humor, music, addressing
warm and cold compress, needs of
and prayer and meditation. nutrition,
2. Nutrition a. Antiemetic or a small elimination,
amount of an alcoholic and physical
beverage to stimulate mobility.
appetite.
b. Encourage liquid foods as
tolerated.
3. Elimination a. Skin care in response to
incontinence of urine or
feces.
b. Change the linen as often as
needed.
c. Keep the room as clean and
odor-free as possible.
4. Hygiene a. Provide frequent baths and
linen change.
b. Assist in Mouth care, skin
care, etc. to maintain
cleanliness and sense of
body image dignity.
5. Physical a. Assist the client out of the
Mobility bed periodically, as able.
b. Regularly change the client’s
position.
c. Spend sometimes with the
patient outdoors, walking or
simple nature time.
Cognitive: - Grief resolution. -The patient
1. Acceptance/ The Patient should a. Help the patient come to was able to
Dignity be able to adjust to term with the idea of their pass grieving
actual or impending own mortality and process by
loss, as impending death in a adjusting to
demonstrated by: supportive empathetic the reality of
a. maintenance of environment. loss, as
living environment b. Use sensitive judgment to manifested by
b. Seeking of social talk openly about death continuing to
support where appropriate, when live, socially
c. Progression patient and families want to active, and
through the stage of do so. reaching
grief. c. Support patients and their acceptance or
family to explore the issues resolution
arising from the transition stage.
from curative care to
palliative care.
d. Verbally support client but
do not reinforce denial or
disbelief.
e. Allow patient as much
control as possible over their
lives.
Emotional: - Redirect emotional -Patient
1. Peace and energy into a. Use empathetic and adjusted her
calmness(Ange rehabilitation by reflective reasoning to focus towards
r outlet) redirecting towards enable the patient and her own life
own life and adjust to family to talk freely if they and adjust to
the actual and wish to. the impending
impending loss. b. Recognize the opportunity, loss, as
-Reinforce sense of by picking up cues, to hold verbalized “I
peace and security of deeper discussions relating want to
the patient. to psychological or maximize my
emotional issues. remaining time
c. Help client understand that her on earth.”
anger is a normal response -Patient
to feelings of loss and exclaimed, “I
powerlessness. feel secured
d. Deal with other needs now, thanks to
underlying any anger you.”
reaction
2. Security a. Provide structure and
continuity to promote
feelings of security
b. Encourage patient to talk to
relieve guilt and irrational
fear.
2. Comfort and a. Confidently facilitate and
Care manage interactions with
(Attention, patients and family.
Time, and b. The use of Touch--- Touch
physical has the ability to convey
Presence)/ huge amount of reassurance
Family and empathy.
relationship c. Listen to the patient
attentively. Use silence,
personal presence, and
therapeutic communication
techniques to enhance
exploration of feelings and
let the clients know that the
nurse acknowledges their
feelings.
Behavioral: - Minimize loneliness, -Modified
1. Rested and fear and depression a. Encourage and allow environment:
Peaceful aura triggered by a chaotic expression of grief from the The patient
or unbearable patient. Provide space and verbalized, “I
environment for the time to express herself as am able to rest
patient. she sees fit. and think
-Patient will attain b. Modify the environment. A about all this
calm behavior and peaceful, noise-free, and things.”
neutral to positive distraction free environment -Patient
mood. will help patient relax and be remained calm
rested. all through the
day.
Spiritual: -The Patient will -Spiritual
1. Hope and receive a good a. Assess the patient using issues are
Positive spiritual care and will guide tools like HOPE and discussed
spirituality be able to deal with FICA to help initiate and interactively
spiritual issues as sustain spiritual assessment. with the
assisted by the health b. Establish and Maintain a patient with
care team. trusting relationship due respect
-Increase quality of between you and the and empathy.
life by extending patient. Trust can be just Patient later
positive perception the healing environment in verbalized, “I
of current life which spiritual care works. felt rueful to
circumstances, c. Set an schedule for my actions. I
characterized by reflection and listening hope God can
ability to cope and session. Listening, focus, still forgive
pervasive mood. and attentiveness are tools me.”
in the creation of an -Patient moves
environment where spiritual toward
care works, and where the positive living.
facet of a person’s well- Mood became
being finds the healing and calm and
wholeness they seek. active.
d. Always use a non- Acceptance is
judgmental approach. manifested.
Spiritual care is to be truly
person-centered, the needs
of the patient is top-priority.
e. Help Patients make sense of
their illness and prognosis by
offering hope, facilitating
reflection in life and values,
fulfilling their wishes and
attempting to meet spiritual
needs
f. Expand patient’s repertoire
of coping mechanism.

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