caring for dying patients and their families Flashcards
1
Q
physiological changes and symptom management
A
- Pain Management
- WHO ladder concept
- Around the clock long acting narcotics
- Immediate release drugs for break through pain
2
Q
WHO ladder for pain
A
- non-opioid analgesic: +adjuvant analgesic
- weak-opioid analgesic: non-opioid analgesic. +adjuvant analgesic
- minimal invasive intervention. non-opioid analgesic. +adjuvant analgesic
- strong opioid analgesic: non-opioid analgesic. +adjuvant analgesic
3
Q
Physiological Changes & Symptom
Management pt. 2
A
- Pain—Other treatments (acupuncture, massage)
- Constipation (immobile, not eating as much, narcotics)
- Avoid bulking agents like psyllium (only works if they have enough fluid intake)
- Fatigue & weakness (inability to move in bed. stairs in legs and moves their way up)
- Decreasing appetite & food intake
- Risk for aspiration (difficulty swallowing)
- Decreasing fluid intake & dehydration (thirst mechanism = not there. use things like ice chips)
- albumin holds water in vascular system. things like IVs won’t work bc it just becomes edema
4
Q
mucosal and conjunctival care
A
- drying up
- mouth wash: tsp of salt, baking soda, warm water
- moisten the mouths
- eyedrops: things like visine
5
Q
cardiac dysfxn
A
- Tachycardia, hypotension –> deficient fluid volume symtom
- Mottling of skin (spidery redish blue skin)
6
Q
true or false. no radial pulse = death within a few hrs
A
TRUE
7
Q
urine output falls
A
- check for retention
8
Q
neurologic dysfxn – early
A
- Impairment in ability to grasp ideas & reason
- Some loss of visual acuity
- Increased sensitivity to bright lights
- Senses, except hearing, dulled
- Maximize safety
- periods of alertness
- use periods of lucidity to make sure nothing is left unsaid
- hearing = last one to go
9
Q
neurologic dysfxn – late
A
- 2 roads to death
- Decreasing level of consciousness –> coma –> death
- Terminal delirium
- Restlessness –> confusion –> tremulous –> hallucinations –>
mumbling delirium –> myoclonic jerks –> seizures –> coma –>
death - Treat for pain, give sedatives
- Restlessness –> confusion –> tremulous –> hallucinations –>
10
Q
respiratory dysfxn
A
- Periods of apnea: longer periods of where they don’t breathe and then come back
- Cheyne Stokes breathing: deep breath, less, less, less, apnea, deep breath
- Agonal Respirations –> gasping. gurgling, crackling
- Loss of ability to swallow
11
Q
comfort needs of family
A
- Private room if possible
- Sleep, food, drink
- Respite care
- Encourage communication
- Help family help their loved one (massage this, talk to them, sing to them)
- Family memories
- Encourage touch –> hold the person, their hand, etc
12
Q
spiritual support
A
- Pastoral Care
- Religious customs –> ask them. Ex: anointing of the sick
- Provide necessary information
- No longer a radial pulse so that typically means they only have a few hrs
13
Q
care at time of death
A
- Pronouncement of death –> typically a physician, coroner, hospice nurse (in MO) can pronounce time of death
- Determine
- Organ donation –>need to know sooner rather than later
- Autopsy –> this changes what you need to do
- pt needs to grant this or next of kin
14
Q
care of body
A
- Religious customs
- Rigor mortis –2-4 hours (stiffening of joints and muscles)
- Position body
- Removal of tubes, venous devices (if there’s not gonna be an autospy)
- put absorpant pad under them if they are having an autopsy because of poop and pee
15
Q
care of family
A
- Care of family
- Prepare environment/ family
- Provide time as needed
- Assist with phone calls
- rolling over = air escapes the lungs = sounds like breathing
- Removal of body
16
Q
grief
A
- total response to the emotional experience related to loss
17
Q
mourning
A
- work is done to help us move thru grief
- behavioral process through which grief is resolved or altered
18
Q
bereavement
A
- Combination of the 2
19
Q
grieving
A
- Essential for good mental &
physical health - Social process
- Work
20
Q
anticipatory grief
A
- grief before loss
