Nursing Care Plan
... I observed that when D.H is given foods, it is placed beside her where she cannot reach the tray and does not have enough energy to feed herself; however, when I sat with her and fed her meals, she enjoyed it and showed interest in trying to finish as much as possible. Nursing Action: Provide companionship during meals and assist her in eating; consult on staff dietitian to consider providing palliative foods or suggesting to her daughter to bring in soft foods that she knows her mother enjoyed prior to entering Heartland. Since she is a hospice patient, comfort measures during this time are key. Elimination: My observations: Frequently constipated; wears briefs for urine and bowel incontinence. Nursing Action: For constipation, increase daily fluid intake of 2000-3000 ml/day; increase fiber in diet; continue with Miralax laxative daily; monitor for fecal impaction ( if fecal impaction occurs, remove digitally); increase mobility as much as tolerated. Body Alignment/Activity: My observations: Activity Intolerance due to weakness, reconditioning, fatigue due to nutritional status, pain, and imbalance between oxygen supply and demand. Nursing Action: Encourage/consult OT to do daily ROM exercises with her to prevent stiffness or contraction and to improve circulation; when transferred from bed to chair watch for orthostatic BP or rapid pulse; Limit over activity, and provide resting periods when she is moved around excessively; Keep a portable oxygen tank with her at all times; Turn and reposition her while in bed napping every 2-4 hours to prevent skin breakdown. Environment: My observations: Resident shares room with another person; bed is next to window, there are pictures of her daughter and religious cards and plaques on her dresser. Nursing Action: Keep temperature at a comfortable level; make sure room is free of clutter and that anything she needs such as water, food, tissues, call light are in reach. Emotional/Spiritual Support: My observations: Resident exhibits signs of loneliness, often crying out “help me” and is alone in her room most of the time; She is often placed in the wing’s TV room, which she doesn’t seem to like to be. Nursing Action: Communicate with daughter to visit with her more often or possibly get a sitter from hospice to come in and keep her company when aides/nurses are not available; Have someone take her for a wheelchair ri...