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CHPN Exam > Care of Patient and Family > Flashcards

Care of Patient and Family Flashcards

1
Q

US Hospice founded?

A

Connecticut Hospice Florence Wald (former Dean of Yale Nursing School) early 1970s

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2
Q

US Hospice modeled after?

A

work of Dame Cicely Saunders at the St. Christopher’s hospice in London, England

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3
Q

Hospice developed to

A

address specific needs of the dying and their families

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4
Q

Hospice: medicare/medicaid benefit began?

A

1980s

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5
Q

Palliative care model branched off?

A

from traditional hospice programs in late 1980s in academic teaching hospitals such as Cleveland Clinic and Medical College of Wisconsin

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6
Q

Palliative focus: goal

A

address problems facing hospice philosophy in addressing long-term, progressive disease paths as well as in allowing patients a choice of hterapies

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7
Q

Palliative focus: effort

A

made to improve the quality-or-life concerns for those patients whose death was not near yet, a distinct and complicated set of care issues

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8
Q

Palliative: medicare/medicaid

A

not regulated or funded by Medicare

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9
Q

Common fears of dying patient

A

pain fear of being a burden fear of loss of control and independence death bodily changes

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10
Q

Fears of dying patient:pain

A

lingering and uncontrolled suffering relieving discomfort provides improved quality of life

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11
Q

Fears of dying patient: being a burden

A

family face tasks of dealing with own fears as well as increased responsibility for the patient that can be taxing and unwelcome by either party

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12
Q

Fears of dying patient: loss of control and independence

A

patients need to maintain a sense of control in decision-making in all areas of their life and care sense of control helps alleviate feelings of guilt, frustration and helplessness

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13
Q

Fears of dying patient: dying alone

A

ill persons often feel they will be abandoned

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14
Q

Fears of dying patient: death

A

facing the unknown. leaving loved one or “unfinished business”

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15
Q

Fears of dying patient: bodily changes

A

loss of body parts and changes to physique can be unnerving and shift the patient’s sense of self

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16
Q

National Consensus Project: 5 goals

A

Identify definitions, philosophies and principles create clinical ractice guidelines enable clinical practices to grow and improve provide key elements of palliative care promote quality recognition, initiatives, and stability

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17
Q

National Consensus Project: promote

A

quality recognition initiatives for growth and certification stability for reimbursement and practice measures

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18
Q

National Consensus Project: key elements of palliative care

A

that may be used in practices where there is an absence of formal care programs

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19
Q

National Consensus Project: enable clinical practices to

A

grow and improve their resources and performances through structural organization and defined requirements

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20
Q

National Consensus Project: create clinical practice guidelines for

A

high quality care for both the patient and family

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21
Q

National Consensus Project: identify

A

definitions philosophies principles concerning palliative care that will be nationally recognized

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22
Q

Palliative care: recognizes and respects

A

each individual’s uniqueness across the lifespan and in diverse settings

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23
Q

Palliative care:center

A

patient centered and guided in order to improve the patient’s quality of life through supportive care

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24
Q

Palliative care: is both

A

scientific humanistic

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25
Q

Palliative care: doesn’t limit

A

patient’s treatment options and includes any therapy medically indicated and desired by patient includes life-prolonging care even when death is imminent

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26
Q

Palliative care: World Health definition

A

an approach that improves quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho-social and spiritual

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27
Q

Palliative care: effective care

A

includes: multiple dimensions of care: holistic approach to pain and symptom control nursing interventions psycho-social and spiritual resources

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28
Q

Palliative care: goal

A

to provide an active, caring presence for patients and families

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29
Q

Hospice: care designed

A

to fit needs of terminally ill in the last 6 months of life

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30
Q

Hospice: philosophy

A

of improved quality of life for the terminally ill

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31
Q

Hospice: offers

A

symptom management physical care emotional care psycho-social care spiritual care bereavement care

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32
Q

Hospice: settings

A

inpatient various residential

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33
Q

Hospice: focus

A

to provide comfort and support to patients and families experiencing a life-limiting illness when cure-oriented treatments are no longer feasible

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34
Q

Hospice: caregivers offer

A

specialized knowledge of medical care and symptom management, with emphasis on pain and discomfort management

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35
Q

Hospice: not designed

A

to either prolong life or hasten the death

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36
Q

Hospice: goal

A

improve quality of patient’s last days through comfort and dignity

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37
Q

Maladaptive behaviors

A

denial guilt depression avoidance decathexis aggression

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38
Q

Maladaptive behaviors: denial

A

way for person to reject reality of the situation refusal of physical, psychological and emotional triggers of knowledge they do not want to believe of deal with

