Chapter 27: End-of-Life Care

Question 1

anticipatory grief

Answer 1

A period of mourning when the dying person or his family is expecting the death

Question 2

Autopsy

Answer 2

An examination of a body by a pathologist to try to determine the cause of death

Question 3

Bereavement

Answer 3

The period following a loss in which mourning occurs

Question 4

Complicated grief

Answer 4

Intense, long-lasting grief that does not seem to improve even after time has passed

Question 5

cremation

Answer 5

The process of burning a dead body until it turns to ash

Question 6

Death

Answer 6

The end of life: the cessation of all body functions

Question 7

Grief

Answer 7

A deeply emotional process that is a response to loss

Question 8

Grief counseling

Answer 8

Therapy to try to help a person cope after someone has died

Question 9

Grief process

Answer 9

the varying emotional responses to grief

Question 10

mourning

Answer 10

the period in which people work to adapt to a loss; influenced by culture, tradition, and society

Question 11

Pallitative care

Answer 11

Care that focuses on pain relief, controlling symptoms, preventing side effects and complications, and maintaining quality of lie for a person who is very ill and/or is dying

Question 12

Pathologist

Answer 12

A doctor with advanced training in the examination of organs and tissues

Question 13

Postmortem care

Answer 13

Care of the body after death

Question 14

Rigor mortis

Answer 14

The Latin term for the condition after death in which the muscles in the body become stiff and rigid

Question 15

Terminal illness

Answer 15

A disease or condition that will eventually cause death

Question 16

What are the goals of palliative care?

Answer 16

1) Control symptoms
2) Reduce suffering
3) Prevent side effects
4) Maintain quality of life
5) Emphasize holistic approach
6) It does not work to cure a disease

Question 17

What happens when a serious illness is classified as a terminal illness?

Answer 17

It is considered a disease or condition that could eventually cause death. Usually hospice care is often the next step.

Question 18

What are the points about hospice care?

Answer 18

1) Ordered by a doctor for a person who has six months or less to live
2) Can be given in a hospital, care facility, or in the home
3) Uses a holistic approach
4) Focuses on resident and family as a unit
5) Offers medically-directed, team-managed care
6) Offers compassionate care
7) Focuses on soothing and comfort care, rather than curative care
8) Emphasizes pain and symptom management
9) Provides alternative to traditional care
10) Helps family obtain financial counseling and legal assistance
11) Offers assistance for psychosocial needs

Question 19

What are the rights that a person has when they are terminally ill (Dying)?

Answer 19

1) The right to have visitors
2) The right to privacy
3) The right to be free from pain
4) The right to honest and accurate information
5) The right to refuse treatment

Question 20

Why do residents have the right to visitors?

Answer 20

1) It may be inconvenient to have visitors coming and going at odd hours, but when death is close, it is an emotional time for all those involved
2) Saying goodbye can be a very important part of dealing with a loved one’s death
3) It may also be very reassuring to the dying person to have someone in the room, even if they don’t seem to be aware of their surroundings
4) Only report a visitor if he is disruptive or he becomes a threat

Question 21

Why do residents have the right to privacy?

Answer 21

Privacy is a basic right

Question 22

Why does a resident get the right to be free from pain?

Answer 22

It is very important to monitor dying residents for signs that they are in pain because if something is caught they may be able to prolong their life or find a way to heal them.

Question 23

Why do residents get the right to honest and accurate information?

Answer 23

Residents have the right to honest information about what is happening and what their diagnosis is. Refer medical questions that are outside your scope of practice to the nurse

Question 24

Why do residents get the right to refuse treatment?

Answer 24

We need to remember that whether we agree or disagree with the decisions, the choice is not ours, but belongs to the person involved.
Sometimes, when the residents are not capable of making a decision, they have told their family how they wish things to be done. Be supportive of family members; do not judge them. They are probably following the person’s wishes

Question 25

Guidelines for Skin, Nose, and Mouth care on a dying resident

Answer 25

1) Give frequent skin care
2) Bathe often
3) Change gowns and sheets often
4) Give incontinence care promptly
5) Turn and reposition often
6) Give oral care frequently
7) Offer ice chips
8) Use lubricant on nose and mouth

Question 26

Guidelines for breathing problems and a dying resident

Answer 26

1) Report gurgling or rattling

2) Elevate the head of the bed and change positions as ordered

Question 27

Guidelines for Food and Fluid issues with a dying resideng

Answer 27

1) Feed residents slowly
2) Encourage fluids
3) Do not force residents to eat or drink
4) Report nausea, vomiting, and diarrhea
5) Elevate head of bed

Question 28

Guidelines for Pain control and comfort with dying residents

Answer 28

1) Pain relief is critical
2) Observe and report signs of pain
3) Adjust blankets for temperature changes

Question 29

Guidelines for diminished Senses and dying residents

Answer 29

1) Keep room softly lit
2) Use alternate forms of communication
3) Speak normally and describe care that is being performed

Question 30

What are the factors that influence feelings and attitudes about death?