- children’s responses –> concrete, magical thinking
- could be death, loss of body part, loss of financial stability, etc
21
Q
normal grief
A
- Normal feelings, behaviors, reactions to grief
22
Q
chronic grief
A
- normal grief reactions that do not subside over very long periods of time
- someone who is still struggling 2-3 years later
23
Q
delayed grief
A
- normal grief reactions suppressed or postponed
- survivor consciously or unconsciously avoids the pain of
the loss
24
Q
exaggerated grief
A
- survivor resorts to self-destructive behaviors such as suicide
- drinking too much because they can’t deal with the pain
25
masked grief
- survivor is not aware that behaviors that interfere with normal functioning are the result of a loss
- ex: immersed in work. can't deal w/ what is going on
26
disenfranchised grief
- Loss is experienced but can’t be
- openly acknowledged
- socially sanctioned
- publicly shared
- school shooter who died --> family can't openly grieve
27
psychological symptoms of grief
- Feelings of confusion
- Difficulty concentrating
- Preoccupation with thoughts of lost object/person
28
physical symptoms of grief
- Weakness
- Tightness in chest
- Loss of energy
- Restlessness
- Upset stomach
29
behavioral symptoms of grief
- Angry outburst
- Impatience
- Agitation
- Withdrawal
- Change in sleep pattern
- Conversation
30
emotional symptoms of grief
- Sadness
- Anxiety, fear
- Anger, guilt
- Feeling numb
- Feeling helpless
31
stages of grief
- Rando
- Recognizing the loss
- Reacting to the pain of separation
- Reminiscing
- Relinquishing the attachment (reorganize and restructure)
- Readjusting to life after the loss
32
factors influencing loss and grief responses
- Age/ development
- Personal relationships
- Nature of loss
- Coping strategies
- Culture
- Spiritual beliefs
- Socioeconomic status
33
assessment in loss and grieving
- Who
- When
- What
- Type of grief
- Grief reactions
- Stages & tasks of grieving
- Factors that may affect the grief process
- Overall health of survivor
34
nursing diagnosis
- complicated grieving
- risk for complicated grieving
- grieving
- spiritual distress
35
nursing intervention -- presence
- “My heart is nearly broken with sorrow, remain here and watch
with me.” Matthew, 26: 38.
36
nursing intervention -- communication
- Fear of not knowing what to say
- Support the grieving family
- tell me more abt ___ what was she like
37
interventions
- Respect cultural practices
- Facilitate Mourning
- Normalize the grief process
- Actualize the loss and facilitate living without it
- Enlist interprofessional team
- Be mindful of nursing staff’s grief reaction
- Secondary or vicarious trauma
38
evaluation of adaptation to loss
- Grief work is never completely finished
- Healing characterized by
- pain of loss is less
- survivor has adapted to life without lost object/ person
- survivor has physically, psychologically and socially “let go”
39
Which of the following statements is true about grief?
- Recurring, wavelike feelings of sadness and loss are common feelings in a person who is grieving
39
Which of the following best describes anticipatory grief?
- it can be colored by ambivalent feelings
40
The nurse is caring for a patient who is expected to die within a month. The patient states, “I can’t go on anymore, help me!” Which of the following best describes this patient’s stage of dying?
- depression
41
Stoicism and denial of grief are examples of how family coping with death is affected by:
- culture
- ex: guys can't cry
42
A patient’s adult children call the nurse hourlymwith concerns about their mother’s end-of-life
care. The nurse’s best response is to:
- provide frequent updates
43
One month after the death of her
spouse of 60 years, a widow could be expected to
- experience intense grief
44
All of the following are steps that the nurse should take after a patient dies. Put the steps in order.
- Call physician to pronounce time of death
- Ascertain if an autopsy is desired
- Remove all IV devices
- Apply appropriate identification to the body
- Place body in the shroud