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39
Q

Maladaptive behaviors: guilt

A

unreasonable feeling of responsibility for negative influences of which the person may or may not have control

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40
Q

Maladaptive behaviors: depression

A

a mental state of hopelessness and despair severe loss of happiness and motivation

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41
Q

Maladaptive behaviors: avoidance

A

withdrawal; turning away from actions of consequences associated with negative stimulus

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42
Q

Maladaptive behaviors: decathexis

A

detachment from mood and feelings lack of variation in emotional responses despite changing circumstances

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43
Q

Maladaptive behaviors: aggression

A

hostile behavior, physical or verbal, meant to be demeaning, destructive, and increase negative emotions in those around them

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44
Q

Hospice inter-dimensional care process

A

assessment identified problems and needs set goals and interventions provide therapeutic care evaluate

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45
Q

Hospice inter-dimensional care process: assessment

A

in depth holistic assessment in order to collect both subjective and objective data from patient and family

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46
Q

Hospice inter-dimensional care process: identify

A

root cause for needs, problems and opportunities to improve patient’s quality of life backbone for all care provided

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47
Q

Hospice inter-dimensional care process: goals and interventions

A

collaborate with team members to set patient- and family-directed goals establish appropriate interventions understood and accepted by all team members

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48
Q

Hospice inter-dimensional care process: care

A

palliative therapeutic care, education, collaboratoin, and ongoing assessments that empower the patient and family and focus on their needs

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49
Q

Hospice inter-dimensional care process evaluate

A

all care and interventions for future planning, identifying productive areas for continuation and areas needing revision

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50
Q

Life completion and closure: landmarks

A

sense of completion satisfaction in life and work feelings of love and acceptance identify understanding of meaning of life willingness to move forward into unknown

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51
Q

Life completion and closure: sense of completion

A

in all affairs, including worldly, community, and interpersonal relationships with family and friends feel they have taken care of all unfinished business

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52
Q

Life completion and closure: satisfaction in life and work

A

after reflecting on their lives, patients can accept themselves and their accomplishments as fulfilling and worthwhile

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53
Q

Life completion and closure: feelings of love and acceptance

A

for self and others: pursuing worthiness, forgiveness, gratitude, closure and resolution of past hurts and wrongs to bring about peace and satisfaction

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54
Q

Life completion and closure: identify understanding of meaning of life

A

identify a general understanding of the meaning and finality of life

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55
Q

Life completion and closure: willingness to move forward into unknown

A

by accepting death and saying good-bye

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56
Q

Hospice: eligibility related to

A

patient’s prognosis

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57
Q

Hospice: prognosis

A

patient will reach end of life through course of natural disease process within 6 months of qualifying

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58
Q

Hospice: certification

A

from physician confirming this status is required and can limit access for some who may have benefited

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59
Q

Hospice: timely referral

A

education needed to reinforce to physicians timely referral of patients

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60
Q

Palliative care: eligibility

A

exceeds 6 months

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61
Q

Palliative care: designed to

A

meet needs of a variety of individuals with chronic illnesses such as Alzheimer’s disease

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62
Q

Palliative care: limits

A

not limited to comfort care of a specific time frame

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63
Q

Palliative care: treatement

A

any treatment to improve quality of life is respected by palliative care team

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64
Q

Palliative care: costs

A

aspects must also be considered no Medicare and Medicaid funding

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65
Q

Hospice: costs

A

is available for those who qualify for Medicare and Medicaid

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66
Q

Hospice core services: designed to

A

maintain general health and quality of life for paitent

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67
Q

Hospice core services required by law

A

physician and nursing services social work dietary services spiritual bereavemnt

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68
Q

Hospice core services: further services based on

A

may be added based on patient need and availability

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69
Q

Hospice core services: added benefits

A

physical therapy occupational therapy speech therapy massage infusion therapy home health aides medical supplies and equipment daycare homemaking services funeral services

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70
Q

Domains of Consensus Project

A

Structure and Practice of Care Physical Psychological and Psychiatric Social Spiritual, Religious and Existential Cultural Imminently Dying Patient Ethics and Law

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71
Q

Domains of Consensus Project: Structure and Practice of Care

A

Care is based on the interdisciplinary team’s commitment to comprehensive assessment and care of the patient and family, education and quality improvement, and support of each other as a team

