ADULT 2 End of Life Care Review

Question 1

What is End of Life?

Answer 1

Refers to the final phase of a patient’s illness, when death is imminent

The time from diagnosis of a terminal illness to actual death varies considerably, depending on the patient’s diagnosis, the extent of disease, comorbid diseases, and the treatment received

Patients/families have a choice: curative treatment vs. focus on comfort

Question 2

What is palliative care?

Answer 2

Care or treatment focusing on reducing the severity of symptoms
• Begins during curative or restorative health care
• allows for curative and palliative treatment simultaneously
• Extends into end-of-life care
• Bereavement care follows death

Goals
• Regard dying as a normal part of life
• Symptom relief (pain, nausea, SOB, anxiety)
• Affirm life, and not hasten nor postpone death
• Enhance quality of life
• Offer the support needed for patients to remain as active as possible until death
• Family support

When do we use palliative care?
• When a diagnosis of a life-limiting illness is made, and patients need symptom relief
• Examples: Cancer, COPD, CHF

Involves Inter-professional collaboration, Ongoing communication, and Care in multiple settings

Question 3

What is hospice care?

Answer 3

care that is provided when curative care is a foregone conclusion.

Requires physician certification that life expectancy is 6 months or less.

Concept of care that provides compassion, concern, and support for persons in the final phases of a terminal disease
• Live fully
• Live comfortably
• Die pain-free and with dignity

Available 24 hours/day, 7 days/week

Hospice nurses are pivotal for:
•	Pain control
•	Symptom management
•	Spiritual assessment
•	Assessment and management of family needs

Hospice Settings
•	Home
•	Residential hospice
•	Long-term acute care hospital
•	Skilled nursing facility
•	Acute care hospital
•	Assisted living facility

Question 4

What are the goals of EOL care?

Answer 4

• Provide comfort and supportive care during the dying process
• Improve quality of remaining life
• Help ensure a dignified death
• Provide emotional support to the family

Question 5

Planning for EOL care:

Answer 5

Involve patient and family

RN should Advocate for

a. Patient wishes
b. Comfort and safety
c. Care of emotional and physical needs
d. Where patient wants to die; note on transporting** - if pt wants to go home, may need to inform family that client may pass during transport

Question 6

Death

Answer 6

Occurs when all vital organs and body systems cease to function; Irreversible cessation of cardiovascular, respiratory, and brain function

Pronouncing time of death may vary per facility.
Examples:
1. 2 Registered nurses:
2. auscultate no lung, no heart sounds.
3. If on telemetry-print 2 leads with asystole (isoelectric, flat line).

Question 7

Brain Death

Answer 7

Irreversible loss of all brain functions including the brainstem; Occurs when the cerebral cortex stops functioning or is destroyed

performed by a neurologist

Once brain death is declared, a patient is legally considered dead

For a diagnosis of brain death, a patient must have:

1. Coma or unresponsiveness
2. Absence of brainstem reflexes-cranial nerve assessment-cough, gag, corneal, eye movements/pupils
3. Apnea (no breathing when off ventilator)

Question 8

Advanced directives:

Answer 8

also called a living will; the written documents of those wishes and the designated spokesperson

May not necessarily be followed if become incompetent and family wants something else, but it is clear what the pt wants

Question 9

Full Code vs DNR vs FAT DNR

Answer 9

Full Code - all measures taken

DNR - No Code

FAT DNR – Full Active Treatment DNR – full code all the way until CPR

Question 10

DNR requirements

Answer 10

In a capacitated patient:
Any level licensed physician caring for the patient can order it

In an incapacitated patient:
The surrogate decision maker and 2 physicians documented

A verbal directive given to:
1 attending physician and 2 witnesses