LEAMINGTON DISTRICT MEMORIAL
HOSPITAL 194 Talbot Street West Leamington, Ontario N8H 1N9 (519) 326­2373 PLAN OF CARE (POC) NURSING DIAGNOSIS: End of Life Care related to diagnosis_____________________________ Date Expected Client Outcomes: Knowledge & Grieving: Client/Patient & Family will Outcome Target Outcome Met Date Initials Date Initials Date Initials Date Initials Date Initials Date Initials Date Initials Date Initials Date Initials Date Initials Understand client need for compassionate consistent & realistic care during terminal illness Be aware of the need to express feelings & fears & will feel comfortable asking questions &/or discussing concerns Comfort: Client/Patient Pain will be < _________ (Assess ct/pt pain goal) Demonstrate or report comfort Skin Integrity: Client/Patient Skin will remain intact Current breach(s) in skin integrity will not worsen & new breaches will not develop Self Care: Client/Patient Self care needs will be met End of Life Plan: Client/Patient & Family/Other will Participate in developing the Plan of Care & will discuss Resuscitation wishes with Physician Identify & express cultural, religious & personal beliefs &/or values related to death Identify requests r/t treatment of the body after death (Aesthetic, Physical, Cultural or Religious) Identify the person(s) to be contacted in the event of untoward change, imminent death or death of client Family Member: ___________________________ Phone Number: ____________________________ Alternate Contact: __________________________ Phone Number: ____________________________ Discuss Organ / Tissue Donation as appropriate. (It may be more appropriate for the physician to discuss or culturally/politically incorrect). Nurse Pronouncement Planned Family/Client aware of Nurse Pronouncement Name of Physician to sign Death Certificate: _____________________________________________________ Name of Coroner to be called before moving the body in a Coroner’s Case______________________________ Physician may be called to be notified of client death Anytime OR Between the Hours of _____ & _____ Refer to Clinical Practice Guidelines As Needed
LEAMINGTON DISTRICT MEMORIAL
HOSPITAL 194 Talbot Street West Leamington, Ontario N8H 1N9 (519) 326­2373 PLAN OF CARE (POC) Date NURSING INTERVENTIONS: Assessments & Actions Initiated & Nursing Diagnosis: Palliation Related to Dx of _________________ Initials Date DC/d & Initials Knowledge & Grieving: Assess client & family understanding of medical condition. Explain procedures and treatments and reinforce physician’s explanation of illness, treatment, and prognosis. Contact physician if clarification needed. Assess understanding of client & family level of anxiety fears & present coping behaviours. Support positive coping behaviours. Provide time to listen. Encourage expression of feelings, questions &/or concerns Provide an explanation of the changes noted to client physical emotional mental & spiritual status PRN. Provide quiet reassurance where possible. Establish & maintain positive communication & a relationship of trust Mental Health Nurse or Chaplain Referral PRN Comfort: Assess comfort & administer analgesics ordered (Use Standard Documentation). Advocate for client pain management. Contact physician PRN to change analgesic type, dose or administration frequency. Collaborate with Pharmacy re: drug of choice, dosage & drug combination. Explain availability of different medications & therapies, their correct use & major Side Effects (SE) PRN Support maintenance of physical mental emotional & spiritual function (E.g.: Elimination musculosketal & psychological & spiritual integrity) Skin Integrity: Provide a pressure reduction/relief support surface Self Care: Assess client mobility & activity tolerance and motivation. Encourage client self care & provide care as deficits present. Allow family to assist in care as appropriate. Observe for dyspnea, cyanosis, SOB, tachypnea, bradypnea & intervene as appropriate. Maintain patent airway End of Life Care: Encourage support & presence of family & include these in plan of care. Identify & respect, cultural, religious beliefs as well as personal values and aesthetics related to death & treatment of the body after death. Special Treatment/ Considerations Identified: 1) 2) 3) Date Initials Review* of Review* of Review* of Review* of N D E N D E N D E N D E Interventions Interventions Interventions Interventions *Review of Interventions – review plan of care means you look at potential interventions and actions – you are satisfied what has been initiated is appropriate and you may add or discontinue.