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Test #3 Nursing > Chronic End of Life > Flashcards

Chronic End of Life Flashcards

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1
Q

What is loss?

A

Experience loss daily

Unexpected change

Whenever there is change, there is loss

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2
Q

Actual loss

A

Can be identified by others

Includes: death of a loved one (or relationship), theft, deterioration, destruction, and natural disaster.

Ex. Job, hair, body parts, loss of future, etc.

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3
Q

Perceived loss

A

Identified only by the person experiencing it.

More internal, self-concept, autonomyhfhcjxovrrjeufhffjfigjgjghigogigigig

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4
Q

What is the best way to treat a person regarding loss?

A

What do they perceive as the biggest loss?

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5
Q

Physical loss

A

injuries (amputation)
removal of an organ
loss of function (mobility)

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6
Q

Psychological loss

A

Challenges our belief system.

Commonly seen in the areas of sexuality, control, fairness, meaning, and trust.

Ex. removal of prostate gland - man feels both physical and psychological loss of sexuality

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7
Q

External loss

A

Actual losses of objects that are important due to cost or sentimental value

ex. jewelry, pet, home

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8
Q

Internal loss

A

Another term for perceived or psychological loss

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9
Q

Loss of aspects of self

A

Physical losses (body organs, limbs, body functions, etc.) as well as psychological losses (personality, dev. change), developmental change (aging process), loss of hopes and dreams, and loss of faith

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10
Q

Environmental loss

A

Change in the familiar, even if the change is perceived as positive.

Ex. new home, job, going to college

Can be perceived or actual losses

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11
Q

Loss of significant relationships

A

Includes (not limited to) actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation

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12
Q

Grief

A

Requires energy
Can interfere with health and delay healing
Essential to psychological healing after a loss

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13
Q

What factors affect grief?

A 
Significance of loss
Amount of support
Conflicts already existing
Circumstances of loss
Previous loss
Spiritual/cultural beliefs and practices
Timeliness of death
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14
Q

How infants and toddlers react to death

A
  • Least significance to children < 6 months
  • May continue to act as though person is alive
  • As they grow older they will be willing to let go of the person
  • Reacts to parental anxiety and sadness
  • Reacts more to pain and discomfort of a serious illness than probable fatal prognosis
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15
Q

How preschool children react to death

A
  • See illness as punishment for their thoughts and actions
  • May feel guilty and responsible for death of a sibling
  • Greatest fear regarding death is separation from parents
  • React more outward d/t fewer defense mech.
  • Death is reversible
  • Death is sleeping
  • Separation anxiety
  • More affected by change instead of what caused the change
  • Attached to objects (blankets)
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16
Q

How school-age children react to death

A
  • Fear of unknown greater than their fear of the known
  • Guilt - something they did caused it to happen
  • death is permanent and irreversible, but may not understand cause
  • Death is avoidable
  • Careful w/ language with these ages
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17
Q

How adolescents react to death

A
  • most difficult in coping
  • Least likely to accept cessation of life
  • Death is associated with old age
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18
Q

How young adults react to death

A

Look at life situation:
children?
taking care of other people?

19
Q

What is uncomplicated grief?

A

Normal grief.
Natural response to loss
Emotions are intense but gradually diminish over time
(several months to several years)

20
Q

What is complicated grief

A

Distinguished by length of time and intensity of emotions.
Responses are maladaptive, dysfunctional, unusually prolonged, or overwhelming.

May become a “workaholic”, socially isolated, or addictive behaviors

21
Q

What is delayed grief?

A

Grief that is put off until a later time

Suppress it

22
Q

Concern for delayed grief

A

Support is there after a death, person may experience grief after support has left

23
Q

Anticipatory grief

A

Experienced before loss occurs.

Those caring for someone with a long illness may grieve along the process.

24
Q

Definition of death

A

The ultimate loss

The irreversible cessation of all functions of the brain, including the brain stem.

25
Q

What is higher brain death?

A

Irreversible cessation of all “higher” brain functions such as cognitive functioning, consciousness, memory, reasoning, etc.

26
Q

Stages of dying and grief

A 
Denial
Anger
Bargaining
Depression
Acceptance
27
Q

What are goals of palliative care?

A

Focus on reducing the severity of the disease and improve quality of life

Relief of symptoms
Regard dying as a normal process

28
Q

What is the difference between palliative care and hospice care

A

Palliative allows the person to simultaneously receive curative and palliative treatments

Hospice - not allowed to receive curative treatments

29
Q

What must a patient have before going on hospice?

A

2 physicians must certify the patient has less than 6 months to live

The patient must desire services and agree in writing to hospice care

30
Q

What are advanced directives?

A

Written documents that provide information about a patient’s wishes and his/her designated spokesperson

31
Q

What does it mean when your patient is DNR/DNI

A

Do not resuscitate, do not intubate

32
Q

What is a durable power of attorney?

A

Listing person(s) allowed to make financial and health care decisions when the patient is unable to.

33
Q

What is a living will?

A

Give instructions regarding future care - must identify special treatments a person wants or doesn’t want at end of life.

34
Q

Assessment of a hospice patient

A

No longer focus on ABC

Focus on comfort

Pain medication when feeling pain

35
Q

Physical manifestations of impending death

A 
Hearing last sense to disappear
Delayed absorption of drugs IM or SubQ
Inability to cough or clear secretions
Mottling on hands, feet, arms, and legs
Wax-like skin when very near death
36
Q

Psychosocial manifestations at end of life

A 
Altered decision making
Anxiety about unfinished business
↓ socialization
Fear of loneliness
Fear of meaninglessness
Fear of pain
Helplessness
Life review - very important
Peacefulness
Saying goodbyes
Unusual communication
Vision-like experiences
Withdrawal
37
Q

4 specific fears associated with dying

A
  • fear of pain
  • fear of shortness of breath
  • fear of loneliness and abandonment
  • fear of meaninglessness
38
Q

How can nurses facilitate grief work?

A

Help them express their feelings

Recall memories

Find meaning in their lives

Speak truth about losing function

39
Q

How does the nurse manage pain in impending death?

A 
Assess
Minimize irritants
Administer meds around the clock
Provide CAMs
Evaluate effectiveness
Do not delay pain relief
40
Q

How does the nurse manage dyspnea in impending death?

A 
Assess
Elevate HOB
Use fan or AC
Administer O2 as needed
Suction PRN to remove accumulation of mucus
41
Q

How does the nurse manage bowel patterns in impending death?

A 
Assess function
Assess fecal impactions
Encourage movement
Encourage fiber
Encourage fluids
Use suppositories
Stool softeners
Laxatives or enemas if ordered
42
Q

How does the nurse manage anorexia in impending death?

A 
Assess complaints and causes
Have family provide favorite foods
Discuss modifications to drug regimen with HCP
Provide antiemetics before meals
Offer culturally appropriate foods
Provide frequent mouth care
43
Q

What is involved in post-mortem care?

A 
Be respectful (dignity)
Follow state laws
Keep family  involved
Close eyes
Remove tubes (unless autopsy indicates)
labeling
44
Q

How do we care for ourselves while we care for those who are dying or grieving?

A

Confront own feelings of mortality
Experience feelings of grief and loss
Talk with colleagues

Test #3 Nursing (3 decks)

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