Care Plan

P aloneiative get by would allow the leaf node to receive a combined and holistic approach for musics, equipment, unseeing, and symptom treatment all fascinated by one program. The community health foster unavoidably to be addressful not to impose ones own perception ab show up quality of animation upon the client. With the suffer of having sufficeed both of my parents by dint of the dying(p)(p) process, I notice that it is valuable to separate my own throw and perceptions from those of my client. Just as each person takes on spirit with a different philosophy, so it goes with the dying process.The maintain must not assume that the forbearings priorities are the same as his or hers. Open conversation regarding the uncomplainings wants and ineluctably must be initiated. Though not all affected roles absorb had the beat or sk complaints to know how to deal with a death disgustedness, one of the most central Jobs of the nurse is to connect the patient to the proper resources unavoidable for navigating through with(predicate) the various aspects and stages of their disease process, and to do so without Judgment or bias. B. M any remainderly ill patients begin to navigate through the stages of grief as outlined by Elisabeth Kibble-Ross.While caring for this client with a lingering terminal illness such as goatcer, my first strategy would be to keep the lines of communication open, managing the patients frantic and spiritual need in full and outlining the stages of grief as the client progresses through them. By initiating a superb line of communication, one can recognize and template both Mr.. And Mrs.. doubting doubting doubting Thomas through denial, anger, bargaining, depression and acceptance (Kibble-Ross). It will be easier to better manage Mrs.. Thomas visible needfully if her psychological social inescapably hire been addressed.My second strategy in helping to improve the quality of animation- m for Mrs.. Thomas and her husband would be to manage Mrs. Thomas comfort. Working carefully with a palliative or hospice aggroup to manage the animal(prenominal) discomforts of the tangents illness, can greatly increase quality of life. This is often a critical area of educating the patient on incommode control. patients are often afraid to take b separateation musics, and therapeutic communication is likely to be necessary. Monsoon). My ternion strategy would be to set up an interdisciplinary palliative care team to to manage the health of Mrs..Thomas. Terminal illness can be evoke for a family, where likely there are other(a) factors be it financial, familial, psychological, and no one person can manage it all. By working with the family to institute a proper team or care, the burden can be lifted off the family and this will ideally allow them to care for their loved one without bonnie burdened or overwhelmed. It is important to consult the family regarding any spiritual choke that they w ould feel comforting. Is there a minister or spiritual guide before long in their life?If not, would they be open as well as visit from someone that is akin to their spiritual values? These are questions that should be carefully addressed. C. treat bursting charge jut out 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, time-honored 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 metastasiss to the lungs and the candidate is now deemed to be poor with palliative care now being inspireed. (Task 2). Diagnosis issue One Acute painful sensation related to incision inessential to surg ical intervention as prove by tangents visible discomfort/crying in bed, pallor, respirations, blood pressure and a report of 8/10 pain. Goal 1.patient role will verbalize a pain rating of 4 or less on a scale of 10 with each assessment. 2. trouble 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 return 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 bid Plan Guide) 3. Assist patient with perspective for comfort Implement .Evaluated effect of medication, utilize pain scale 2. Assessed effectivity of diversionary strategies (SHE Nursing bring off Plan Guide) 3. Assisted with position changes Diagnosis Number Two Activity Intolerance related to generalized weakness as evidenced by change magnitude fatigue Goal 1. The nurse will help fa scinate a physical therapist to help with mobility 2.. Will ambulate IX around put off daily Patient 3.. Patient will fully participate in Talls within physical limitations without dizziness or change in vital signs by 8/1/14 1 .Assess patients direct of mobility, educate within patients capability 2. Assess nutritional status. Adequate energy reserves are ask for employment. (Swearing) 3. Ambulate patient XX a twenty-four hour period 1. Educated patient on benefits of mobility and the proper body mechanics for mobility 2. Encourage nutrition prior to application and the proper body mechanics for mobility Monsoon) 3. Ambulated patient XX daily Diagnosis Number 3 Ineffective Coping related to financial burden and aro apply impact of diagnosing on family as evidenced by patients change magnitude isolation 1.Set up a quality interdisciplinary team incorporating counseling go for the family 2. Patient will demonstrate problem understand techniques Monsoon) 3. Patient ill verba lize acceptance of diagnosis 1. Patient will utilize available give systems and work with counselor for socio psych issues 2. Assist client to come across priorities and attainable goals as he/she starts to plan for necessary lifestyle and role changes 3. Perform actions to facilitate the grieve process (Elsevier) 1. Patient met with counseling service 2. Patient identified priorities and set goals 3.Patient demonstrated knowledge of the 5 stages of grief and how to work through them In rig 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 necessarily to be man old so that manipulation can be successful, without discomfort. It is quite common for patients to be concerned about seemly addicted to pain medication as in the crusade of Mrs.. Thomas. Addiction is psychological addiction on a drug and is not the same as tolerance or physical dependence, fit in to Oncologist, DR P.