Ch. 9 - End Of Life Care Flashcards
When is death viewed as a relief ?
When the dying process is long or painful
What are the Kubler-Ross’ stages of grief ?
- Denial
- Anger
- Depression
- Bargaining
- Acceptance
What are some key identifiers of the Denial stage of grief ?
- Avoidance
- Confusion
- Elation
- Shock
- Fear
what are some key identifiers in the Anger stage of grief ?
- Frustration
- Irritation
- Anxiety
What are some key identifiers in the Depression stage of grief ?
- Overwhelmed
- Helplessness
- Hostility
- Flight
What are some key identifiers in the Bargaining stage of grief ?
- Struggling to find meaning
- Reaching out to others
- Telling one’s story
- Support groups
What are some key indentifiers in the Acceptance stage of grief ?
- Exploring options
- New plan in place
- Moving on
When does Dying begin ?
At the moment called “crisis knowledge of death”
When does dying end ?
At the moment of physiologic death
the Living-dying interval is the time between what two points ?
Crisis knowledge of death THROUGH physiologic death
The __________ phase is when the speed of physical dying is accelerated, and the person no longer has the energy to maintain the activities of everyday life
Terminal phase
What is the six C’s approach during the dying period ?
- Care
- Control (help keep self control/independence, etc.)
- Composure
- Communication
- Continuity (perserve as normal life as possible)
- Closure
Palliative care can be provided along with what ?
Curative treatment
_________ care is appropriate at any age and at any stage in a serious illness ?
Palliative care
Palliative care is made up of what two things ?
Care & Comfort
What is the Focus of palliative care ?
Focus is on care and comfort (treatment of symptoms) versus cure.
What is the goal of palliative care ?
To improve quality of life for both the patient and the family
_________ care may progress to hospice care ?
Palliative
Types of Hospice care ?
- Inpatient
- Hospice facility
- Long-term care
- Home (most common)
What is the average length of stay in Hospice ?
22 days
Is there a time frame for palliative care ?
There are NO time restrictions
What is the typical time frame for Hospice ?
Considered to be terminal or within six months of death
Euthanasia definition
Is the client’s right to refuse life-sustaining medical measures
????????
What is Xerostomia ?
Sensation of oral dryness
Xerostomia _____________ with age ?
increases
What assessment is crucial when dealing with anorexia/decreased swallowing ?
ASSESS ABILITY TO SWALLOW pills and/or food bolus
Ascites definition ?
Accumulation of vascular fluid in the peritoneal space resulting from altered capillary dynamics
Comfort measures for Ascites treatment ?
- Small frequent meals
- Positioning
- Skin care
Initial drug treatment for Ascites ?
- Diuretics
- Eventually not responsive
- Paracentesis : may be intermittent or placement of catheter
What is the only reliable indicator of Dyspnea ?
The subjective report by the patient
Similar to pain
Increased Dyspnea is common in which age group ?
The elderly
Nebulized opioids have no benefit compared to _______/________ delivery ?
Oral/Parenteral
What are end of life medications used to treat dyspnea ?
- benzodiazepines
- opioids
- corticosteroids
When should an opioid infusion be considered ? (ex: morphine drip)
If actively dying with respiratory distress
Respiratory secretions occur most commonly when ?
In the last hours of life
What is Myoclonus ?
Sudden, uncontrollable, non-rhythmic jerking, usually of the extremities
Cause of Myoclonus in palliative care ?
Often related to opioid use
As a nurse, what should you do when you suspect imminent Death ?
start calling the family
- Imminent = About to happen
As a nurse, what is one rule you should abide by when engaging in a family meeting ?
Listen twice as much as you speak
