Chapter 36: End-of-Life Care Flashcards
Suicide committed with the help of another individual
Assisted suicide
A medical order advising providers not to initiate cardiopulmonary resuscitation in the event of cardiac or respiratory arrest
Do not resuscitate (DNR)
Period when recovery from illness is not expected, death is anticipated, and focus is on comfort
End of life
A program that delivers palliative care to dying individual and support to dying person and that person’s family and caregivers
Hospice care
Care that relieves suffering and provides comfort when cure is not possible
Palliative care
Decision by competent terminally ill person to end his or her life
Rational suicide
___ is an inevitable, unequivocal, and universal experience, common to all.
Death
The cessation of life is often dealt with in terms of __ and __.
fury and fear
Gerontological nurses commonly face the reality of death because more than __% of deaths occur in old age
80%
The final termination of life, the cessation of all vital functions, or the act or fact of dying
definitions of death
Avoiding discussions about death and not making a will or other plans related to one’s own death are clues to the lack of ___
internalization of one’s mortality.
__ one’s own mortality can be therapeutic to the nurse personally, as well as helpful in the care of dying patients.
Understanding
T/F: Nurses were discouraged from showing emotion when a patient died
True
the study of death and dying
thanatology
Not only was open discussion of an individual’s impending death rare but also it was typical for the dying person to be moved to a separate and often ___
isolated location during the last few hours of life.
If the family was present, they were frequently left alone with the dying person, with or without benefit of a professional’s support?
without
When death did occur, the body was removed from the unit in secrecy so that ___
other patients would be unaware of the event.
Only through this ___ can the most therapeutic and individualized support be given to the dying person.
assessment
__, __, __, and __ are all characteristics of an aging client with altered thought processes.
Depression, anxiety, fear, and isolation
__ __ is not typically associated with altered thought processes or fear.
Deficient knowledge
Patients’ reactions to __ are influenced by previous experiences with death, age, health status, philosophy of life, and religious, spiritual, and cultural beliefs.
dying
Elisabeth Kübler-Ross developed a conceptual framework outlining the coping mechanisms of dying in terms of ___ stages
five
The 5 stages are:
- denial
- anger
- bargaining
- depression
- acceptance
Perhaps the most important nursing action during this stage is to accept the dying individual’s reactions and to provide an open door for honest dialogue.
denial stage
During this time, the family may feel guilt, embarrassment, grief, or anger in response to the dying person’s anger. May believe nothing is right, they have unfilled desires and unfinished business.
Anger
What stage: They may agree to be a better Christian if God lets them live through one more Christmas; they may promise to take better care of themselves if the physician initiates aggressive therapy to prolong life; they may promise anything in return for an extension of life.
Bargaining
An interest in prayer and a desire for visits from clergy are commonly seen during this stage. Reality of the dying process is emphasized.
Depression
What stage: For many dying persons, a time comes when the struggling ends and relief ensues. It is as though a final rest is being taken to gain the strength for a long journey. Maybe they’ll have their final conversations with their family members during this stage
Acceptance
Significantly, __ commonly permeates all stages of the dying process
hope
Concern regarding the degree of ___ that will be experienced and its management may be a considerable source of distress for dying individuals; nurses can reduce distress for patients by supplying them with realistic information regarding __. (same word for both blanks)
pain
Complaints of pain or discomfort, nausea, irritability, restlessness, and anxiety are common indicators of __
pain
In some circumstances, __ can be associated with pain.
confusion
For the dying patient, the goal of pain management is to
prevent pain from occurring
__ or __ is used for mild pain
aspirin or acetaminophen
__ or ___ is used for moderate pain
codeine or oxycodone
__ or __ is used for severe pain.
morphine or hydromorphone
__ and ___ are contraindicated for pain control in older adults because of their high incidence of adverse effects, particularly psychosis, at relatively low dosages.
Meperidine and pentazocine
__ __ is a common problem in dying patients
Respiratory distress
Psychological distress can be associated with the __, __, and __ that results from the thought of suffocating
fear, anxiety, and helplessness
The causes of respiratory distress can range from __ to __.
pleural effusion to deteriorating blood gas levels
Atropine or furosemide may be administered to reduce __ __
bronchial secretions
What can cause constipation in the dying patients?
