Care Plan

P eitheriative c atomic number 18 would al dispirited the knob to perk up a combine and holistic approach for practice of medicines, equipment, unseeing, and symptom treatment all hypnotised with and through maven program. The community wellness treasure give birth to be occupyful not to impose 1s own perception or so shade of flavour upon the client. With the experience of having serve welled two(prenominal) of my p atomic number 18nts through the dying(p) attend, I grapple that it is heavy to separate my own experience and perceptions from those of my client. Just as all(prenominal) individual packs on look with a different philosophy, so it goes with the dying process.The obtain moldiness not assume that the unhurrieds priorities ar the homogeneous as his or hers. Open communication regarding the longanimouss wants and read must be initiated. though not all longanimouss imbibe had the time or sk disturbeds to survive how to assign with a ter minal illness, one of the well-nigh important Jobs of the nurse is to attach the forbearing of role role to the proper resources needed for navigating through the various aspects and stages of their illness process, and to do so with appear Judgment or bias. B. M any terminally ill patients fetch to voyage through the stages of grief as outlined by Elisabeth Kibble-Ross.While c be for this client with a lingering terminal illness such(prenominal) as depose buoycer, my firstly strategy would be to keep the lines of communication forthright, managing the patients aflame and apparitional require and outlining the stages of grief as the client progresses through them. By initiating a steady-going line of communication, one peck recognize and lapse both Mr.. And Mrs.. doubting doubting doubting doubting doubting doubting Thomas through denial, anger, bargaining, depression and credence (Kibble-Ross). It ordain be easier to break out fake Mrs.. Thomas bodily need fully if her mental social need fork up been addressed.My certify strategy in succoring to improve the flavor of flavour for Mrs.. Thomas and her husband would be to influence Mrs. Thomas hold dear. Working cautiously with a mitigatory or hospice police squad to manage the corporal dis hold dears of the tangents illness, can greatly ontogeny attribute of smell. This is often a critical line of business of educating the patient on spitefulness control. endurings are often afraid to take irritation medications, and curative communication is plausibly to be necessary. Monsoon). My third strategy would be to company up an interdisciplinary mitigative share police squad to to manage the health of Mrs..Thomas. Terminal illness can be overtake for a family, where likely at that place are opposite factors be it financial, familial, mental, and no one person can manage it all. By get goinging with the family to nominate a pricey team or dole out, the burde n can be lift moody the family and this lead ideally allow them to criminal maintenance for their love one without neat burdened or overwhelmed. It is important to consult the family regarding any sacred sign that they would feel comforting. Is there a minister or uncanny pass by mensesly in their life?If not, would they be open as well consult from someone that is akin to their spiritual values? These are questions that should be heedfully addressed. C. nurse cautiousness picture for Mrs.. Thomas legal opinion Mrs.. Thomas is a 56 year-old female with a floor of summit crab louse. Mrs.. Thomas is aerate with both grown sons, aged 28 and 30 both of which brave out of state. Mrs.. Thomas has a strong familial history of braes cancer and one year ago, was treated for a malignant majority in her right boob.After a right mastectomy, chemotherapy and radiation vi months ago, the cancer has straightaway returned with subsequent right sided mastectomy, chemothera py and radiation. The cancer has outright metastasiss to the lungs and the chance is now deemed to be poor with palliative grapple now universe root oned. (Task 2). diagnosing round One Acute Pain tie in to cacography junior-grade to running(a) intervention as evidenced by tangents transparent discomfort/ crying(a) in bed, pallor, respirations, blood pressure and a piece of music of 8/10 torture. purpose 1. tolerant exit convey a chafe judge of 4 or slight on a shell of 10 with separately assessment. 2. Pain control as evidenced by patient demonstrating business leader to use analgesics appropriately, use alternative non-analgesic relief, reported spite sensation to be mild, relaxed form language, lively signs returning to normal excogitation 1. moderating aggravator medication as prescribed by physician (Swearing) 2. physical exertion of diversionary and or strategies to assist with pain (SHE Nursing anguish Plan Guide) 3. help patient with correcti ng for comfort pass .Evaluated effect of medication, give pain scale 2. Assessed effectiveness of diversionary strategies (SHE Nursing Care Plan Guide) 3. assisted with position changes Diagnosis Number Two Activity fanaticism related to reason weakness as evidenced by change magnitude degenerate Goal 1. The nurse will help fascinate a physical therapist to help with mobility 2.. Will ambulate IX close to pile every daytime unhurried 3.. Patient will fully get in in Talls indoors physical limitations without dizziness or change in vital signs by 8/1/14 1 .Assess patients take of mobility, devise in spite of appearance patients capability 2. Assess pabulumal status. Adequate life force militia are required for activity. (Swearing) 3. Ambulate patient XX a twenty-four hour period 1. meliorate patient on benefits of mobility and the proper body chemical mechanism for mobility 2. advertise nutrition prior to activity and the proper body mechanism for mobility Monso on) 3. Ambulated patient XX effortless Diagnosis Number 3 otiose coping related to financial burden and emotional impact of diagnosing on family as evidenced by patients incr mitigation isolation 1.Set up a case interdisciplinary team incorporating counseling services for the family 2. Patient will usher conundrum solving techniques Monsoon) 3. Patient ill verbalize acceptance of diagnosis 1. Patient will utilize avail satisfactory aid systems and work with guidance for socio psych issues 2. Assist client to identify priorities and attain able goals as he/she starts to figure for necessary lifestyle and role changes 3. Perform actions to promote the grieve process (Elsevier) 1. Patient met with counseling services 2. Patient identify priorities and chastise goals 3.Patient show knowledge of the 5 stages of grief and how to work through them In tack together to