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Nursing Care Adults with Chronic Issues > 8.1 End of Life Care > Flashcards

8.1 End of Life Care Flashcards

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1
Q

Care of Dying

A
  • Technologies applied in advanced illness make the process of dying anything but peaceful
  • Technological Imperative practice - Every available means to extend life must be tried
  • Hippocratic oath - Do not harm. Prohibits physicians from administering deadly drugs
  • Living Will - Medical decisions left to family members
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2
Q

Brain Death

A
  • Irreversible unconsciousness with complete loss of brain function (heart may still beat)
  • Accepted criteria for establishing time of death
  • Fixed and dilated pupils (irreversible cessation of brain)
  • Lack of eye movement
  • Absence of respiratory reflexes (apnea)
  • Unresponsiveness to pain stimuli
  • Evidence that patient had a disease that could cause brain death
    FINAL DETERMINATION OF BRAIN DEATH Lack of electrical activity in the brain taken by 2 EEG’s 12 and 24 hours apart
  • Must rule out hypothermia or drug toxicities (mimics brain death)
  • Spinal reflexes and CNS function can still persist
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3
Q

Nurse Role in End of Life Care

A
  • Knowledge of palliative care and end of life principles are essential to nursing
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4
Q

National Consensus Project for Quality Palliative Care

2013

A
  • 8 domains of human approach to care of dying
  • Structure, physical aspects, psychological aspects, social aspects, spiritual aspects, ethical cultural aspects, end of life care.
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5
Q

Focus on dying

A
  • Motivated by an aging population
  • Publicity and prevalence surrounding life-threatening illness
  • Increased likelihood of prolonged period of chronic illness prior to death
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6
Q

Care of dying should include..

A
  • Timely access to end of life care
  • Comprehensive coverage for palliative services
  • Improved communication between provider
  • Emphasis on advanced care end-of-life planning
  • Professional education and development
  • Stronger public education and engagement
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7
Q

Technology

A
  • End of life has shifted from communicable diseases to chronic degenerative diseases
  • People are surviving disease because of technology
  • Death has been shifted from home setting to hospital
  • Great number of deaths occur in ICU
  • Causes death to be anything but peaceful
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8
Q

Glasser and Strauss

4 Contexts related to dying

A

4 contexts related to dying
Closed awareness - Patient is unaware of dying but everyone else knows
Suspected awareness - Patient suspects what others know and attempts to find out
Mutual Pretense - Everyone knows but pretends otherwise
Open awareness - Everyone knows and openly acknowledges

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9
Q

Assisted Suicide

A
  • Providing another person a means to end their life
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10
Q

Oregon Death with Dignity Act (1994)

A
  • Washington state followed in 2008

- Legalized assisted suicide

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11
Q

DNR (Do not Resuscitate)

A
  • Physician Order

- Has different levels from doing nothing to doing partial care

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12
Q

Advanced Directives

A
  • Written documents of the patients preferences
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13
Q

Living Will

A
  • Patients treatment preferences
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14
Q

Proxy

A
  • Authorize someone to represent them if they cannot represent themselves
  • Authorizes only for medical services
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15
Q

Durable Power of Attourney

A
  • Authorizes individual to make decisions on behalf of the patient when they are not able to
  • Includes everything
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16
Q

Palliative Care

A
  • Comprehensive symptom management
  • Psychosocial care, spiritual support needed to enhance quality of life
  • Treating suffering
  • Started off as hospice care, end of life care but evolved to be all under palliative care
  • It can occur in any setting
  • Death must be accepted for hospice care
  • Pain and symptoms of terminal illness must be managed
  • Family must also be cared for as a single unit
  • Home care of dying is necessary
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17
Q

Bereavement Care

A
  • Provided care to family after death
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18
Q

Hospice

A
  • Concept of care. Doesn’t matter where the patient is, its the concept of care
  • Not fully integrated into mainstream health because of difficulty of making terminal prognosis, especially in non-cancer patients
  • Strong association of hospice with death because there can be treatments even in late stages of illness
  • Least likely is also financial pressure for providers to continue care.
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19
Q

Hospice Care

A 
- All covered under Medicare/Medicaid
4 levels of hospice care
- Routine Home Care
- Inpatient Respite Care
- Continuous Care
- General Inpatient Care
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20
Q

Routine Home Care

A
  • All services provided and included in the daily rate of hospice care
21
Q

Inpatient/Respite Care

A
  • Patient admitted for a 5 day inpatient care

- Provided to relieve caregivers and give them 5 days of rest.

22
Q

Continuous Care

A
  • Care of medical crisis until it is resolved

- Example is development of seizures while in hospice care. They need continuous care until issue is resolved.