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72
Q

Domains of Consensus Project: Physical

A

Best practices are employed to address the patient’s pain and other symptoms, and educate the patient and family and include them in the plan of care

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73
Q

Domains of Consensus Project: Psychological and Psychiatric

A

Psychological, psychiatric, grief, and bereavement issues are addressed and managed with high standards using pharmacological, nonpharmacological, support, and counseling treatments as needed

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74
Q

Domains of Consensus Project: Social

A

Comprehensive care plans will take into account family and social dynamics, interpersonal needs, finances, caregiver availability, and access to health care to promote well-being and ease patient and caregiver burdens

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75
Q

Domains of Consensus Project: Spiritual, Religious, and Existential

A

Assessing, recognizing, respecting, and supporting spiritual concerns and religious beliefs

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76
Q

Domains of Consensus Project: Cultural

A

Careful consideration is given to assessing, respecting, and accommodating for culture-specific needs Resources available reflect cultural diversity and the needs of community

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77
Q

Domains of Consensus Project: Imminently Dying Patient

A

Recognition of imminent death, making appropriate referrals, and educating the patient and family in an appropriate and sensitive manner

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78
Q

Domains of Consensus Project: Ethics and Law

A

Demonstrating knowledge of federal and state laws, statutes, and regulations while respecting and implementing patient and family goals and choices in plan of care

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79
Q

Diverse cultures: ways to show respect

A

assess own background obtain further knowledge show acceptance acknowledge differences be sensitive and open do not make assumptions

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80
Q

Diverse cultures: own assessment

A

background values beliefs to avoid biases

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81
Q

Diverse cultures: obtain further knowledge

A

in order to understand the background being addressed

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82
Q

Diverse cultures: show acceptance

A

of differences even when they may diverge from the nurse’s own comfort zone and culture

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83
Q

Diverse cultures: acknowledge differences

A

concerning end-of-life care

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84
Q

Diverse cultures: be open and sensitive

A

to individual patient’s beliefs rather than trying to predict behavior

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85
Q

Diverse cultures: do not make assumptions

A

regarding care, needs, or beliefs should not made based on race or ethnicity

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86
Q

Language differences: federally funded agencies

A

required to provide free interpretive services for clients speaking commonly encountered foreign languages

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87
Q

Language differences: patient must be informed

A

that an interpreter will be made available to them

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88
Q

Language differences: interpreter

A

trained in medical terminology fluent in both languages being used familiar with the ethics and HIPPA regulations

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89
Q

Language differences: family members

A

can’t be required to serve as interpreters unless client specifically requests a family member to act in this capacity

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90
Q

Language differences: emergency situations

A

use whatever means are readily available to assist in communicating with patient

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91
Q

Grief: definition

A

emotional response to a loss that begins at the time a loss is anticipated and continues on an individual timetable.

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92
Q

Grief: process

A

not an orderly and predictable

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93
Q

Grief: involves overcoming

A

anger disbelief guilt myriad of related emotions

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94
Q

Grief: individual

A

may move back and forth between stages or experience several emotions at any given time

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95
Q

Grief: response

A

unique to own coing patterns, stress levels, age, gender, belief system and previous experiences with loss

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96
Q

Spiritual care: assessment

A

patient’s basic beliefs assessed to provide holistic care at end of life

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97
Q

Spiritual care: provided according to

A

patient’s religion of choice caregiver must be unbiased regardless of his or her own beliefs

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98
Q

Spiritual care: if patient does not wish

A

should not be forced upon them

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99
Q

Spiritual care: advice and comfort

A

can be provided by anyone known to patient

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100
Q

Spiritual care: advice and comfort: intention

A

to relieve spiritual suffering and answer questions patient and family may have

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101
Q

Spiritual care: no formal religion

A

may have questions and search for meaning and comfort at end of life

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102
Q

Dying: task-based model

A

physical tasks psychological tasks social tasks spiritual tasks

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103
Q

Dying: task-based model: physical

A

bodily needs must be met and physical distress minimized in ways that are consistent with patient’s values and beliefs

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104
Q

Dying: task-based model: psychological

A

patient must feel a sense of dignity seek reassurance and satisfaction in lives, securtiy, and autonomy

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105
Q

Dying: task-based model: spiritual

A

identify, develop and reaffirm sources of spiritual energy and comfort in order to define the purpose to their existence and create hope

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106
Q

Cultural competence: behavior

A

goes beyond knowing general facts dynamic process of being aware and showing respect for cultural differences of all types

