Ch 36: End of Life Care Flashcards
definitions of death
-Inevitable, unequivocal, universal experience
-People can be reluctant to accept mortality
-“Cessation of vital functions without the capacity of
resuscitation”
types of medical deaths
- Brain death: death of brain cells; flat EEG
- Somatic death; absence of cardiac and pulmonary functions
- Molecular death; cessation of cellular functions
3 ways of nurses assessing for brain death
- corneal reflex
- pain response
- pupillary response
family experiences with the dying process
Western culture has limited experiences with death/dying
* Few people dying earlier
* Deaths occurring in institutionalized settings
Avoid discussions about death/not making a will lack of internalization of
mortality
Understanding one’s own mortality can be therapeutic and help with care of
dying clients
supporting the dying individual
Offer humanistic approach
Meet the total needs of the client in a holistic manner
Involve family members and significant others
Individualized nursing intervention
Carefully assess previous experiences with death, age, health status, philosophy of life, religious/spiritual/cultural beliefs, and attitudes/beliefs/values related to death
hospice care
Specialty that supports individuals through the
dying process
Provided in a variety of settings
includes interdisciplinary efforts to provide:
Pain relief
Symptom control
Social work and counseling services
Coordinated home care and institutional care
Medical equipment and supplies
Volunteer assistance and support
Bereavement follow-up and counseling
kubler-ross stages of grief
denial
anger
bargaining
depression
acceptance
denial
- Denying the reality of the situation
- Provides an opportunity to test certainty of information
and gives time to internalize - Nursing: accept reactions and open door for honest
dialogue; accept use of defenses
anger
- Feels nothing is right; family could have guilt,
embarrassment, grief, or anger - Nursing: Create a beneficial environment, don’t take it
personal, anticipate needs, maintain a pleasant attitude,
vent to a colleague
bargaining
- Negotiation of the inevitable
- Nursing: understand disappointment may occur;
explore feelings; be mindful of spiritual/cultural
considerations
depression
- Depression that doesn’t resolve with encouragement
or reassurance - Nursing: don’t use many cheerful words; encourage
clergy-patient relationship
acceptance
- Comes to terms of death and found a sense of peace
- Nursing: touching, comforting, and being near the person; hope; family needs assistance with this stage
what is rational suicide
Competent adults makes a reasoned decision to die by
suicide; cognitively intact; relatively free from pain
what is assisted suicide
Individual has decided to end life with an aid of another
person (medical professional)
Legal in some states, not all
s/s of pain:
pain/discomfort,
nausea,
irritability,
restlessness,
anxiety,
sleep disturbances,
reduced activity,
diaphoresis,
pallor,
poor appetite,
grimacing,
withdrawal,
confusion
goal of pain management
prevent pain, rather than treating it
analgesia contraindicated in older adults
Meperidine and pentazocine are contraindicated due to adverse effects
palliative care
prevents and relieves pain, not only for dying clients
alternative to meds for pain
guided imagery,
hypnosis,
relaxation,
massage,
acupressure,
acupuncture,
therapeutic touch,
diversion,
application of heat/cold
respiratory distress interventions
elevate HOB,
pacing,
relaxation exercises,
administering 02,
narcotics,
atropine or furosemide to reduce bronchial secretions
constipation interventions
increase activity,
increasing intake of fluids and fiber,
laxatives on a regular schedule;
monitor for impaction
poor nutritional intake
small portioned meals,
providing favorite foods,
antiemetics,
antihistamines,
ginger,
clean/pleasant environment for eating;
company during meals;
assisting with feeding,
oral hygiene
spiritual care needs
Each religion has its own practices related to
death
Nurses should be sensitive to differences and
ensure spiritual needs are met
***Review table 36-2 for specific religious
beliefs and practices related to death.
Perform spiritual assessment
Clergy and family involvement as the
client/family allow
signs of imminent death
Use this data to ensure the family has an opportunity to
see the client
Decline in BP
Rapid, weak pulse
Dyspnea or periods of apnea
Slower or no pupil response to light
Profuse perspiration
Cold extremities
Bladder/bowel incontinence
Pallor/mottling of skin
Loss of hearing and vision
Clergy as necessary; speak to and comfort the client during this time even if unresponsive
Organizations must provide information about Patient Self-Determination Act - advance directives
Outlines preferences in care if they aren’t able to
communicate it
Medical Orders for Life-Sustaining Treatment
(MOLST) or Physician Orders for Life-Sustaining Treatment
(POLST)
- Describes medical
treatments that they wish to
receive in a medical
emergency - NOT legal documents and
don’t contain information
about surrogates about who
can make decisions; just list
medical orders - Specific forms vary by state
SUPPORTING FAMILY AND FRIENDS DURING THE DYING PROCESS
Family/friends go through stages of grief
Denial avoid talking/thinking about death, visit less frequently, states they will get better when they get home, shop for doctors
Anger criticizing staff, questioning why this is happening, direct anger to other family members
Bargain may bargain to complete an action to help the client feel/get better
Depression more dependent on staff, crying, limiting contact
Acceptance wanting to spend more time with the client, request special things for the client, make arrangements in their own
life
Nursing
Be aware of the state-by-state legal interventions
Offer an opportunity to discuss death openly
SUPPORTING FAMILY AND FRIENDS AFTER DEATH
-Nurse should be available to support the family
-Respect the personal desires of family/friends and don’t make judgments
-Allow an environment to express grief openly
-Advocate for the family
-Teach family to learn about the funeral industry
-Nurse can arrange visiting nurse, church member, social worker to check on family weeks after death
-Support groups
post-mortem care
Determine if there are any tissues/organs to be
donated
Contact organ donation company
Determine if death needs an autopsy or not
Determine if the family wants to participate
Follow organizational policy!
Remove equipment (except for autopsy)
Clean body and cover with clean sheet, place pillow
on the head and leave arms outside the sheet
Offer privacy of the family
Return belongings to family
Attach identification tags per policy and apply shroud
supporting nursing staff in end-of-life care
- May be difficult for nurses to accept a client’s death; may be considered a failure and feel powerless
- Can experience stages of grief
- Express feelings about client’s death; don’t bottle it in
