Hospice care focuses on providing compassionate end-of-life care to terminally ill patients, emphasizing comfort, dignity, and quality of life. This nursing diagnosis guide outlines key aspects of hospice care, helping nurses deliver comprehensive palliative care while supporting patients and their families.
Causes (Related to)
Hospice care becomes necessary due to various factors affecting terminal patients:
- Progressive terminal illness
- Advanced stage cancers
- End-stage organ failure (heart, liver, kidneys)
- Advanced neurological conditions
- Severe chronic diseases
Patient-specific factors include:
- Declining functional status
- Uncontrolled symptoms
- Multiple comorbidities
- Limited life expectancy (6 months or less)
- Complex pain management needs
Family-related factors include:
- Caregiver stress
- Complex family dynamics
- Limited support systems
- Cultural and spiritual needs
- Grief and anticipatory loss
Signs and Symptoms (As evidenced by)
Hospice patients present with various symptoms requiring specialized nursing care.
Subjective: (Patient/Family reports)
- Pain and discomfort
- Anxiety about death
- Spiritual distress
- Depression
- Fatigue
- Loss of appetite
- Difficulty breathing
- Fear of being a burden
- Existential concerns
Objective: (Nurse assesses)
- Declining vital signs
- Weight loss
- Decreased level of consciousness
- Changes in breathing patterns
- Skin breakdown
- Decreased mobility
- Altered mental status
- Signs of pain or distress
Expected Outcomes
Successful hospice care aims to achieve:
- Optimal pain and symptom management
- Enhanced quality of life
- Maintained dignity and comfort
- Improved family coping
- Met spiritual and emotional needs
- Peaceful death process
- Supported grieving family
- Fulfilled end-of-life wishes
Nursing Assessment
Comprehensive Pain Assessment
- Evaluate pain characteristics
- Document pain patterns
- Assess the effectiveness of interventions
- Monitor non-verbal pain indicators
- Review pain management history
Physical Status Evaluation
- Monitor vital signs
- Assess skin integrity
- Check respiratory status
- Evaluate nutritional status
- Document activity tolerance
Psychological Assessment
- Evaluate mental status
- Assess anxiety levels
- Monitor depression signs
- Document coping mechanisms
- Check emotional well-being
Family Support Needs
- Assess caregiver strain
- Evaluate support systems
- Monitor family coping
- Document educational needs
- Assess grief responses
Spiritual Care Requirements
- Evaluate spiritual needs
- Assess cultural preferences
- Document religious practices
- Monitor spiritual distress
- Check support requirements
Nursing Care Plans
Nursing Care Plan 1: Chronic Pain
Nursing Diagnosis Statement:
Chronic Pain related to terminal illness progression as evidenced by verbal reports of pain, grimacing, and protective behaviors.
Related Factors:
- Disease progression
- Tissue damage
- Psychological distress
- Anticipatory fear
- Physical immobility
Nursing Interventions and Rationales:
- Administer prescribed pain medications on schedule
Rationale: Maintains therapeutic pain control levels - Assess pain characteristics regularly
Rationale: Enables proper pain management adjustments - Implement non-pharmacological pain measures
Rationale: Provides complementary pain relief methods
Desired Outcomes:
- The patient reports adequate pain control
- The patient demonstrates improved comfort
- Patient maintains an optimal level of function
Nursing Care Plan 2: Anticipatory Grieving
Nursing Diagnosis Statement:
Anticipatory Grieving related to terminal diagnosis as evidenced by expressed feelings of loss, sadness, and anxiety about death.
Related Factors:
- Terminal prognosis
- Loss of independence
- Role changes
- Family dynamics
- Existential concerns
Nursing Interventions and Rationales:
- Provide active listening and emotional support
Rationale: Validates feelings and facilitates grief processing - Include family in care planning
Rationale: Promotes family involvement and support - Facilitate access to spiritual care
Rationale: Addresses spiritual and existential needs
Desired Outcomes:
- Patient expresses feelings about death
- The family demonstrates healthy coping mechanisms
- Patient achieves peace with end-of-life process
Nursing Care Plan 3: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to decreased mobility and nutritional status as evidenced by pressure points and fragile skin condition.
Related Factors:
- Limited mobility
- Poor nutritional status
- Incontinence
- Decreased circulation
- Medication effects
Nursing Interventions and Rationales:
- Implement a regular turning schedule
Rationale: Reduces pressure on vulnerable areas - Perform thorough skin assessments
Rationale: Enables early intervention for skin breakdown - Maintain proper hygiene and skin care
Rationale: Preserves skin integrity
Desired Outcomes:
- Skin remains intact
- Early signs of breakdown are identified and treated
- Comfort is maintained during care
Nursing Care Plan 4: Spiritual Distress
Nursing Diagnosis Statement:
Spiritual Distress related to end-of-life concerns as evidenced by expressed questioning of beliefs and meaning of life.
Related Factors:
- Terminal illness
- Cultural beliefs
- Religious practices
- Life review needs
- Existential questioning
Nursing Interventions and Rationales:
- Facilitate spiritual support services
Rationale: Addresses spiritual care needs - Provide culturally sensitive care
Rationale: Respect individual beliefs and practices - Support the life review process
Rationale: Helps achieve closure and peace
Desired Outcomes:
- The patient expresses spiritual peace
- Cultural/religious needs are met
- The patient achieves a sense of closure
Nursing Care Plan 5: Caregiver Role Strain
Nursing Diagnosis Statement:
Caregiver Role Strain related to complex care demands as evidenced by expressed feelings of burden and exhaustion.
Related Factors:
- Complex care requirements
- Limited support systems
- Emotional demands
- Financial concerns
- Physical exhaustion
Nursing Interventions and Rationales:
- Assess caregiver needs regularly
Rationale: Identifies support requirements - Provide respite care options
Rationale: Prevents caregiver burnout - Teach care techniques
Rationale: Increases caregiver confidence and competence
Desired Outcomes:
- Caregivers demonstrate effective coping
- Support resources are utilized
- Caregiver expresses reduced strain
References
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