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107
Q

Cultural competence: begins with

A

being aware of one’s own beliefs not letting them interfere with care provided

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108
Q

Cultural competence: care plan

A

each patient and family have unique contributions to care plan

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109
Q

Cultural competence: provides

A

competent care that corresponds with patient and family’s own cultural background

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110
Q

Cultural competence: assessment

A

complete, unbiased, sensitive of background and beliefs obtains further knowledge as necessary coordinates and eecutes plan of care

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111
Q

Cultural competence: plan of care

A

meaningful to patient and family, regardless of care provider’s own beliefs

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112
Q

Normal grief: preoccupied with

A

self-limiting to loss itself

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113
Q

Normal grief: emotional responses

A

will vary and may include open expressions of anger

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114
Q

Normal grief:may experience difficulty

A

sleeping or vivid dreams lack of energy weight loss

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115
Q

Normal grief: crying

A

evident provides some relief of extreme emotion

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116
Q

Normal grief: individual remains

A

social responsive seeks reassurance from others

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117
Q

Depression: marked by

A

extensive periods of sadness preoccupation extending beyond 2 months

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118
Q

Depression: not limited to

A

a single event

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119
Q

Depression: absence of

A

pleasure or anger

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120
Q

Depression: isolation

A

from previous social support systems

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121
Q

Depression: individual experiences

A

extreme lethargy weight loss insomnia hypersomnia no recollection of dreaming

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122
Q

Depression: crying

A

is absent or persistent provides no relief of emotions

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123
Q

Depression: intervention

A

professional intervention is required to relieve

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124
Q

Body after death: prepared

A

to give clean, peaceful impression for family members who desire an opportunity to say goodbye before funeral home removal

125
Q

Body after death: caring for body

A

show family care and concern and continued value of the deceased, as well as models grief-facilitating behaviors for others present

126
Q

Body after death: religious rituals

A

should be encouraged invite family to participate in preparation of body

127
Q

Body after death: explain

A

process and what to expect as care is given

128
Q

Body after death: remove

A

tubes, drains and other medical devices

129
Q

Body after death: bandages

A

should be applied as fluids may still be expressed

130
Q

Body after death: waterproof pad or incontinence brief

A

helpful for containing fluids

131
Q

Body after death: vagina and rectum

A

packing of vagina or rectum is unnecessary

132
Q

Body after death: care

A

wash body and comb hair

133
Q

Body after death: dressing

A

consider dressing the body in something normalizing

134
Q

Body after death: “sigh”

A

body may “sigh” as it is rolled and lungs compressed

135
Q

Body after death: room temperature

A

cool decomposition process will be slowed, allowing family time to grieve

136
Q

Bereavement complications: assess for

A

multiple life crises that take energy away from grieving process other recent unresolved, or difficult losses that may need to be addressed

137
Q

Bereavement complications: important factor

A

grieving individual’s history with past grieving experiences

138
Q

Bereavement complications: need to be addressed before

A

can move toward reolution of current loss

139
Q

Bereavement complications: additional stressors

A

age mental health substance abuse extreme anger anxiety dependence on individual dying

140
Q

Bereavement complications: additional risk factors

A

income strains community support outside and personal responsibilities absence of cultural and religious beliefs difficultly of disease process age of loved one

141
Q

Rigor Mortis: adenosine phosphate (ATP)

A

within 4 hours of death ATP is no longer synthesized because of depletion of glycogen stores

142
Q

Rigor Mortis: ATP affects

A

muscle fiber relaxation

143
Q

Rigor Mortis: lack of ATP

A

causes exaggerated contraction of muscle fibers immobilizes joints

144
Q

Rigor Mortis: begins in

A

involuntary muscles found in heart, GI tract, bladder and arteries

145
Q

Rigor Mortis: progresses through

A

muscles of head, neck, trunk and lower limbs

146
Q

Rigor Mortis: after 96 hours

A

muscle activity totally ceases rigor passes

147
Q

Rigor Mortis: large muscle mass

A

may be prone to more pronounced rigor mortis

148
Q

Rigor Mortis: frail individuals

A

less prone to rigor mortis

149
Q

Rigor Mortis: post-death postioning

A

minimize effects limbs and hands are in proper body alignment eyelids and jaw should be closed dentures should be placed in mouth

150
Q

Suffering: multiple aspects

A

emotional spiritual physical affects whole person

151
Q

Suffering: must be addressed from a

A

comprehensive, holistic perspective

152
Q

Suffering: recognize

A

it is not always possible to find source or resolve suffering

153
Q

Suffering: indentifictaion

A

careful observation different disciplinary perspectives

154
Q

Suffering: issues

A

must be addressed or suffering is more likely to compound rather than diminish over time

