care of the dying and their fam Flashcards by Katie James

Q

needs of dying patients

physiological needs

A

physical care including hygiene, pain control, and nutrition

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Q

needs of dying patients

psychological needs

A

sense of control over:
-fear of the unknown
-separation from loved ones
loss of dignity
-pain mangement
-coping with unfinished business and isolation

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Q

needs of dying patients

spiritual needs

A

-love and relatedness
-forgiveness and hope
-exploration of meaning and purpose

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Q

describe care of dying

A

-ensure dignity is maintained
-care for individual and for the loved ones
-routine interventions maintained (hygiene, clean linens, ass for pain and comfort, consult support services, provide for loved ones comfort)

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Q

clinical signs of impending death

CV

A

weak, slow, irregular pulse, decreasing BP

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Q

clinical signs of impending death

resp

A

NOISY, irregular, cheyne stokes resps, apnea

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Q

clinical signs of impending death

GI/GU

A

nausea, flatus, abdominal distention, constipation, incontinence, decreased urine output

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Q

clinical signs of impending death

neuro

A

Difficulty talking or swallowing; loss of voluntary movement, sensation & reflexes; restlessness, decreased level of consciousness, agitation, hallucinations

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Q

clinical signs of impending death

skin

A

Cold, clammy skin; mottling & cyanosis

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Q

what is the legal definition of death

A

Uniform Definition of Death Act (1981): An individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead.

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Q

what medical criteria is used to certify a death has occurred

A

-Cessation of breathing
-No response to deep painful stimuli AND
-Lack of reflexes (gag reflex, corneal reflex) and spontaneous movement

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Q

what are some changes of the body after death

A

Primary flaccidity then rigor mortis (stiffening)

Algor mortis (cooling)

Livor mortis (discoloration)

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Q

what are the nursing responsibilities at the time of death

A

Notification of:
Physician
Loved ones
Spiritual Care
Organ Donation Consultant

Facilitation of legal requirements

Care of the deceased

Care of the loved ones

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Q

describe notification of death

A

-Physician pronounces the death (legal time of death)
- Loved ones
Next of kin or guardian

Spiritual Care
-Rituals for the deceased
-Care for the loved ones
-Support for the staff

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Q

describe care of the deceased

A

Place a sign on the patient’s door

Relocate room mate

Prepare for loved ones to visit

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Q

describe management of personal belongings

A

Management of deceased’s personal belongings
Remove jewelry, glasses, religious items, personal blanket
Remember to distribute the personal items not worn by the patient (medical devices-walkers, etc)
Give all personal belongings and valuables to the family members
Document who was given what items
If family members are not present, secure items in facility’s secured location
Document what was stored where
All documentation of distribution of effects is part of the permanent medical record
Nurses are responsible for the management of the patient’s belongings

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Q

if loved ones are present with the deceased immediately after death:

A

Provide a conference room for them to have a private space
Provide access to phones, chargers (if possible)
Provide opportunity to meet with facility chaplain
Before they view the deceased prepare the body
Side rails down
Chairs at side of the bed
Evaluate the need for your presence or for privacy

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Q

before loved ones leave…

A

Offer to call funeral home, personal spiritual provider (priest, rabbi, clergy, etc)
Determine if there are special religious
or cultural practices they wish to carry
out
Obtain contact information in case they need to be reached in the next couple of hours
Distribute patient’s personal belongings

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Q

describe preparing the deceased’s body

A

Bathe the body (observing any cultural or religious rituals)
Perform any interventions required for organ or tissue donation
Close eyes
Place dentures in mouth
Ensure patient is in a supine position, HOB at 30°, arms at sides
Remove* all tubes, drains & cover with a clean dressing; change all soiled dressings
*If autopsy will be performed, all tubes and lines must be left in place, but can be disconnected from other equipment

Obtain morgue pack or shroud

Ensure patient is appropriately identified
Maintain facility ID band on wrist
Tag from morgue pack on toe, ankle, or wrist
Another tag will be placed on the outside of the bag

Place abd pads or disposable pad between buttocks

Follow facility protocol for securing extremities and chin

Wrap the patient in the bag or shroud
Place final identification tag on the outside of the bag

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Q

describe transferring the deceased

A

Be aware of any special handling that is required for communicable diseases

Transfer to morgue or funeral home following facility policy

Registered Nurse signs to release the body to the next location

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Q

what are some legal requirements r/t death

A

Completion of the death certificate
Must be signed by the pronouncing physician
Authorization of tissue or organ donation
Authorization for autopsy
Consent for autopsy is obtained by the physician
Release of the body to the morgue or funeral home
Nursing Documentation
Time of death
Persons notified, time of notification
List and disposition of personal belongings
Time deceased was transferred from your care, destination, who transported the deceased

