Chronic End of Life Flashcards

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
What is higher brain death?
Irreversible cessation of all "higher" brain functions such as cognitive functioning, consciousness, memory, reasoning, etc.
26
Stages of dying and grief
``` Denial Anger Bargaining Depression Acceptance ```
27
What are goals of palliative care?
Focus on reducing the severity of the disease and improve quality of life Relief of symptoms Regard dying as a normal process
28
What is the difference between palliative care and hospice care
Palliative allows the person to simultaneously receive curative and palliative treatments Hospice - not allowed to receive curative treatments
29
What must a patient have before going on hospice?
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
What are advanced directives?
Written documents that provide information about a patient's wishes and his/her designated spokesperson
31
What does it mean when your patient is DNR/DNI
Do not resuscitate, do not intubate
32
What is a durable power of attorney?
Listing person(s) allowed to make financial and health care decisions when the patient is unable to.
33
What is a living will?
Give instructions regarding future care - must identify special treatments a person wants or doesn't want at end of life.
34
Assessment of a hospice patient
No longer focus on ABC Focus on comfort Pain medication when feeling pain
35
Physical manifestations of impending death
``` 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
Psychosocial manifestations at end of life
``` 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
4 specific fears associated with dying
- fear of pain - fear of shortness of breath - fear of loneliness and abandonment - fear of meaninglessness
38
How can nurses facilitate grief work?
Help them express their feelings Recall memories Find meaning in their lives Speak truth about losing function
39
How does the nurse manage pain in impending death?
``` Assess Minimize irritants Administer meds around the clock Provide CAMs Evaluate effectiveness Do not delay pain relief ```
40
How does the nurse manage dyspnea in impending death?
``` Assess Elevate HOB Use fan or AC Administer O2 as needed Suction PRN to remove accumulation of mucus ```
41
How does the nurse manage bowel patterns in impending death?
``` Assess function Assess fecal impactions Encourage movement Encourage fiber Encourage fluids Use suppositories Stool softeners Laxatives or enemas if ordered ```
42
How does the nurse manage anorexia in impending death?
``` 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
What is involved in post-mortem care?
``` Be respectful (dignity) Follow state laws Keep family involved Close eyes Remove tubes (unless autopsy indicates) labeling ```
44
How do we care for ourselves while we care for those who are dying or grieving?
Confront own feelings of mortality Experience feelings of grief and loss Talk with colleagues