23
Q

General Inpatient Care

A
  • Symptoms management that cannot be managed or provided in the home or patient needs to be admitted
24
Q

Who Uses Hospice?

A
  • Dementia, Heart Disease, Lung Disease

- Used to only be for cancer patients but not anymore

25
Q

Communication about Death

A
  • Must be culturally aware and sensitive to approaches

- Set aside our own assumptions and attitudes such as open disclosure about terminal illness varies among cultures.

26
Q

Culture Differences

A
  • Some cultures believe direct contact about terminal illness is harmful
  • If you are not sure about culture then just ask
27
Q

Advanced Directives

A
  • Written legal documents sanctioned in every state through the “Patient Self Determination Act of 1991”
  • Allows competent people to document preferences regarding use of medical treatment
    “If I cannot eat on my own do not give me a feeding tube”
28
Q

Proxy Directive

A
  • Authorization of a person to make medical decisions for you when you cannot speak for yourself
  • Underuse of these documents show society remains uncomfortable with death
29
Q

Determination Act 1991

A
  • Requires healthcare institutes to provide information on advanced directives to adult patients upon admission
30
Q

Living Will

A
  • Written statement of patients medical desires or medical directive
31
Q

HIPPA Violations

A
  • When discussing with family members related to end of life it must be with the next of kin (closest living blood relative including spouse and adopted relative)
32
Q

Communicating Bad News

A
  • Involves medical team (nurse and physician)
  • Create the right setting with quietness. No pagers or phones
  • Should be able to sit at eye level
33
Q

Nursing Interventions

A
  • The most important one is listening empathetically
  • Effective listening involves avoiding distractions, noise, impulse to give advice, responses like “I know how you feel”
  • Its okay to have silence, resist impulse to fill in empty spaces in communication
  • Allow patient/family time to answer questions with “do you want to think about this?”
  • Do not try to solve the families problems
  • Assess their preferences and practices
34
Q

Spiritual Care

A
  • Features of religion but not the same
  • Meaning and purpose of life to that person
  • Beliefs, faiths, attitudes towards death.
35
Q

FICA(H) Tool

A 
- Used to address spiritual issues if you are not sure with what to ask or uncomfortable 
F - Faiths and beliefs
I - Importance and Influence
C - Community
A - Address and Care
(H) - Hope
36
Q

Supporting Hope

A
  • Persists in every stage of illness in some form
  • Listen attentively and encourage to share feelings
  • Provide accurate information
  • Encourage and support control over their circumstance, choices and environment
  • Assist patients in exploring ways to find meaning in their lives whenever possible
  • Have patients share uplifting memories
37
Q

Supporting Hope

A
  • Facilitate effective communication with families
  • Make referrals to psychological or spiritual counseling when requested
  • Assist with development of support groups
  • Less determined to fix and more willing to listen
38
Q

Management of Physiologic

A
  • Bronchodilators for COPD
  • Pain is preventable or treatable in most patients
  • Nurses role to prevent and manage pain
  • You can still provide care for DNR’s. Just do not resuscitate when they stop breathing or heart fails
39
Q

Dyspnea

A
  • Most prevalent symptom at end of life
  • Challenging to manage because meds used to treat it can also slow breathing to the point of not breathing
    (Pain meds, blood transfusions, bronchodilators)
40
Q

Nutrition/Hydration

A
  • Agents can be used to stimulate appetite
  • Artificial nutrition and hydration (comes with risks and doesn’t always contribute to end of life comfort)
  • Tube feedings can result in diarrhea and dehydration
41
Q

Diagnostic Tests

A
  • ## No change in treatment based on diagnostic results means no reason to do it
42
Q

Death Vigil

A
  • Withdrawal
  • Sleep more
  • More drowsy
  • Preceded by increased intervals of respiration
  • Weak and irregular pulse
  • Drop in BP
  • Mottling (blue/pale skin and even coolness)
43
Q

Death

A
  • Permanent cessation of respiratory and circulatory function
  • Absence of heart and lung sounds
  • Encourage family to spend time with loved ones, maintain privacy, honor cultural rituals
44
Q

T-Coroners Case / Medical Examiner Case

A
  • Examples is someone who had surgery in the last 24 hours or had suspicious death
  • ## Maybe need for autopsy
45
Q

Grief

A
  • Personal feelings that accompany anticipated loss
46
Q

Mourning

A
  • Family/Group and cultural expressions of grief and associated behaviors
47
Q

Bereavement

A
  • Period of time in which mourning or loss takes place
48
Q

Assessment of Grief/Mourning/Bereavement

A
  • Assess feelings, coping skills, offering professional referrals
  • Promote healthy personal habits (diet/exercise/stress reduction/sleep habits/guard against detrimental effects of stress)

Nursing Care Adults with Chronic Issues (16 decks)

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