9 - End Of Life Flashcards
Stage 1 of dying: (not KR model)
Life expectancy 20+ yrs
Thoughts are forward-reaching, growth-oriented, there’s no end in sight
Stage 2 of dying: (not KR model)
End of life inevitability
Life expectancy less than 5 yrs
Thoughts are conciliatory and directed to resolution
Frequent awareness of mortality
Stage 3 of dying: (not KR model)
The process of dying
Life expectancy less than 6 mos
Thoughts preoccupied with unrelenting loss of function and abilities
Renewed focus on life after death for oneself and for those who remain alivev
Stage 4 of dying: (not KR model)
The act of dying
Life expectancy less than one month
10 signs that someone is near death (less than one month)(stage 4)
Loss of appetite Thirst diminishes Increased fatigue Dehydration Increased weakness Social withdrawal Disorientation Swelling in the extremities Coolness in the tips of the fingers and toes Molted veins
Five stages of death according to Kubler-Ross
Denial and isolation Anger Bargaining Depression Acceptance
What are the Kubler-Ross stages all about?
Experienced by both the person and dying and loved ones
No particular order or length of time for each stage
Useful to identify what is being felt
Denial and isolation:
Individuals believe the diagnosis is somehow mistaken, and cling to false, preferable reality
Anger
When the individual recognizes that denial cannot
continue, they become frustrated, especially at proximate
individuals. Certain psychological responses of a person
undergoing this phase would be: “Why me? It’s not fair!”;
“How can this happen to me?”; “Who is to blame?”; “Why
would this happen?
Bargaining
The individual hopes that they can avoid the
cause of grief. Usually, the negotiation for an extended
life is made in exchange for a reformed lifestyle. People
facing less serious trauma can bargain or seek
compromise. For instance: “I’d give anything to have him
back.” Or: “If only he’d come back to life, I’d promise to be
a better person!”
Depression
During this stage, the individual
despairs at the recognition of their mortality. In
this state, the individual may become silent,
refuse visitors and spend much of the time
mournful and sullen. “I’m so sad, why bother
with anything?”; “I’m going to die soon, so what’s
the point?”; “I miss my loved one; why go on?
Acceptance
In this last stage, individuals
embrace mortality or inevitable future, or that of
a loved one, or other tragic event. People dying
may precede the survivors in this state, which
typically comes with a calm, retrospective view
for the individual, and a stable condition of
emotions. “It’s going to be okay.”; “I can’t fight it;
I may as well prepare for it.”
How can the stages of dying (KR model) lead to conflict between patient and family?
The patient and family are usually NOT at the same stage
End of life resources
- Home and family/friends
- Home health
- Provider home visits
- Visiting nurses
- Nursing homes
- ED and inpatient support
- Palliative care
- Hospice care
What is palliative medical care?
A specialized form of interdisciplinary care for patients with serious life-threatening illnesses
For anyone living with a serious illness, like HF, COPD, CA, dementia, parkinson’s, etc
Overall goal of palliative medical care?
Enhance the patients quality of life
Physical goals and objectives for palliatvive medical care
Nutritional support
Incontinence and constipation
Pain management
Sxs management
Hospice
Provides comprehensive comfort care as
well as support for the family, but all
attempts to cure the person’s illness are
stopped.
Who gets hospice?
Terminal illness where docs think patient has <6 mos to live if the illness runs its natural course
Where is hospice offered?
Either at home or in a facility
It’s an APPROACH to care, not a physical place (it’s not like, “grandma’s going to hospice care,” it’s “ grandma is going to receive hospice care”
Functions of hospice care
Provider - pain management
Nursing - meds, triage, bowel/bladder management, wound care, hygiene
Counseling - spiritual, personal
Planning - financial, family care
Note - hospice does NOT provide:
Funeral services
Issues surrounding death and dying:
Costs
Advanced directives
Will / estate
Where will the patient die?
Funerals (i.e. cremation vs burial)
After the funeral (the after-party?)
Why did the scarecrow receive an award?
Because he was outstanding in his field
