Care of the Dying: Loss, Grief, and Growth

Question 1

Dying is a unique experience for patients and family that we all have in common. True/False

Answer 1

True

Question 2

What are the four realms of dying that must be attended?

Answer 2

1. Physical 2. Psychological 3. Social 4. Spiritual

Question 3

Dying is not confined to cancer or AIDS. True/False

Answer 3

True; it includes all life-threatening illnesses and cases of sudden death

Question 4

How many of the terminally ill patients will lose all of their savings?

Answer 4

1/3

Question 5

Who consists of the patient’s “unit of care”?

Answer 5

The family

Question 6

Family includes people and animals. True/False

Answer 6

True

Question 7

Is EOL/hospice care covered under medicare?

Answer 7

Yes

Question 8

How many states have medicaid coverage of hospice?

Answer 8

43 states and D.C.

Question 9

How many businesses offer hospice benefits?

Answer 9

82%

Question 10

What percentage of family members quit work to provide care to someone dying in their family?

Answer 10

20%

Question 11

Is there a law that mandates accessibility to good EOL care?

Answer 11

No; even for those who have insurance coverage

Question 12

What factors must be involved when trying to understand the dying patient?

Answer 12

Role in the family Employment Social factors Cultural Factors Spiritual factors

Question 13

What needs must be meet for the dying patient?

Answer 13

1. Receive adequate pain and symptom management 2. Avoid inappropriate prolongation of dying 3. Achieve a sense of control 4. Relieve burden 5. Strengthen relationships with loved ones.

Question 14

A patient may elect to be less comfortable in order to be alert. True/False

Answer 14

True

Question 15

Families frequently overestimate the suffering of their loved one. True/False

Answer 15

True; sometimes they want an end to the suffering

Question 16

People over 80 want more treatment to extend their life. True/False

Answer 16

True; there are fewer days ahead than behind

Question 17

Why is the sense of control so important in the needs of a dying patient?

Answer 17

You need to give people time to get their affairs in order.

Question 18

Name some tools that are useful when caring for the dying patient.

Answer 18

Advance medical directives Code status General POA Office notes Personal letters Organ donation

Question 19

Tennessee honors documents from all 50 states. True/False

Answer 19

True

Question 20

How many states honor the “5 wishes” from FL?

Answer 20

40 states

Question 21

Who is the most common decision maker for an incapacitated person recognized in most states?

Answer 21

the spouse

Question 22

What are some contributors of sudden death?

Answer 22

MI and accident(10-15%_

Question 23

What are some contributors in a progressive disease with a terminal phase?

Answer 23

Pancreatic cancer(10-15%)

Question 24

What are some contributors to chronic, fatal diseases and sudden death?

Answer 24

CHF,COPD, DM, AIDS, Neuro(70-80%)

Question 25

Which pattern do most people follow when dying? A. Sudden death B. Progressive disease with a terminal phase C. Chronic, fatal disease

Answer 25

C. Chronic fatal disease As time goes forward, the patient’s condition gets worse

Question 26

There is an expanded notion of pain and suffering. True/False

Answer 26

True Physical, Psychological/emotional Social Spiritual

Question 27

Palliative care is a huge portion of managing symptoms. True/False

Answer 27

True

Question 28

When will a patient be referred to hospice care?

Answer 28

When there is 6 months or less to live

Question 29

What are the issues involved in caring for the dying?

Answer 29

1. Tension between two extremes(killing vs. letting die) 2. Care even when cure is impossible 3. Effective management of pain in all of its forms

Question 30

When deciding to withdraw or withhold treatment, which question should always be addressed?

Answer 30

Does this help the patient

Question 31

Define assisted suicide.

Answer 31

Pt asks doctor for a prescription that aids in dying( this is the assisted part)

Question 32

Where is assisted suicide legal in the U.S?

Answer 32

WA, OR, NM, VT, MT

Question 33

Define euthanasia.

Answer 33

the practice of intentionally ending the life b/c it is the only way to relieve the suffering of the patient

Question 34

What are the stages of grief according to Kubler-Ross?

Answer 34

Denial

Anger

Bargaining

Depression

Acceptance

Question 35

What are the stages of grief according to Temes?

Answer 35

Numbness

Disorganization

Reorganization

Question 36

How much time is needed for the person and the family to accept death?

Answer 36

About 6 months

Question 37

About how much time does it take to cope with the death of a loved one?

Answer 37

takes up to 24 months

Question 38

Name some emotions associated with grief.

Answer 38

Anger

Confusion

Dazed feeling

Denial

Depression

Despair

Fear

Guilt

Isolation

Sadness

Question 39

When should a person who is coping with death get help?

Answer 39

Apparent absence of grief
Hyperactivity and prolonged restlessness
Assuming the symptoms of the one who died
Psychosomatic illnesses
Emotional numbness
Abrupt or severe changes in lifestyle
Self-destructive behavior
Long-lasting or very deep depression
Hostility
Rage
Continued inappropriate emotional outbursts
Thoughts or talk of suicide

Question 40

What are some things that can be said to the loved ones of a dead patient?

Answer 40

I’m so sorry for your loss.
How are you feeling?
Are you able to talk about what happened?
Can you tell me?
S/he loved you so much.
S/he was a wonderful friend.
You were a wonderful husband/wife/daughter/
son.

Question 41

What are some things that should NOT be said to the loved one of a dying/dead patient?

Answer 41

I know just how you feel. (We know how we feel but we really don’t know how they feel)

It’s better this way.

You’ll feel better in a little while.

I’m glad it’s over for you.

Now you can heal and get some closure.