155
Q

Suffering: answers

A

when patient address these questionsit is not necessarily expected for caregiver to give, or have, the answers to questions

156
Q

Suffering: caregiver should

A

reassure patient of his presence and support while patient finds answers hiimself

157
Q

Suffering: useful exploration

A

religious or spiritual

158
Q

Spiritual assessment: must assess

A

prior and present religious affiliations and beliefs about God and the afterlife

159
Q

Spiritual assessment: information

A

devotional practices rituals routine

160
Q

Spiritual assessment: identify

A

involvement and support from patient’s chosen religious community

161
Q

Spiritual assessment: opens door for

A

effective spiritual care-giving allows patients to access spiritual coping strategies and support mechanisms

162
Q

Spiritual assessment: holistic assessment

A

addresses ability to resolve meaningful spiritual questions identifying meaning retaining hope, strength, and peace

163
Q

Spiritual assessment: questions can include

A

patient’s interpretation of meaning and purpose of life personal strengths connections to various spiritual communities, including nature

164
Q

Spiritual assessment: provisions

A

should be made to explore spiritual relationships and provide support for loss and crisis as desired by the patient and family

165
Q

Algor Mortis: temperature

A

when circulation and hypothalamus stop functioning, the body’s core temperature begins to drop by about 1.8 degrees every hour until it reaches a stasis at room temperature

166
Q

Algor Mortis: skin

A

begins to lose its natural elasticity as the body cools

167
Q

Algor Mortis: high fever

A

if it was present at time of death, person may lose excess fluid through the skin, causing the skin to feel moist or giving the appearance of sweating even after death

168
Q

Algor Mortis: loss of moisture and elasticity

A

casuse skin to become more fragile and easily damaged

169
Q

Algor Mortis: body

A

should be handled gently, avoiding excess pressure or traction on skin

170
Q

Algor Mortis: dresing

A

should be applied with a wrap or paper tape

171
Q

Algor Mortis: definition

A

cooling of body that follows death

172
Q

Loss: term

A

blanket term used to denote absence of valued object, position, ability, attribute, or individual

173
Q

Loss: experience

A

individualized and subjective depends on perceived attachment between individual and missing aspect

174
Q

Loss: value range

A

little or no value to significant

175
Q

Loss: represented by

A

withdrawal of a valued relationship one had or would have had in the future

176
Q

Loss: reactions

A

depending on the unique and indivdual responses to perception of loss and its significance, reactions to loss withe vary accordingly

177
Q

Loss: three main attributes (Robinson and McKenna)

A

something had been removed item removed had value to person response is individualized

178
Q

Disenfranchised grief: occurs

A

when loss being experienced cannot be openly acknowledged, publicly mourned, or socially supported

179
Q

Disenfranchised grief: responsible for grief

A

society and culture are partly responsible for an individual’s response to a loss

180
Q

Disenfranchised grief: social context

A

if a person incurring the loss will be putting himself or herself at risk if grief is expressed, disenfranchised grief occurs

181
Q

Disenfranchised grief: risk for

A

greatest among those whose relationship with individual they lost was not known or regarded as significant

182
Q

Disenfranchised grief: found among

A

bereaved persons who are not recognized by society as capable of grief young children ex-spouse secret lover

183
Q

Postmortem decomposition: bruising and softening of body

A

largely related to breakdown of red blood cells

184
Q

Postmortem decomposition: hemoglobin

A

as cells breakdown, hemoglobin is released, resulting in a staining effect on the vessel walls and surrounding tissues

185
Q

Postmortem decomposition: mottling or bruising

A

frequently appears on dependent parts of the body as well as any area that experienced recent trauma, such as puncture wounds from invasive procedures

186
Q

Postmortem decomposition: discoloration

A

can become extensive in a very short period of time

187
Q

Postmortem decomposition: remainder of body

A

take on a gray hue

188
Q

Postmortem decomposition: face

A

often appears purple in color when death is a result of cardiac complications

189
Q

Postmortem decomposition: assure family

A

this bruising process is a normal after-death occurence

190
Q

Bereavement: definition

A

emotional and mental state associated with having suffered a personal loss

191
Q

Bereavement: reactions of

A

reactions of grief and sadness initiated by the loss of a loved one

192
Q

Bereavement: normal process

A

of feeling deprived of something of value

193
Q

Bereavement: “reave”

