Chronic End of Life Flashcards
What is loss?
Experience loss daily
Unexpected change
Whenever there is change, there is loss
Actual loss
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.
Perceived loss
Identified only by the person experiencing it.
More internal, self-concept, autonomyhfhcjxovrrjeufhffjfigjgjghigogigigig
What is the best way to treat a person regarding loss?
What do they perceive as the biggest loss?
Physical loss
injuries (amputation)
removal of an organ
loss of function (mobility)
Psychological loss
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
External loss
Actual losses of objects that are important due to cost or sentimental value
ex. jewelry, pet, home
Internal loss
Another term for perceived or psychological loss
Loss of aspects of self
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
Environmental loss
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
Loss of significant relationships
Includes (not limited to) actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation
Grief
Requires energy
Can interfere with health and delay healing
Essential to psychological healing after a loss
What factors affect grief?
Significance of loss Amount of support Conflicts already existing Circumstances of loss Previous loss Spiritual/cultural beliefs and practices Timeliness of death
How infants and toddlers react to death
- 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
How preschool children react to death
- 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)
How school-age children react to death
- 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
How adolescents react to death
- most difficult in coping
- Least likely to accept cessation of life
- Death is associated with old age
How young adults react to death
Look at life situation:
children?
taking care of other people?
What is uncomplicated grief?
Normal grief.
Natural response to loss
Emotions are intense but gradually diminish over time
(several months to several years)
What is complicated grief
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
What is delayed grief?
Grief that is put off until a later time
Suppress it
Concern for delayed grief
Support is there after a death, person may experience grief after support has left
Anticipatory grief
Experienced before loss occurs.
Those caring for someone with a long illness may grieve along the process.
Definition of death
The ultimate loss
The irreversible cessation of all functions of the brain, including the brain stem.
What is higher brain death?
Irreversible cessation of all “higher” brain functions such as cognitive functioning, consciousness, memory, reasoning, etc.
Stages of dying and grief
Denial Anger Bargaining Depression Acceptance
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
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
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
What are advanced directives?
Written documents that provide information about a patient’s wishes and his/her designated spokesperson
What does it mean when your patient is DNR/DNI
Do not resuscitate, do not intubate
What is a durable power of attorney?
Listing person(s) allowed to make financial and health care decisions when the patient is unable to.
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.
Assessment of a hospice patient
No longer focus on ABC
Focus on comfort
Pain medication when feeling pain
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
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
4 specific fears associated with dying
- fear of pain
- fear of shortness of breath
- fear of loneliness and abandonment
- fear of meaninglessness
How can nurses facilitate grief work?
Help them express their feelings
Recall memories
Find meaning in their lives
Speak truth about losing function
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
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
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
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
What is involved in post-mortem care?
Be respectful (dignity) Follow state laws Keep family involved Close eyes Remove tubes (unless autopsy indicates) labeling
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
