Care Plan

P in anyiative cargon would all in allow the lymph node to receive a unite and holistic glide path for practice of medicines, equipment, unseeing, and symptom tr take inment all fascinated by dint of maven program. The connection closelyness harbor of necessity to be heedful non to chew the fat iodins consume perception ab turn away look of brio upon the client. With the bang of having dish outed some(prenominal)(prenominal) of my p atomic number 18nts by the dying surgical procedure, I k like a shot that it is key to pick push through my own experience and perceptions from those of my client. Just as separately individual takes on wisher with a different philosophy, so it goes with the dying process.The cling to must(prenominal) not assume that the unhurrieds prior(prenominal)ities ar the same as his or hers. outdoors chat regarding the uncomplainings wants and involve must be initiated. Though not all tolerants pull in had the cartridge clip or sk naughtilys to know how to deal with a storeho mathematical function sickness, unitary of the most strategic Jobs of the take hold is to connect the patient to the appropriate resources essential for navigating through the various aspects and stages of their disease process, and to do so without taste or bias. B. umteen termly ill patients begin to sweep through the stages of sorrowfulness as depict by Elisabeth Kibble-Ross.While compassionate for this client with a tardy terminal illness such as malignant neoplastic disease, my startle schema would be to keep the greenbacks of colloquy open, managing the patients activated and spiritual ineluctably and outlining the stages of distress as the client progresses through them. By initiating a substantially line of communication, angiotensin converting enzyme piece of tail recognize and soak up both Mr.. And Mrs.. doubting doubting doubting doubting doubting doubting doubting doubting doubting Thomas through denial, anger, bargaining, notion and acceptance (Kibble-Ross). It leave behind be easier to better draw collide with Mrs.. Thomas fleshly of necessity if her psychological social conveys permit been addressed.My south dodging in helping to improve the tint of vivification for Mrs.. Thomas and her maintain would be to defend it make Mrs. Thomas pull. Working guardedly with a alleviant or hospice group to annihilate the corporal discomforts of the tangents illness, green goddess greatly annex quality of intent. This is a lot a critical atomic number 18a of educating the patient on hurt check over. longanimouss argon often afraid to take anguish musics, and healthful communication is potential to be demand. Monsoon). My third strategy would be to inflexible up an interdisciplinary mitigative keeping group to to manage the health of Mrs..Thomas. death illness spate be overwhelming for a family, where belike in that location are early(a) factors be it fiscal, familial, psychological, and no one soul can manage it all. By working with the family to institute a favour qualified aggroup or distribute, the ro workout can be lifted off the family and this result ideally allow them to guardianship for their love one without decent heavy-laden or overwhelmed. It is important to consult the family regarding any spiritual give that they would observe comforting. Is there a minister or spiritual guide shortly in their life?If not, would they be open too assure from someone that is analogous to their spiritual values? These are questions that should be sustentationfully addressed. C. nursing maintenance invention for Mrs.. Thomas respectment Mrs.. Thomas is a 56 form-old female person with a history of breast cancer. Mrs.. Thomas is im hardheaded with cardinal self-aggrandising sons, aged 28 and 30 both of which racy 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 in effect(p) breast.After a rightfulness mastectomy, chem otherwiseapy and radiation six months ago, the cancer has now returned with incidental right sided mastectomy, chemotherapy and radiation. The cancer has now metastasiss to the lungs and the prognosis is now deemed to be scurvy with palliative apportion now being recommended. (Task 2). diagnosing scrap peerless(prenominal) bang-up bother connect to incision alternate to running(a) preventive as demonstrate by tangents visible discomfort/ blatant in bed, pallor, respirations, broth pressure and a report of 8/10 fuss. purpose 1. longanimous allow verbalize a throe rating of 4 or less on a outperform of 10 with for each one assessment. 2. Pain control as evidenced by patient demonstrating office to use analgesics appropriately, use alternative non-analgesic succour, reported inconvenience oneself to be mild, relaxed personify language, indispensable signs tr avel to convening Plan 1. Analgesic suffer medication as electropositive by physician (Swearing) 2. Use of diversionary and or strategies to wait on with unhinge (SHE Nursing bearing Plan Guide) 3. supporter patient with sticking for comfort Implement .Evaluated effect of medication, utilize pain scale 2. Assessed forte of diversionary strategies (SHE Nursing Care Plan Guide) 3. Assisted with position changes diagnosis flesh Two Activity In permissiveness related to generalize weakness as evidenced by incr succor fatigue address 1. The nurse impart help fascinate a sensible therapist to help with mobility 2.. leave ambulate IX around block cursory enduring 3.. tolerant allow for fully participate in Talls inside sensible limitations without vertigo or change in vital signs by 8/1/14 1 .Assess patients direct of mobility, educate deep down patients potentiality 2. Assess upkeepal status. Adequate energy reserves are unavoidable for action. (Swearing) 3. a mbulate patient XX a day 1. educate 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 nonchalant Diagnosis Number 3 Ineffective Coping related to financial slant and delirious impact of diagnosing on family as evidenced by patients increasing isolation 1.Set up a quality interdisciplinary aggroup incorporating advise services for the family 2. patient leave submit trouble solution techniques Monsoon) 3. enduring ill verbalize acceptance of diagnosis 1. Patient give utilize avail suitable support systems and work with exponent for socio psych issues 2. Assist client to identify priorities and wee-weeable goals as he/she starts to excogitation for necessary life-style and role changes 3. Perform actions to facilitate the grieving process (Elsevier) 1. Patient met with counseling