A

plunder, spoil, rob

194
Q

Bereavement: recognizes lost individual

A

had value and a defining role in surviving individual’s life

195
Q

Bereavement: encompassess

A

all acts and emotions surrounding the feeling of loss for the individual

196
Q

Bereavement: grieving period

A

increased risk for mortality

197
Q

Bereavement: positive bereavement

A

means being able to recognize the significance of loss while still recognizing the resilience and value of life

198
Q

Anticipatory grief: definition

A

mental, social, and somatic reactions of an individual as they prepare themselves for a perceived future loss

199
Q

Anticipatory grief: individual experiences

A

a process of intellectual, emotional, and behavioral responses in order to modify their self-concept, based on their perception of what the potential loss will mean in their life

200
Q

Anticipatory grief: process timeframe

A

takes place ahead o the actual loss, from the time the loss is first perceived until it is resolved as a reality for the individual

201
Q

Anticipatory grief: process can blend with

A

with past loss experiences

202
Q

Anticipatory grief: associated with

A

individual’s perception of how life will be affected by the particular diagnosis as well as the impending death

203
Q

Anticipatory grief: acknowledging allows

A

family members to begin looking toward a changed future

204
Q

Anticipatory grief: suppressing may inhibit

A

relationships with the ill individual and contribute to a more dificult grieving process at a later time

205
Q

Anticipatory grief: does not take place of

A

grief during the actual time of death

206
Q

Therapeutic relationships: principles

A

empathy unconditional positive regard genuiness

207
Q

Therapeutic relationships: to build qualities

A

express empathy(try to understand other’s viewpoint) nonjudgmental acceptance of other genuine concern and respect attention to detail

208
Q

Therapeutic relationships: ability to convey

A

trustworthiness honesty openness in professional manner

209
Q

Therapeutic relationships: attention to detail

A

allows nurse to think critically and analyze situation without drawing hasty conclusions of assumptions

210
Q

Therapeutic relationships: attentive to

A

own part in relationships watching for actions, words, or attitudes that may be destructive to the realtionship if they are misinterpreted by other party

211
Q

Unrealistic hope: determine

A

if hope is broad or too severe

212
Q

Unrealistic hope: to severe

A

complete denial of disease process belief cure when there is none available

213
Q

Unrealistic hope: if unlikely to be realized

A

how determined is individual to their course

214
Q

Unrealistic hope: able to admit

A

limitations and acknowledge the possibility of a negative outcome

215
Q

Unrealistic hope: does individual state

A

sure knowledge of what will happen rather than expressing realistic hopes and fears

216
Q

Unrealistic hope: individuals more likely to

A

engage in reckless behaviors and ignore or avoid acknowledging worsening symptoms or warning signs

217
Q

Unrealistic hope: may alienate

A

individual from family and friends

218
Q

Unrealistic hope: alienation creates

A

isolation from family and friends

219
Q

Unrealistic hope: person experiencing?

A

increasing distress and anxiety

220
Q

Unrealistic hope: impeding

A

ability to place personal affairs in order or acknowledge their own loss

221
Q

Nurse: vital role

A

to facilitate communication and establish a trusting relationship with patient and family

222
Q

Communication: levels

A

takes place on many different levels message received may not always be in control of the sender

223
Q

Communication: 80%

A

nonverbal

224
Q

Communication: information

A

overwhelming for patient and family

225
Q

Communication: most individuals express

A

honesty and truthfulness

226
Q

Communication: should establish

A

trust and openness include patient and family in all options and care decisions assure individual they will be listened to respect they they will not be ignored or abandoned avoid and resolve conflict allow patients to vocalize their needs and expect them to be addressed

227
Q

Communication: extend communication

A

healthcare team to facilitate understanding and continuity of care

228
Q

Family-centered palliative care: recognizes

A

terminally ill patient’s place within a family environment

229
Q

Family-centered palliative care: illness effects

A

entire family necessitating involvement of whole family in plan of care

230
Q

Family-centered palliative care: nurse coordinate based on

A

not only individual need of patient, but needs of patient as a family member and needs of additional family members

231
Q

Family-centered palliative care: family unit

A

how patient functions within the family unit is a vital portion of the patient’s needs in a transitioning life structure

232
Q

Family-centered palliative care: transition experienced by

A

entire family and each member will play a role in the loss experience

233
Q

Factors affecting individual outlook during terminal illness

A

ability to experience one or more meaningful relationships maintaining feelings of lightheartedness, delight, joy or playfulness become more accepting of self spiritual beliefs short-term goals hope

