Updated Care Plan for Hospice Patient

Category / Primary Body System:

Palliative Care / Comfort Management

Problem:

The resident is a hospice patient requiring comprehensive palliative care.

Goal:

The resident will be kept comfortable during the dying process.

Plan/Approach:

1. Coordination with Hospice Agency:

   • Step: Cooperate with the hospice agency.
   • Rationale: Effective coordination ensures that the resident receives comprehensive and continuous care aligned with hospice guidelines.
   • Actions: Maintain regular communication with hospice staff, participate in care planning meetings, and follow hospice protocols.

2. Condition Monitoring and Notification:

   • Step: Notify the hospice agency of any changes in the resident’s condition promptly.
   • Rationale: Timely updates enable hospice staff to adjust care plans and interventions to meet the resident’s changing needs.
   • Actions: Monitor the resident’s condition closely, document any changes, and inform the hospice agency immediately.

3. Pain Management:

   • Step: Monitor the effectiveness of pain management.
   • Rationale: Ensuring effective pain control is crucial for maintaining the resident’s comfort and quality of life.
   • Actions: Assess the resident’s pain levels regularly using appropriate pain scales, administer prescribed pain medications, and adjust the pain management plan as needed in consultation with hospice staff.

4. Emotional Support:

   • Step: Provide emotional support to the resident and family.
   • Rationale: Emotional support helps the resident and family cope with the emotional challenges of the dying process.
   • Actions: Offer active listening, reassurance, and counseling services. Encourage family presence and involvement in care. Facilitate access to spiritual care and support groups if desired.

5. Oxygen Therapy:

   • Step: Administer oxygen as needed for comfort (O2 PRN).
   • Rationale: Supplemental oxygen can alleviate dyspnea and improve comfort for patients experiencing respiratory distress.
   • Actions: Monitor the resident’s respiratory status, administer oxygen as prescribed, and adjust the flow rate to ensure comfort.

6. Symptom Management:

   • Step: Manage other symptoms such as nausea, constipation, anxiety, and insomnia.
   • Rationale: Comprehensive symptom management improves overall comfort and quality of life.
   • Actions: Administer medications and non-pharmacological interventions as prescribed for symptom relief. Monitor effectiveness and adjust treatment plans as necessary.

7. Hydration and Nutrition:

   • Step: Provide hydration and nutrition support as appropriate and desired by the resident.
   • Rationale: Maintaining hydration and nutrition supports overall comfort and can prevent unnecessary discomfort from dehydration or hunger.
   • Actions: Offer small, frequent sips of water or nutritional supplements as tolerated. Respect the resident’s wishes if they decline food or fluids.

8. Care Plan Review:

   • Step: Review and update the care plan regularly in collaboration with the hospice team.
   • Rationale: Regular review ensures that the care plan remains responsive to the resident’s evolving needs and preferences.
   • Actions: Conduct care plan meetings with the hospice team, resident, and family at regular intervals and make necessary adjustments based on feedback and observations.