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 a good deal 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 distortes that rush 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 apportion 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 founds 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 deliver 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 horny and practical issues of dying. Willet-Legislations). Mr.. Thomas is carrying a big physical and emotional burden during his wifes terminal illness. The Thomas familys case is complicated by Mr.. Thomas chronic depression and high evince 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 cost increase to begin planning for many decisions. Many spouses are weighted with concern about the patients comfort and be death as well as all twenty-four hour period problems. This is an emotionally intense, exhausting, and singular expe rience, set in a world apart from eitherday life patterns. (Siegel). Mr.. Thomas needs to be reminded that in disposition to help care and be emotionally supportive to his wife, he needs to take care of himself. medicinal drug 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 first mate will report low or no feelings of burden or distress by 8/01/14, measured by relief stated by spouse. Plan Encourage the health professional to talk about feelings, concerns, uncertainties, and fears.Care PlanTransition Nursing puzzle out Discussion Group 3 Case Study Michael Martin ez Is a 24-year-old Marine who was Involved In a motor vehicle accident (MBA) while on leave. His face hit the dashboard, resulting in a fracture of the mandible. Yesterday, he underwent a surgical incommensurable fixation, (wiring of the Jaw) for stabilization of the fracture. As a result of this surgery, he is futile to open his mouth and is limited to a liquid diet. The restricted diet will be necessary for 4 to 5 weeks until the fracture heals. One day location pop, his vital signs are 120/76, T-99. 2, P-82, and R- 20.After medication, is pain level is 3/10. With the exception of facial bruising, his appearance is within normal Limits, Steps of the Nursing service Patient Information Assessment Objective and subjective data will be entered here. The database presented In the case study will be used. Data is stack away and verified from the primary (apt. ) and the unoriginal (family, friends, health professionals, and medical record). Analysis of this data provides the basis for development of the remaining steps in the nursing process. Subjective Patient expresses disinterest in a liquid only diet Objective wired Jaw Liquid diet Nursing DiagnosisAfter analyzing the assessment data, formulate a priority nursing diagnosis. Remember, a nursing diagnosis is a statement describing the patients actual or potential response to a health problem that the nurse Is licensed and competent to treat. An actual diagnosis Is written In three parts diagnostic label (problem) related to_ as evidenced/exhibited by_. A run a risk diagnosis is written in two parts Risk for (diagnostic label) _ related to Nutrition less than body requirements related to Inability to eat solid foods as evidenced by liquid diet post-surgery Planning Goals Now is the time set patient centered goals.Here you will develop expected selection of interventions base on six important factors outlined in your text. Please write the interventions you select below in implementation. Patient will be f ree of signs of malnutrition post dinner time each shift Implementation Here is where the nurse will carry out the plan of care. Then refer data order and modify the plan of care as needed and document care provided. What nursing interventions will you provide to enhance patient outcomes? Assess patients weight every shift Calculate bowel sounds Evaluate total daily food intake Provide high calorie, nutrient-rich dietary supplementsEvaluation The purpose of evaluation is to support the effectiveness of nursing practice which is patient-centered and patient-driven. This phase measures the patients response to nursing interventions and progress towards achieving goals using five elements listed in the text. Did you achieve the goal for this nursing diagnosis? Will you continue the plan of care, revise the plan of care, or discontinue? Reassess patients lab value daily for signs of malnutrition. If malnourished call health care provider for push orders Patient will weight within 10% of normal body weight every morningCare PlanA. Our client, Mrs.. Thomas has been given the pitiable diagnosis of metastasis breast cancer. When considering the current and future needs of this client, significant thought and planning must be directed toward the clients 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 a s each person takes on life with a different philosophy, so it goes with the dying process.The nurse must not assume that the patients priorities are the same as his or hers. Open communication regarding the patients 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.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 patients emotional and spiritual needs and outlining the stages of grief as the client progresses through them. By initiating a good line of communicatio n, 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 tangents 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 overpowering for a family, where likely there are other factors be it financial, familial, psychological, and no one person ca n 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 shortly 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 m astectomy, chemotherapy and radiation. The cancer has now metastasiss to the lungs and the outlook 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 tangents 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 stoppage daily Patient 3.. Patient will fully participate in Talls within physical limitations without dizziness or change in vital signs by 8/1/14 1 .Assess patients level of mobility, educate within patients capability 2. Assess nutritional status. Adequate energy reserves are inevitable 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 pati ents 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 grieve 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, accord 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 oftentimes 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 hosp ice 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 wifes terminal illness. The Thomas familys 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. medicine 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 abo ut 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.Care PlanA. 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 clients 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 h ealth. 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 patients priorities are the same as his or hers. Open communication regarding the patients 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 resource s 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.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 patients 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 m anage the physical discomforts of the tangents 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 metastasiss 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 tangents 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 o r 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 Talls within physical limitations without dizziness or change in vital s igns by 8/1/14 1 .Assess patients level of mobility, educate within patients 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 patients 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 c hanges 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. Wille t-Legislations). Mr.. Thomas is carrying a big physical and emotional burden during his wifes terminal illness. The Thomas familys 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.