234
Q

Outlook: sense of being needed

A

patient needs to feel a sense of being needed, a part of something

235
Q

Outlook: identify positive personal attributes

A

maintaining feelings of lightheartedness, delight, joy, or playfulness helps individual identify postivie personal attributes

236
Q

Outlook: accepting

A

patients are more accepting of themselves and others as they continue to be able to identify courage, determination, serenity, and positive self-worth

237
Q

Outlook: spiritual beliefs

A

participation in spiritual rituals provide a sense of meaning to livesi

238
Q

Outlook: short-term goals

A

patient can focus energy on achieving short-term, positive goals that provide direction to lives and allow them to continue to share themselves with others

239
Q

Outlook: final stage

A

patients who maintained feeling of hope are able to look toward their eventual death n peace and serenity

240
Q

Mourning: definition

A

is a public grief response for the death of a loved one

241
Q

Mourning: determined by

A

personal and cultural belief systems

242
Q

Mourning: Kagawa-Singer definition

A

“the social customs and cultural practices that follow a death”

243
Q

Mourning: Durkehim definition

A

mourning is not a natural movement of private feelings wounded by a cruel loss; it is a duty imposed by the group”

244
Q

Mourning: involves participation in

A

religious and culturally appropriate customs and rituals designed to publicly acknowledge the loss

245
Q

Mourning: rituals signify

A

individuals are adjusting to the change in relationships created by loss, as well as mark the beginning of the reorganization and forward movement of their lives

246
Q

Spirtiual assessmetn tool: HOPE

A

H = hope O = organized P = Personal E = effects

247
Q

HOPE: Hope

A

What sources of hope (who or what) do you turn to?

248
Q

HOPE: Organized

A

Are you a part of an organized religion or faith group? What do you gain from membership in this group?

249
Q

HOPE: Personal

A

What personal spiritual practices such as prayer or meditation are most helpful to you?

250
Q

HOPE: Efffects

A

What effects do your beliefs play on any medical care or end-of-life issues and decisions? Do you have any beliefs that may affect he type of care the health care team can provide you with?

251
Q

Spiritual assessment tools

A

HOPE FICA SPIRIT

252
Q

Spiritual assessment tools: FICA

A

F = faith I = importance C = community A = address

253
Q

FICA: Faith

A

Do you have a faith or belief system that gives your life meaning?

254
Q

FICA: Importance

A

What significance does your faith have in your daily life?

255
Q

FICA: Community

A

Do you participate and gain support from a faith community?

256
Q

FICA: Address

A

What faith issues would you like me to address in your care?

257
Q

Newborn/infant rights

A

to be listened to as individual right to cry entitled to hope allowed to interact with family needs can be met at home or hospital

258
Q

Newborn/infant rights: right to be listened to

A

as individual person with rights not property of his parents, caregivers, medical personnel, or society

259
Q

Newborn/infant rights: right to cry

A

natural course of emotion cries should be acknowledged and comfort given as needed

260
Q

Newborn/infant rights: entitled to hope

A

he or she can create fantasies

261
Q

Newborn/infant rights: interaction with family

A

should not be restricted from interacting with is or her siblings and parents

262
Q

Newborn/infant rights: home or hospital

A

needs can be met at home or hospital, wherever parents are comfortable having care delivered family members may help provide that care

263
Q

Spiritual assessment tools: SPIRIT

A

S = spiritual P = personal I = integration R = ritual I = implication T = terminal events

264
Q

SPIRIT: Spiritual

A

Do you have a formal religious affiliation?

265
Q

SPIRIT: Personal

A

Which practices and beliefs do you personally accept and practice? Does spirituality play a part in your daily life?

266
Q

SPIRIT: Integration

A

Do you participate in a spiritual community and receive support from that community

267
Q

SPIRIT: Ritual

A

Are there specific practices and restrictions in your religious convictions that would affect your health care choices?

268
Q

SPIRIT: Implication

A

Are there aspects of your spirituality you would like me to keep in mind during your care?

269
Q

SPIRIT: Terminal Events

A

As you prepare for the end-of-life, how does your faith affect the decisions you make or how you feel about death?

