Cognition, dementia, end-of-life care, and death & dying Flashcards

Question

What are some of the manifestations of geriatric failure to thrive?

Answer 1

Manifestations include weight loss, decreased appetite, poor nutrition, inactivity Frequently accompanied by dehydration, depression, impaired immune function, low cholesterol levels

Answer 2

The idea: a dying person is free from discomfort, in the presence of loved ones, and in the environment of their choice1

Answer 3

An approach that improves the quality of life of patients & their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering

Answer 4

patients with life-threatening illness who are not imminently dying, but in physical decline who need holistic, multi-disciplinary support services

Answer 5

Covered by Medicare hospice benefit, but can also be covered by Medicaid, other insurance, or private pay Must meet certain criteria Physician determined prognosis of <6 months, from hospice physician and patient’s PCP Acknowledgement that they no longer seek curative measures Patient’s can revoke if they wish to seek curative measures PT is covered by Medicare Hospice Benefit

Answer 6

Patient revoked hospice Patient transferred to different provider Patient no longer terminally ill per MD Patient moved out of service area

Answer 7

Pain management Rehabilitation in reverse: Optimize patient’s remaining function with safe and energy-efficient mobility, through education of patient and family/caregivers Enhance quality of life for remaining time

Answer 8

Documented desires of medical management Legal document

Answer 9

Identifies the patient’s requests for healthcare decisions in the event of serious illness Can be very specific

Answer 10

Appointment of a trusted person 18+ years old to make decisions on the patient’s behalf when they are no longer able to do so themselves Can be granted for decisions related to financial matters, mental healthcare, or general healthcare Notarization may be required in some states If not “durable,” the document can be seen as void if the grantor becomes incompetent

Answer 11

Advanced directive Competent adult identifies their requests for healthcare decisions in the event of serious illness Can be very specific Must be accompanied by durable POA to be respected by physicia

Answer 12

Typically completed when a person is terminally ill or facing the possibility of imminent death Enables a person to explicitly identify the extent & nature of life-sustaining interventions, which range from comfort care only to hospitalization and full resuscitation Can be very specific Ex: No compressions, OK to intubate

Answer 13

Clearly specifies the patient’s refusal for cardiac resuscitation DNR

Answer 14

Confusion, delirium, disorientation, increased time spent sleeping, anxiety, restlessness, hallucinations (visual & verbal) Weakness, loss of function, fatigue Drop in BP, HR variability, breathing variability Cold, clammy skin; distal extremities may be bluish, edema Loss of interest in food/fluids, GI disturbance, incontinence, decreased urine output as death nears

Answer 15

Denial: common defense mechanism; rejection Anger: expressed as patients concede the reality of a terminal illness; may project as blaming others Bargaining: patient seeking control over their illness Depression: sadness; fatigue Acceptance: recognizing the reality of the diagnosis while no longer struggling against it

Answer 16

You must be sensitive and aware of cultural norms and desires of the patient/client Patients or family members may want traditional healers present Some cultures do not wish for the patient to be aware of the prognosis This can present challenges of ethical conflicts between a well-intentioned healthcare provider who is worried about the patient’s autonomy and a relative’s right to care for a loved one in a cultural or traditionally appropriate manner Culture, religion, and spirituality tend to have increased influences on end-of-life care, including physical therapy It is essential that healthcare providers meet the spiritual needs of patients and family members receiving hospice care, even if their spiritual or religious beliefs/traditions differ from one’s own

Answer 17

Allows mentally competent patients with a terminally-ill condition to request and receive a prescription medication to hasten their imminent and inevitable death Also called “death with dignity” laws Allowed in some states Controversial and ethically-complex issue Not legal in Louisiana