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Q

describe organ donation

A

At the time of death, or when death is imminent, nurses notify the organ donation consultant coordinator for the facility

Nurses provide information to the organ donation consultant regarding the deceased

Consent for donation is obtained by the consultant

Ohio offers “advanced authorization” on drivers’ licenses

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Q

describe autopsy

A

Medical examination after death
used to determine cause of death

Consent must be obtained prior to the completion of an autopsy

The Coroner can over-ride the family’s decision in some cases

Q

describe code status

A

Code Blue (Code Pink) is called when a person experiences cardiac or respiratory arrest

Code status is a physician/provider order

Provider and patient, or patient’s decision maker, discuss code status

# code status full code

All attempts will be made to resuscitate

# code status DNR

No attempts will be made to resuscitate

# code status DNR specified

Determines what type of resuscitative efforts will be made at the time of the arrest Compressions only Medications only Do not intubate (DNI)

# code status DNR CC

Only comfort measures will be used, no further diagnostic measures Oxygen is administered Medications are administered (may include IV fluids, although rare) Routine hygiene and wound care

describe advanced directives

Legal documents that the patient completes to indicate the patient’s wishes should he or she be unable to make decisions must be signed by pt prior to them becoming incapacitated

descrube living will

Addresses wishes regarding ‘extraordinary measures'

describe durable power of attorney for healthcare

Indicates who the patient wishes to make their healthcare decisions

are advanced directives the same as DNR orders?

nope

describe palliative care

Focus on providing relief from the symptoms and stress of a serious illness Goal is to improve quality of life A subspecialty of medicine that is helpful for persons of any age, with many different diagnoses

describe hospice care

The model for quality compassionate care for people facing a life-limiting illness or injury Focuses on medical management, pain management, emotional and spiritual support

describe end of life ethical issues

“Death with Dignity laws allow qualified terminally-ill adults to voluntarily request and receive a prescription medication to hasten their death. California Colorado DC Hawaii Maine New Jersey Oregon Vermont Washington

what are some different types of loss

Actual or Perceived Expected or Unexpected Maturational Loss Situational Loss Anticipatory Loss

describe actual loss

losses that are apparent to others

describe perceived losses

internalized

describe maturational loss

losses that occur as part of normal developmental phase transitions

describe situational loss

losses that come from an unexpected event (ex. natural disasters)

describe anticipatory loss

loss is felt b4 it is experienced

# lifespan considerations infants

dont understand permanence

# lifespan considerations toddler/preschooler

-start to experience separation anxiety -prek are imaginitive -can be very confusing

# lifespan considerations school age/adolescent

-usually have experienced a loss at this time -begin to really understand permanence -can impact developmental process greatly

# lifespan considerations adult/older adult

adults just start racking up losses and they identify coping strategies that work for them older adults have it eve worse and are just losing tons and tons of shit

what is grief

Characteristic patterns of physiological and psychological response to a loss

describe mourning

socially prescribed behaviors of one who has experienced a loss (usually of a loved one)

describe bereavement

person’s total response to the loss; physical, social, emotional, and cognitive responses

name some factors that effect grief

Developmental Stage Cultural Influences Religious Beliefs Circumstances of the Death Available Resources Stressors

describe altered grieving

Grief can be exaggerated, prolonged or absent. Most experts agree that expressions of grief present 3 years or longer after the loss are abnormal Disenfranchised Grief: experience of grieving a loss that is not acknowledged by society

what are engels six stages of grief

what are the kubler-ross 5 stages of grief

describe self care

Examine and clarify your own feelings about death and loss Take time to grieve Find a supportive listener: friend, coworker, chaplain It is acceptable to show your emotions to the deceased’s loved ones Professional boundaries preclude the need for them to console you

what are some nursing diagnoses r/t death

Anticipatory Grieving Dysfunctional Grieving Hopelessness Powerlessness Spiritual Distress

The patient asks a nurse to explain a living will. What is the nurse’s best response? A. It identifies who will pay the patient’s bills B. It is the agreed upon plan of care C. It lists specific instructions for health care D. It specifies if the patient wants to donate organs

C

A terminally ill patient says to her nurse, “My situation is hopeless; I have no control over anything!” Which of the following interventions does the nurse implement? A. Tell her, “We have explored all treatment options” B. Encourage her to tell you more about how she is feeling C. Sit in a chair next to her D. Do not disclose information about disease progression E. Hold her hand

B, C, E

Your patient has just returned from a diagnostic test. The results show that he has very advanced cancer. Who is responsible for what, when, and how the patient is told? A. You, his nurse are. B. His spouse is. C. His physician is. D. The social worker is.

C