270
Q

Death documentation

A

identify patient assessment

271
Q

Death documentation: assessment

A

general appearance lack of reflex or response to stimulufs absence of breathing and lung sound absence of apical and carotid pulse

272
Q

Death documentation: should include

A

patient’s name time of contact and death pronunciation who was present at time of death time of assessment details of physical exam time physician notified identification of all parties notified special plans

273
Q

Death documentation: special plans

A

burial or cremation organ donation autopsy cultural or religious procedures

274
Q

Death documentation: who was present at time of death

A

health care personnel family members freinds

275
Q

Medication use in elderly patients: risk factors

A

multiple health care professionals multiple prescriptions age-related factors self-medicating lack of social support finances fears of addiction or side effects language barriers

276
Q

Medication use in elderly patients: multiple healthcare professionals

A

can lead to multiple medication prescriptions leads to complex dosing schedules, route or parameters for delivery

277
Q

Medication use in elderly patients: age related

A

physiological pharmacokinetic and pharmacodynamic changes visual and hearing difficulties cognitive changes (delirium, dementia, depression and anxiety)

278
Q

Medication use in elderly patients: self-medicating

A

over-the-counter medications alcohol herbal remedies

279
Q

Quality end of life care: initiated

A

when supportive care and quality of life beomce primary patient and family concerns

280
Q

Quality end of life care: experience continuity

A

with standardized protocols and measurable outcome

281
Q

Quality end of life care: best medical treatment

A

should be provided to improve patient function

282
Q

Quality end of life care: patient should be free from

A

overwhelming pain other distressing symptoms

283
Q

Quality end of life care: always ensure

A

comfort

284
Q

Quality end of life care: health care should be

A

continuous comprehensive coordinated

285
Q

Quality end of life care: patient and family feel prepared for

A

future events understand what is likely to happen over course of illness

286
Q

Quality end of life care: patient and family should feel

A

respected and valued have wishes sought, appreciated and followed as much as possible

287
Q

Quality end of life care: allows patient to have

A

dignity self-respect ability to make best of every day, while having sense of control

288
Q

Quality end of life care: goal

A

patient’s burden relieved and relationships are strengthened

289
Q

Learning: mild anxiety

A

can facilitate learning by enhancing awareness and promoting information-seeking behaviors

290
Q

Learning: mild anxiety individual able to

A

absorb, process and test new information within personal parameters

291
Q

Learning:moderate anxiety

A

begins to narrow perceptual field

292
Q

Learning:moderate anxiety indivdual able to

A

observe and learn from new information

293
Q

Learning: severe anxiety

A

reduces individual’s ability to absorb new information because focus is on providing immediate relief

294
Q

Learning: severe anxiety: behaviors

A

automatic, distancing, or self-soothing attempt to re-establish equilibrium

295
Q

Learning: uncontrolled, severe anxiety

A

feelings of panic, awe, dread

296
Q

Learning: uncontrolled, severe anxiety: behaviors

A

information is scattered and misinterpreted inability to focus attention outside of themselves or immediate needs

297
Q

Learning: uncontrolled, severe anxiety: establish

A

control before learning can take place

298
Q

Delivering bad news: 8 steps (Girgis and Sanson-Fisher)

A

provide privacy and adequate time assess understanding provide information simply and honestly avoid euphemisms encourage expression of feelings be empathetic give a broad realistic time frame for disease arrange for a review or follow up

299
Q

Delivering bad news: provide privacy and adequate time

A

create a setting that is quiet and comfortable where participants will feel unrushed and uninterrupted establish who should be present

300
Q

Delivering bad news: assess understanding

A

be informed about the condition determine what the family and patient already know

301
Q

Delivering bad news: provide information simply and honestly

A

give a warning and allow participants to prepare themselves for discussion express goals of meeting establish a foundation of basic information that can be built upon use common language and easy to understand explanations provide an interpreter if necessay

302
Q

Delivering bad news: avoid euphemisms

A

discuss matters in a clear and direct manner

303
Q

Delivering bad news: encourage expression of feelings

A

confirm and accept all emotional responses

304
Q

Delivering bad news: be empathetic

A

sit quietly and allow time for information to be absorbed listen carefully and refrain from judgement

305
Q

Delivering bad news: broad realist time frame for disease progression

A

allow for questions and comments discuss need for a legal decision maker watch for indication of self-harm intention

306
Q

DNR: steps

A

establish an appropriate setting establish what family and patient know find our patient’s future expectations discuss DNR order discuss parameters in which resuscitation would be considered respond to emotion and assist in developing a plan

307
Q

DNR: establish understanding of patient’s condition

A

build on current knowledge

308
Q

DNR: discuss so patient can understand

A

given present condition and expectorations for future use language patient can understand identify specific examples and options

309
Q

DNR: respond to emotion and develop plan

A

encourage and respect any responses document patient’s wishes in care plan

CHPN Exam (6 decks)

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