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Clinical Concepts > caring for dying patients and their families > Flashcards

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
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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
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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
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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
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5
Q

cardiac dysfxn

A
  • Tachycardia, hypotension –> deficient fluid volume symtom
  • Mottling of skin (spidery redish blue skin)
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6
Q

true or false. no radial pulse = death within a few hrs

A

TRUE

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7
Q

urine output falls

A
  • check for retention
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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
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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
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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
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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
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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
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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
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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
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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
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16
Q

grief

A
  • total response to the emotional experience related to loss
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17
Q

mourning

A
  • work is done to help us move thru grief
  • behavioral process through which grief is resolved or altered
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18
Q

bereavement

A
  • Combination of the 2
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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
Q

masked grief

A
  • 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
Q

disenfranchised grief

A
  • Loss is experienced but can’t be
    • openly acknowledged
    • socially sanctioned
    • publicly shared
  • school shooter who died –> family can’t openly grieve
27
Q

psychological symptoms of grief

A
  • Feelings of confusion
  • Difficulty concentrating
  • Preoccupation with thoughts of lost object/person
28
Q

physical symptoms of grief

A
  • Weakness
  • Tightness in chest
  • Loss of energy
  • Restlessness
  • Upset stomach
29
Q

behavioral symptoms of grief

A
  • Angry outburst
  • Impatience
  • Agitation
  • Withdrawal
  • Change in sleep pattern
  • Conversation
30
Q

emotional symptoms of grief

A
  • Sadness
  • Anxiety, fear
  • Anger, guilt
  • Feeling numb
  • Feeling helpless
31
Q

stages of grief

A
  • Rando
    • Recognizing the loss
    • Reacting to the pain of separation
    • Reminiscing
    • Relinquishing the attachment (reorganize and restructure)
    • Readjusting to life after the loss
32
Q

factors influencing loss and grief responses

A
  • Age/ development
  • Personal relationships
  • Nature of loss
  • Coping strategies
  • Culture
  • Spiritual beliefs
  • Socioeconomic status
33
Q

assessment in loss and grieving

A
  • Who
  • When
  • What
    • Type of grief
    • Grief reactions
    • Stages & tasks of grieving
    • Factors that may affect the grief process
    • Overall health of survivor
34
Q

nursing diagnosis

A
  • complicated grieving
  • risk for complicated grieving
  • grieving
  • spiritual distress
35
Q

nursing intervention – presence

A
  • “My heart is nearly broken with sorrow, remain here and watch
    with me.” Matthew, 26: 38.
36
Q

nursing intervention – communication

A
  • Fear of not knowing what to say
  • Support the grieving family
    • tell me more abt ___ what was she like
37
Q

interventions

A
  • 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
Q

evaluation of adaptation to loss

A
  • 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
Q

Which of the following statements is true about grief?

A
  • Recurring, wavelike feelings of sadness and loss are common feelings in a person who is grieving
39
Q

Which of the following best describes anticipatory grief?

A
  • it can be colored by ambivalent feelings
40
Q

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?

A
  • depression
41
Q

Stoicism and denial of grief are examples of how family coping with death is affected by:

A
  • culture
  • ex: guys can’t cry
42
Q

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:

A
  • provide frequent updates
43
Q

One month after the death of her
spouse of 60 years, a widow could be expected to

A
  • experience intense grief
44
Q

All of the following are steps that the nurse should take after a patient dies. Put the steps in order.

A
  • 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

Clinical Concepts (18 decks)

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