caring for dying patients and their families Flashcards
physiological changes and symptom management
- Pain Management
- WHO ladder concept
- Around the clock long acting narcotics
- Immediate release drugs for break through pain
WHO ladder for pain
- 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
Physiological Changes & Symptom
Management pt. 2
- 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
mucosal and conjunctival care
- drying up
- mouth wash: tsp of salt, baking soda, warm water
- moisten the mouths
- eyedrops: things like visine
cardiac dysfxn
- Tachycardia, hypotension –> deficient fluid volume symtom
- Mottling of skin (spidery redish blue skin)
true or false. no radial pulse = death within a few hrs
TRUE
urine output falls
- check for retention
neurologic dysfxn – early
- 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
neurologic dysfxn – late
- 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 –>
respiratory dysfxn
- 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
comfort needs of family
- 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
spiritual support
- 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
care at time of death
- 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
care of body
- 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
care of family
- 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
grief
- total response to the emotional experience related to loss
mourning
- work is done to help us move thru grief
- behavioral process through which grief is resolved or altered
bereavement
- Combination of the 2
grieving
- Essential for good mental &
physical health - Social process
- Work
anticipatory grief
- grief before loss
- children’s responses –> concrete, magical thinking
- could be death, loss of body part, loss of financial stability, etc
normal grief
- Normal feelings, behaviors, reactions to grief
chronic grief
- normal grief reactions that do not subside over very long periods of time
- someone who is still struggling 2-3 years later
delayed grief
- normal grief reactions suppressed or postponed
- survivor consciously or unconsciously avoids the pain of
the loss
exaggerated grief
- survivor resorts to self-destructive behaviors such as suicide
- drinking too much because they can’t deal with the pain
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
disenfranchised grief
- Loss is experienced but can’t be
- openly acknowledged
- socially sanctioned
- publicly shared
- school shooter who died –> family can’t openly grieve
psychological symptoms of grief
- Feelings of confusion
- Difficulty concentrating
- Preoccupation with thoughts of lost object/person
physical symptoms of grief
- Weakness
- Tightness in chest
- Loss of energy
- Restlessness
- Upset stomach
behavioral symptoms of grief
- Angry outburst
- Impatience
- Agitation
- Withdrawal
- Change in sleep pattern
- Conversation
emotional symptoms of grief
- Sadness
- Anxiety, fear
- Anger, guilt
- Feeling numb
- Feeling helpless
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
factors influencing loss and grief responses
- Age/ development
- Personal relationships
- Nature of loss
- Coping strategies
- Culture
- Spiritual beliefs
- Socioeconomic status
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
nursing diagnosis
- complicated grieving
- risk for complicated grieving
- grieving
- spiritual distress
nursing intervention – presence
- “My heart is nearly broken with sorrow, remain here and watch
with me.” Matthew, 26: 38.
nursing intervention – communication
- Fear of not knowing what to say
- Support the grieving family
- tell me more abt ___ what was she like
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
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”
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
Which of the following best describes anticipatory grief?
- it can be colored by ambivalent feelings
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
Stoicism and denial of grief are examples of how family coping with death is affected by:
- culture
- ex: guys can’t cry
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
One month after the death of her
spouse of 60 years, a widow could be expected to
- experience intense grief
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