Reduced food and fluid intake, inactivity, and the effects of medications
It must be remembered that what may appear to be diarrhea may actually be ___
seepage of liquid wastes around a fecal impaction
Many dying patients experience anorexia, nausea, and vomiting that can prevent the ___
ingestion of even the most basic nutrients
Nausea and vomiting can be controlled with the use of __
antiemetics and antihistamines; and ginger
Assessment should explore not only their religious affiliation but also their __ __ __.
individual religious practices.
When death is near, bodily functions will slow and certain signs and symptoms will occur, including:
- Erratic breathing (slow) to aganol breathing (not effective)
- cool extremities
- pallor and modeled skin
- decreased L.O.C
- decline in blood pressure
- rapid, weak pulse
- dyspnea and periods of apnea
- slower or no pupil response to light
- profuse perspiration
- bladder and bowel incontinence
- loss of hearing and vision
If a patient is unresponsive, should he or she still be spoken to and touched?
Yes
A patient can express desires regarding terminal care and life-sustaining measures through the legal document of an __ __
advance directive
All health care facilities and agencies that receive Medicare and Medicaid funding must provide information to patients about the__
Patient Self-Determination Act
The __ gives individuals the right to express their choice regarding medical and surgical care and to have those preferences honored at a later time if they are unable to communicate it
Patient Self-Determination Act
What time is when the most intense grief occurs?
After the agitation of the funeral has diminished and fewer visitors are calling to pay their respects.
Medical evaluation of the ___ is crucial
survivors
Nursing staff may feel powerless as they realize that their best efforts can do little to overcome the reality of __ __
impending death
Nursing staff should be encouraged to express their own feelings about __ __
patients’ deaths
In recent years, there has been growing acceptance of ___ suicide
rational
A patient’s decision to put an end to his or her life demands __ and __
exploration and assessment.
People are ___ to accept mortality.
reluctant
Gerontological nurses often face death and must learn to ___.
deal with the entire dying process
___ Death: determined by EEG
Brain
__ death: determined by the absence of cardiac and pulmonary functions
Somatic
___ death: determined by cessation of cellular function
Molecular
In the past there were __ mortality rates.
higher
In the past, death in the home was viewed as a ____ process.
natural
In the present, people have __ experience with death.
limited
Most people have ___ direct involvement with dying individuals.
minimal
Death has become a more ___ and ___ event due to the hospital environment.
impersonal
unusual
Factors that can influence a family on how they feel about the death:
- previous experiences with death
- religious, spiritual, cultural beliefs
- philosophy of life
- age
- health status
The nurse needs to understand which interventions are __ __ during each stage of Kubler-Ross’s framework.
most appropriate
T/F: All dying persons progress through the stages in an orderly sequence and experience all of the stages.
FALSE
Nurses were prepared to deal with care of a dead body, but now they need to be ___
more involved in the dying process
What stage: Initial awareness of impending death
Deny the reality of the situation
Serves several useful purposes
May occur at various times throughout an illness; fluctuation
Denial
What stage: It may be useful for nurses to discuss their feelings about the patient’s anger with an objective colleague who can serve as a sounding board so that the nurse–patient relationship continues to be therapeutic.
Anger
What stage: The nurse may need to help the family understand this depression, explaining that their efforts to cheer the dying person can hinder rather than enhance the patient’s emotional preparation. The nurse may emphasize that this type of depression is necessary for the individual to be able to approach death in a stage of acceptance and peace.
depression
What stage: Touching, comforting, and being near the person are valuable nursing actions.
Acceptance
Hope is used as a temporary ____
form of denial
A realistic confrontation of impending death does not negate the presence of ___.
hope
Constipation and respiratory distress are indications of ___.
pain
Common problem in dying patients is ___ ___, which is due to fear of dying.
respiratory distress.
Signs of imminent death:
Bodily functions slow down
___ & ___ may also pass through the stages of the dying process before they accept the impending death of a loved one.
Family & friends
Postventive work of Edwin Schneidman:
- Total care of a dying person needs to include contact and rapport with the survivors-to-be.
- It is best to begin as soon as possible after the tragedy, within the first 72 hours if possible.
- Remarkably little resistance is met from survivor-victims (most will talk)
- The role of negative emotions toward the deceased needs to be explored, but not at the beginning.
- The professional plays the important role of reality tester
- Medical evaluation of the survivors is crucial.
Death can be viewed as a __ __ by staff.
dissatisfying failure
Many individuals are reluctant to accept ___
mortality
United Nations Vital Statistics Division uses ___ for death.
statistics
