Family care plan for elderly father with terminal cancer diagnosis

Family Care Plan

Nursing Family Care Plan

The Case:

Father, 75, recently diagnosed with small cell carcinoma. On home hospice care with 4-6 months to live; worked in the Philadelphia Naval yard. Former regular smoker, recently quit.

Mother, 76, obese, suffers from Insulin-Dependent Diabetes Mellitus. Has no relevant work history (stay at home mom). Also a former regular smoker; quit at the same time as Father.

Son, 50s, has an ongoing drug addiction. Currently abusing benzodiasipans (klonopin xanax) despite being on controlled methadone maintenance. No children, and no available work history. Regular smoker.

Diagnosis

Quality of life and access to care, jeopardized; related to father's recent diagnosis and expected rapid decline, mother's limited mobility due to obesity and insulin dependent diabetes, son's unreliability due to drug use as manifested by his continued abuse of benzodiasipans during a supervised pharmaceutical regimen.

Objectives:

Ensure regular access to healthcare professionals for all family members, as well as implementing methods for achieving reliable in-home self-care to improve the quality of life and health within the next six weeks.

Family Assigned Interventions:

-Careful monitoring of blood sugar/insulin levels in mother, strict adherence to dietary restrictions in order to improve overall well-being and reliability of health

-Proper care techniques learned by mother and son to assist in quality of life improvements for father

-Renewed efforts on part of son to resist drug addiction, including therapy and support group attendance

Nursing Interventions

-Provide regular in-home care to father as required, largely to lend support/relieve pressures in the family

-Instruct mother in use of testing supplies and dietary regulation and ensure understanding

-Monitor son's drug use as much as possible, watching for sign of future medical distress

Evaluation

Regular visits with brief questions (mother's blood sugar levels and diet, incidents with father, son's drug use, problems reaching medical appointments, etc.) will evaluate the success of these measures.

Diagnosis 2

Family processes, altered; related to father's illness and hospice care as evidenced by the fact that father was the only outside-the-home worker and therefore likely the active caretaker until the point of his diagnosis, creating new level of responsibility for mother and new responsibilities altogether for son.

Objectives

Developing understanding of and competence in new roles in the family dynamic for all three family members (includes father's acceptance of reduced role in order to maintain quality of life during end-of-life care) within two weeks.

Evaluation

Levels of comfort and competence in new family roles should be easily assessed in regular visits through brief questioning. Monitoring father's health through standard vital sign and other appropriate tests will determine level of care; questions determine quality of life. Assessment of son for ability to act with increased responsibility may take a longer evaluative period.

Diagnosis 3

Possibility of resumed smoking by mother and father further reducing quality of life and ability to provide care, related to long-time smoker status and high rates of recidivism in smokers, as manifested in (and exacerbated by) the son's continuing status as a regular smoker

Objectives

To ensure that the mother and father remain non-smokers, and to mitigate the effects (both psychological and physiological) of the son's continued smoking. Son's cessation of smoking would be a secondary objective, but is not immediately advisable given his drug dependency status

Family Interventions

-Mother and father can develop regular responses to nicotine cravings, discuss frustrations

-Son should limit his smoking to outside areas, and preferably out of sight and smell of the house so as not to instigate or worsen cravings on the part of his parents

-Family should make an agreement that son will to leave cigarettes around or share them out, to reduce levels of temptation

Nursing Interventions

-Provision of educational materials and support concerning tobacco addictions

-Provision of quitting-aid substances and devices, if needed

-Developing smoking "schedule" with son to allow planned continuation of his smoking with limited effects on his parents or his wn psychological well-being

Evaluation

Ultimately, only self-reporting of smoking behaviors can be used as an evaluative tool.