Care Plan for Long Term Care Adjustment
Care Plan for Long Term Care Adjustment
Category / Primary Body System
- Psychosocial and Mental Health
Problem
- Patient is at risk for maladjustment due to placement in the facility for long-term care.
Goal
- Patient will adjust to the facility, as evidenced by participating in care daily for 90 days.
Plan/Approach
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Emotional and Psychological Support
- Encourage verbalization of feelings regarding long-term care placement as needed.
- Encourage family visitation as appropriate to provide emotional support.
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Social Services and Therapy
- Arrange social service consults as needed to address psychosocial needs and provide support.
- Arrange PT/OT evaluations and treatments as needed to support physical functioning and enhance adjustment.
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Activity and Engagement
- Encourage participation in diversional activities to promote socialization and engagement.
- Provide a variety of activities to cater to the patient's interests and preferences.
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Medication Management
- Administer medications as ordered to manage any underlying medical or psychological conditions.
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Monitoring and Communication
- Notify MD/RNP of any changes in the patient's medical condition.
- Monitor the patient's adjustment and engagement in care, documenting progress and any issues.
Rationale
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Emotional and Psychological Support
- Verbalizing feelings helps the patient process emotions related to the transition and reduces feelings of isolation.
- Family visits provide comfort, familiarity, and a sense of continuity, aiding in adjustment.
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Social Services and Therapy
- Social service consults provide resources and support for coping with the transition.
- PT/OT helps maintain physical function, contributing to a sense of independence and well-being.
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Activity and Engagement
- Diversional activities provide mental stimulation, social interaction, and a sense of purpose.
- Offering activities that align with the patient's interests helps them feel more at home in the facility.
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Medication Management
- Proper medication management ensures that the patient's health conditions are controlled, contributing to overall stability.
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Monitoring and Communication
- Monitoring and timely communication with the healthcare team ensure that any issues are addressed promptly, promoting a smooth adjustment.
Actions
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Emotional and Psychological Support
- Encourage the patient to express feelings about the transition to long-term care, providing active listening and validation.
- Facilitate family visits and support family involvement in the patient's care.
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Social Services and Therapy
- Schedule social service consults to address any psychosocial issues and provide ongoing support.
- Arrange PT/OT evaluations and treatments to address physical needs and promote independence.
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Activity and Engagement
- Offer a variety of activities and encourage the patient to participate in those that interest them.
- Document the patient's participation in activities and any preferences or feedback.
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Medication Management
- Administer medications as prescribed, monitoring for effectiveness and any side effects.
- Review medications regularly with the healthcare team to ensure optimal management.
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Monitoring and Communication
- Monitor the patient's adjustment, noting any changes in mood, behavior, or participation in care.
- Report any significant changes in the patient's condition to the MD/RNP promptly.
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