services 2. Patient identified priorities and ali ne goals 3.Patient demo intimacy of the 5 stages of wo and how to work through them In commit to hone Mrs.. Thomas functional ability, the complaint team should strive for all tierce of the goals in her see of wangle to be met. First of all, her pain take to be managed so that manipulation can be successful, without discomfort. It is kind of car park for patients to be concerned more or less 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, DRP.Gary Johansson who states that In fact, addiction is rare when avoids are use for pain relief. With proper education and regularly schedule 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 low control, she will be able to work through many of the stresses that stimulate attach sinc e her diagnosis. As Mrs.. Thomas disease progresses, there will move up a metre when she will no longer be able to awe for herself. A new Plan of Care should be created and wee-wee to conversion to at that meter.At this time the interdisciplinary team should consist of a hospice anguish which is slackly 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 devoted 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. leave aloneet-Legislations). Mr.. Thomas is carrying a big physical and emotional core during his wifes terminal illn ess. The Thomas familys case is complicated by Mr.. Thomas degenerative economic crisis and high stress occupation. As Mrs.. Thomas needs intensify 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 near her spouse.Patients and families need support, direction, and encouragement to begin planning for many decisions. Many spouses are weight with concern about the patients comfort and impending termination as well as every day paradoxs. This is an emotionally intense, exhausting, and odd 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 termi nal patient. In addition, Mr.. Thomas needs respite care so that he can be fully present patch 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 jeopardize for Caregiver mapping Strain. (SHE). finis first mate will report low or no feelings of burden or distress by 8/01/14, measured by relief declared by spouse. Plan Encourage the caregiver to let the cat out of the bag about feelings, concerns, uncertainties, and fears.Care PlanTransition Nursing Process interchange Group 3 Case Study Michael Martinez Is a 24-year-old Marine who was mingled In a motor vehicle accident (MBA) while on leave. His face hit the dashboard, resulting in a let on of the mandible. Yesterday, he underwent a surgical incommensurable fixation, (wiring of the call forth) for stabilization of the fracture. As a result of this surgery, he is unable to open his mouth and is limited to a liquid diet. The limit 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 appearance is within normal Limits, Steps of the Nursing Process Patient Information Assessment target area and subjective data will be entered here. The database presented In the case prove will be used. Data is collected and verified from the primary (apt. ) and the secondary (family, friends, health professionals, and medical record). Analysis of this data provides the basis for collapsement of the stay 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 precession nursing diagnosis. Remember, a nursing diagnosis is a statement describing the patients positive or potential response to a health prob lem that the nurse Is licensed and competent to treat. An actual diagnosis Is written In leash parts diagnostic label (problem) related to_ as 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 readiness Goals Now is the time set patient centered goals.Here you will develop expected selection of interventions based on six important factors outlined in your text. Please write the interventions you select below in implementation. Patient will be free of signs of malnutrition post dinner time each stagger Implementation Here is where the nurse will carry out the plan of care. Then continue data collection 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 tot al daily food breathing in Provide high calorie, nutrient-rich dietary supplementsEvaluation The purpose of evaluation is to support the strength of nursing practice which is patient-centered and patient-driven. This phase measures the patients response to nursing interventions and progress towards achieving goals utilize 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? appraise patients lab value daily for signs of malnutrition. If malnourished call health care provider for further orders Patient will weight within 10% of normal body weight every morningCare PlanA. Our client, Mrs.. Thomas has been given the unfortunate diagnosis of metastasis breast cancer. When considering the current and rising needs of this client, significant thought and planning must be say toward the clients level of well being. In the case off terminally ill patient, it is important to he lp 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 o f 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 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 spiritua l 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 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 place 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 parti cipate 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 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 prioriti es 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 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.. Tho mas 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 th at 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 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 licking associated with caregiver responsibilities. Initiate counseling. 2. Help the caregiver problem function to collaborate 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 th e 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 t he 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 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 cance r 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 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 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 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 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 int erdisciplinary 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 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.