Answer 30

1) Experience with death
2) Personality type
3) Religious Beliefs
4) Cultural Background

Question 31

Guidelines for understanding the psychosocial and spiritul needs of dying residents

Answer 31

1) Listen more; talk less
2) Provide privacy for visits
3) Notify the nurse if resident requests visit from spiritual leader
4) Do not discuss personal religious beliefs or try to change resident’s beliefs
5) Do not judge
6) Never share anything private with others, except for the nurse
7) Inform the nurse if resident has expressed fear of dying

Question 32

What are the signs of approaching death?

Answer 32

1) Cyanotic, pale, or darkening skin or mucous membranes
2) Cold skin
3) Skin that looks bruised
4) Heavy perspiration
5) Fever
6) Low blood pressure
7) Increased Pulse
8) Cheyne-Strokes breathing
9) Gurgling and rattling sound when breathing
10) Difficulty swallowing
11) Decreased appetite and sense of thirst
12) Dry mouth
13) Nausea, Vomiting, and diarrhea
14) Decreased sense of touch

Question 33

More signs of approaching death

Answer 33

1) Loss of feeling, beginning int he legs and feet
2) Extreme weakness and exhaustion
3) Loss of muscle tone
4) Fallen jaw, causing the mouth to stay open
5) Inability to speak
6) Loss of vision
7) Dilated pupils and staring eyes
8) Urinary and fecal incontinence
9) Decreased urinary output
10) Hallucinations
11) Disorientation or confusion
12) Loss of hearing

Question 34

What happens to the body after death?

Answer 34

1) No pulse, respiration, blood pressure
2) Eyelids partially open
3) Fixed and dilated pupils
4) Jaw drops
5) Urinary and fecal incontinence

Question 35

What is Algor morits?

Answer 35

the cooling of the body after death and the decrease in elasticity of the skin

Question 36

What is Livor Mortis?

Answer 36

skin discoloration after death in the dependent areas of the body, such as the feet and legs

Question 37

What are the feelings that family and friends may experience after a loved one dies?

Answer 37

1) Feeling numb or being in shock
2) Disbelief or denial of the death
3) Intense sadness and crying
4) Anxiety or fear
5) Anger
6) Physical reactions or symptoms, such as pain, especially chest pain, nausea, or difficulty breathing
7) Feelings of guilt, especially if there were any unresolved problems or issues with the relationship
8) feelings of relief

Question 38

How may family members act toward staff members after a resident dies?

Answer 38

They may direct anger at staff members. They may just be reacting to the loss of a loved one. They may blame staff for a problem that they feel was not addressed. Whatever the reason, refer any family complaints to the nurse.

Question 39

Guidelines for helping families and friends

Answer 39

1) Allow the family to show their feelings
2) Be available. Listen when they want to talk
3) Do not be afraid to show your feelings
4) Do not make inappropriate comments or use cliches
5) Report requests for spiritual leaders to the nurse

Question 40

What do NAs have the right to do when a resident dies?

Answer 40

The right to experience strong feelings. Being able to grieve. Do not underestimate your own feelings, do not hesitate to seek out counseling or bereavement therapy if needed.

Question 41

What are the ways that staff can cope with a resident’s death?

Answer 41

1) Express your feelings- they are normal
2) Getting enough sleep, eating nutritious meals, drinking only in moderation, and not smoking
3) Participating in enjoyable activities and exercising regularly
4) Spending quality time with people they love
5) Sharing memories
6) Joining a support group
7) Talking to a counselor

Question 42

When performing postmortem care what should a nursing assistant avoid?

Answer 42

avoid trauma to the resident’s body throughout the procedure. Treat the body with the utmost respect

Question 43

In what position should you put a body in during postmortem care and why?

Answer 43

Position the body in good alignment, on the back with legs straight. Fold arms across the abdomen because the body will go into rigor mortis soon after the person dies. It is difficult to get the body into that position after rigor mortis

Question 44

Should you bathe a body after the person has died?

Answer 44

Yes, during postmortem care