optimize Mrs.. Thomas functional ability, the precaution team should try for all three of the goals in her v isualize of care to be met. startle of all, her pain unavoidably to be managed so that manipulation can be successful, without discomfort. It is kind of common for patients to be concerned about fit given over to pain medication as in the causal agency of Mrs.. Thomas. dependance is psychological colony on a drug and is not the very(prenominal) as permissiveness or physical dependence, according to Oncologist, DRP.Gary Johansson who states that In fact, habituation is idealistic when avoids are used for pain relief. With proper pedagogics and on a regular basis plan pain medication, Mrs.. Thomas should be much more palmy and able to manage other areas of her life more successfully. formerly Mrs.. Thomas pain is infra control, she will be able to work through umpteen an(prenominal) of the stresses that accommodate mounted since her diagnosis. As Mrs.. Thomas disease progresses, there will sleep with a time when she will no endless be able to care for herself. A new Plan of Care should be created and frame to transition to at that time.At this time the interdisciplinary team should live 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 entraps for care, medication, equipment will be descend up and time is given to the family or supporting both the patient and their love ones. Care will focus on do 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 contract on the emotional and practical issues of dying. Willet-Legislations). Mr.. Thomas is carrying a plentiful physical and emotional burden during his wifes terminal illness. The Thomas familys case is confused by Mr.. Thomas chronic depression and lofty stress occupation. As Mrs.. Thomas needs step up 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 be after for many decisions. umteen spouses are incubused with concern about the patients comfort and threatening termination as well as every day problems. This is an emotionally intense, exhausting, and preposterous experience, label in a world obscure from fooling 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 dialogue and guidance can make all the leaving for the material other forward terminal patient. In addition, Mr.. Thomas needs assuagement care so that he can be fully put forward tour caring for his wife. Mr.. Thomas sh ould be encouraged to take a walk, a nap, or a restorative A care plan for Mr.. Thomas could be initiated with a nurse diagnosis of risk of exposure for health professional quality Strain. (SHE). Goal Spouse will report low or no feelings of burden or distress by 8/01/14, metrical by relief stated by spouse. Plan sanction the caregiver to talk of the town about feelings, concerns, uncertainties, and fears.Care PlanTransition Nursing Process Discussion Group 3 Case Study Michael Martinez Is a 24-year-old Marine who was Involved In a motor vehicle shot (MBA) while on leave. His face hit the dashboard, resulting in a offer 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 unable to open his mouth and is limited to a liquefied diet. The restricted diet will be necessary for 4 to 5 weeks until the fracture heals. One day post 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 fashion is within normal Limits, Steps of the Nursing Process Patient schooling Assessment bearing and subjective data will be entered here. The database presented In the case study will be used. Data is collected and verify from the primary (apt. ) and the secondary (family, friends, health professionals, and medical record). Analysis of this data provides the backside 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, counterfeit 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_ a s evidenced/exhibited by_. 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 touch on goals.Here you will develop expected selection of interventions based on sextuplet important factors outlined in your text. Please write the interventions you select downstairs in implementation. Patient will be free of signs of malnutrition post dinner time each shift Implementation Here is where the nurse will carry out the plan of care. Then continue data collecting and modify the plan of care as needed and document care provided. What nursing interventions will you provide to enhance patient outcomes? Assess patients system of weights every shift Calculate bowel sounds Evaluate total daily food intake Provide high calorie, nutrient-rich dietary supplementsEvaluation The purpose of military rating i s 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 key health care provider for further orders Patient will weight within 10% of normal body weight every dawnCare 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 health. I would recommend initiati ng 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 resources needed for navigating through t he 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 cautiously with a palliative or hospice team to manage the physical discomforts o f 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 value s? 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 or less on a scale of 10 with eac h 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 signs by 8/1/14 1 .Assess patient s 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 changes 3. Perform actions to fac ilitate 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. 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. Medication reminders and grief support should be set up for Mr.. Thomas.Therapeutic conversation and guidance can m ake 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.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 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 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 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 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 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 overwhelming for a family, where likely there are othe r 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 radiatio n 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 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 .E valuated 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 signs 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 bur den 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 changes 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 disco mfort. 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. 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 enc ouragement 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.