Comfort, end of life care Flashcards
Primary purpose of End of life care
prolong life or to improve quality of life (QOL).
what is more important prolonging life or preserving QOL
Preserving QOL
Nurses role in end of life
Family and patient support/teaching
Medication administration
Assessing for death (heart auscultation)
Notifying the next of kin (NOK)
Coordination with the funeral home
Preparing the body (you will never do this alone!)
Assessing for organ donation
Etiology
he cause, set of causes, or manner of causation of a disease or condition.
Social death
occurs when others begin to withdraw from someone who is terminally ill or has been diagnosed with a terminal illness.
Psychic death
occurs when the dying person begins to accept death and to withdraw from others and regress into the self.
Brain death
is the irreversible cessation of all cerebral and brainstem functions, including the ability of the brain stem to regulate vegetative and respiratory activities
Autonomy
Patients have the right to self-determination, including the right to stop or withhold lifesaving care.
Patients also have the right to a dignified death.
Beneficence
The obligation to “do good” for the patient, including minimizing suffering
Nonmaleficence:
The obligation to do no harm
This may come into conflict with the other principles (autonomy and beneficence) during end-of-life care, which generally take precedence over nonmaleficence.
Many situations offer no truly “good” options.
What id the dying patient wishes to stop nutrition
We listen to them
Inadequate hydration may do what to a dying patient
should be tailored to the individual case
a living will allows the patient to
document wishes at the end of life. Goes into effect when 2 physicians certify the patient is unable to make decision. Patient is terminally ill or in a permanent state of unconsciousness
Medical per of attorney is
known as a healthcare proxy. Allows the patient to appoint someone to make medical decisions for the patient. Goes in effect when a physician concludes that the patient is unable to make sure their own decisions
“I feel bad. We are starving him!”
The digestive and respiratory systems begin to shut down during the gradual process of dying.A dying person no longer wants to eat as digestion slows and the digestive track loses moisture and chewing, swallowing, and elimination become painful processes.
“Why is she so cold?”
Circulation slows and mottling or the pooling of blood may be noticeable on the underside of the body appearing much like bruising.
“It sounds like he is drowning!”
Breathing becomes more sporadic and shallow and may make a rattling sound (“death rattle”) as air travels through mucus filled passageways
“Should I be talking to her?”
The person often sleeps more and more and may talk less although continues to hear.
“They passed away but they groaned!”
When air and gases left in a corpse start to escape through the throat and nose, they could make the vocal cords vibrate, resulting in a noise that sounds like a groan
Birth - 2 understanding of death
no understanding sensitive to loss and serperation
age 3-5 understanding on death
death is reversible thought include magical thinking
age 6-9understanding of death
understand the concrete finality. difficult receiving their own death may be peroccupues with medical or physical aspects of dying
age 10-12 understanding of death
understand that death is final and eventually affects everyone thinks about how death will effect you personally
Adolescents
views death on an adult level. understands that their own death is inevitable but is a difficult concept to perceive able to think about the spiritual and religious aspects
Kubler ross stage of grief
denial anger bargaining depression acceptance
denial
defence mechanism and is temporary reaction. Denial, or disbelief or shock, protects us by allowing such news to enter slowly and to give us time to come to grips with what is taking place. The person who receives positive test results for life-threatening conditions may question the results, seek second opinions, or may simply feel a sense of disbelief psychologically even though they know that the results are true.
Anger
direction toward people friends family healthcare workers situation It is much easier to be angry than to be sad or in pain or depressed. It helps us to temporarily believe that we have a sense of control over our future and to feel that we have at least expressed our rage about how unfair life can be.
Bargaining
person is trying to regain control “if only”involves trying to think of what could be done to turn the situation around
Depression
sadness, regret, and worry. This depression makes others feel very uncomfortable and family members may try to console their loved one
acceptance
not everyone will reach this Acceptance involves learning how to carry on and to incorporate this aspect of the life span into daily existence. Reaching acceptance does not in any way imply that people who are dying are happy about it or content with it. It means that they are facing it and continuing to make arrangements and to say what they wish to say to others. Some terminally ill people find that they live life more fully than ever before after they come to this stage.
perceived loss
defined by the individual experiencing the loss (friendship, independence, freedom)
Maturational loss
necessary loss occurring across a life span
Situational loss
sudden and unpredictable loss (vision, amputation)
Bereavement
refers to outward expressions of grief
anticipatory greif
occurs before impending loss. this is the process of letting go
complicated grief
intense long lasting grief the person is unable to move forward
Disfranchised greif
the heart is grieving the person us unable to talk about loss or pain
Actual loss
the loss of ones senses loss go an actual person pet or role
perceived loss
loss is real to the person but may not be seen by others
maturational loss
occurs with natural stages of living (child goes to school)
Situational loss
sudden unoredictable life events such as fire
Palliative care focuses on
providing comfort and relief from physical and emotional pain to patients throughout their illness
Therapeutic goal in palliative care
Alleviating refractory or intractable symptoms such as pain, dyspnea, or delirium in terminally ill patients (as opposed to terminating their life)
Palliative sedation
Benzodiazepines – decrease anxiety
Antipsychotics – decrease confusion
Opioid analgesics – decrease pain
Brain Death
A complete and permanent loss” of brain function.
Unresponsive coma with loss of capacity for consciousness.
Loss of brainstem reflexes.
Inability to breathe unassisted.
Loss of function unable to resume spontaneously and unable to be restored through intervention
Postmortem Care
Postmortem care is a component of EOL care and is the care given to a deceased client. Nurses and unlicensed assistive personnel (UAPs) perform most postmortem care until the deceased client is transferred to funeral provider.
what is the nurse responsible for when caring for a client after death
Coordination of organ and tissue donation
Coordination with the funeral home
The family and viewing
Postmortem care supplies
bathing, cotton balls, clean sheets, short kit, absorbent pad, bag for the clients belonging
what is an important aspect of end of life care
religious beliefs and traditions
what is a way to help pain without meds
a massage using the palm of your hand is a circular motion
When was MAID made legal
Feb 6 2015
MAID eligibility
request voluntarily, 18 older, capacity to make decisions, must provide informed consent, diagnosed with serious and incurable illness, advanced decline, enduring physical suffering
MAID natural death is reasonabley foreseable
-must make a written request with witness
-2 practitioners must confirm eligibility
-person must be informed they can withdraw
-Immediatly before it happens they must be offered to stop
MAID natural death is not foreseable in the future
-must make a written request with witness
-2 practitioners must confirm eligibility
-person must be informed they can withdraw
-Immediatly before it happens they must be offered to stop
-Minimum 90 days
-must inform mental health professional
-both practitioners discussed
do RNs need to be involved in MAID
Not if they wish not to
can an RN administer substance for MAID
no
