Death and Dying Flashcards
What is a large reason that palliative care is initiated late?
Pain is not assessed early on/frequently enough
How is hospice delivered?
interprofessional manner with a holistic approach
What is included in the five wishes?
The person I want to make care decisions for me when I can’t
The kind of medical treatment I want or don’t want
How comfortable I want to be
How I want people to treat me
What I want my loved ones to know
What are examples of tier 1 symptom management?
Mind-body therapies
Nutritional therapies
Natural products
Supplements
Integrative nursing therapies
What are examples of tier 2 symptom management?
movement therapies
nutritional therapies
natural products and herbs
What are examples of tier 3 symptom management?
mind-body therapies
energy therapies
health coaching
manipulative therapies
What is tier 4 symptom management?
whole systems
What is tier 5 symptom management?
pharmacological therapies
psychotherapy/behavioral therapy
Other invasive therapies
What medications can be given for bladder spasms?
oxybutynin
prostaglandins
Which medications can be used to treat rectal spams?
diltiazem
clonidine
benzos
Which medications can be given to treat colicky pain due to bowel obstruction?
scopalamine
octrotide
What are bisphophonates used for?
inhibit osteoclastic activity
What occurs with circulatory depression secondary to opioid use?
orthostatic hypotension d/t dilating action of opioids on peripheral vascular system
Why does urinary retention occur with opioid use?
increased smooth muscle tone of detruser muscle of bladder
Why do cutaneous effects, such as pruritus, flushing, and sweating occur with opioid use?
histamine release d/t opioids
Why does respiratory depression occur with opioid use?
Decreased sensitivity of respiratory center to CO2 (< 8bpm)
Why does dyspnea occur at the EOL?
Narrowing of airways d/t bronchial constriction from swelling, tumor invasion or decreased alveolar function d/t fluid retention, tumor invasion
What are examples of non-pharm treatments for pruritis?
Keep room humidity @ 30 – 40%
Cool room temperature
Fans/ moving air
Cotton & loose fitting clothing
Hypoallergenic soap
Avoid alcohol & spicy foods
Hydration (3000ml/ day)
Keep skin lubricated
What are factors that may cause delirium at the EOL?
Medications (opioids, benzodiazepines)
Hypoxia
Dehydration
Metabolic (hypercalcemia, hyponatremia)
Sepsis
Polypharmacy
Intracranial pressure
What are the neuro indicators of imminent death?
decreased verbal response, agitation, restlessness
What are the cardiac indicators of imminent death?
increased/ irregular HR, decreased BP, widening pulse pressure, dehydration
What are the pulmonary indicators of imminent death?
increased RR, dyspnea, increased use accessory muscles, Cheyne-Stokes respirations, noisy breathing
What does CARES stand for on the EOL cares tool?
C = Comfort
A = Airway
R = Restlessness and delirium
E = Emotional and spiritual care
S = Self care for care providers
