Death and Dying & Pt Education

Question 1

What are the 5 stages of Kubler Ross stages of grief ?

Answer 1

• denial
• anger
• bargaining
• depression
• acceptance

Question 2

What is denial ?

Answer 2

cannot accept the fact of the loss
- form of protection from loss they cannot yet bear

Question 3

What is anger ?

Answer 3

expresses resistance or anger at God, other people, the situation

Question 4

What is bargaining ?

Answer 4

postpones awareness of the loss by trying to prevent it from happening

Question 5

What is depression ?

Answer 5

realizes the full impact of the loss

Question 6

What is acceptance ?

Answer 6

incorporates the loss into their life

Question 7

What is palliative care ?

Answer 7

pt experiencing severe medical illness particularly for pt’s approaching end of life
- can receive palliative care with also curative treatments

Question 8

What is the goal of palliative care?

Answer 8

help pt’s and families achieve best possible quality of life

Question 9

What is the focus of hospice care ?

Answer 9

providing comfort, dignity, and personal growth

Question 10

What is hospice care ?

Answer 10

for pt’s that usually have less than 6 months to live
- available in home, hospital, extended care, or nursing home settings

Question 11

How does hospice care involve the family towards the end of life of the patient ?

Answer 11

the hospice team provides intensive support to the pt and family

Question 12

What is something you need to be eligible for hospice care ?

Answer 12

for home hospice services
- pt must have family caregiver to provide care when patient is no longer able to function alone
- to help for hygienic needs
- RN coordinates and manages symptoms relief

Question 13

What are some pain relief measures for the skin ?

Answer 13

• provide skin care
• apply lotion to skin
• dry clean linens

Question 14

What are some pain relief measures for the mucous membrane discomfort ?

Answer 14

• provide oral care (include tongue) q 2-4 hrs
• apply lip balm
• apply topical analgesics to oral lesions
• cause: mouth breathing or dehydration leads to dry MM, tongue or lips become dry or chapped

Question 15

What are some pain relief measures for corneal irritation ?

Answer 15

• apply artificial tears to reduce corneal drying
• cause: blinking reflexes diminish near death which cause drying of the cornea

Question 16

What are some pain relief measures for altered LOC ?

Answer 16

• keep calm, comfortable, safe
• don’t try to reorient to space since it can only confuse them further

Question 17

What are some pain relief measures for nausea ?

Answer 17

• give antiemetics
• discontinue med or food that cause nausea
• provide oral care q2-4 hrs
• offer clear liquid diet and ice chips
• avoid acid foods
• cause: decreased intestinal blood flow with impending death, meds, or pain

Question 18

What are some pain relief measures for constipation ?

Answer 18

• use stimulant laxative with opioids
• dietary alterations as preferred
• increase fluid intake
• cause: opioids, meds, and immobility slow peristalsis

Question 19

What are some pain relief measures for diarrhea ?

Answer 19

• assess for fecal impaction
• confer with HCP to change meds
• protect skin with moisture barrier

Question 20

What are some pain relief measures for altered perfusion ?

Answer 20

• keep comfy temp
• normally do not check VS very often
• cause: coolness and color changes in extremities, nose, fingers

Question 21

What are some pain relief measures for ineffective breathing patterns (dyspnea, SOB) ?

Answer 21

• position for comfort
• provide O2
• use fan for air movement
• cause: anxiety, pain, increased O2 demand, disease process, anemia

Question 22

What are some pain relief measures for noisy breathing “death rattle” ?

Answer 22

• HOB up
• turn from side to side
• stop PO intake
• avoid suctioning because of discomfort and ineffectiveness
• anticholinergics meds can be useful

Question 23

What is the cause of noisy breathing “death rattle” ?

Answer 23

sound of secretions moving in the airway during inspiratory and expiratory phases caused by thick secretions, decreased muscle tone, swallow and cough

Question 24

What are some pain relief measures for dehydration ?

Answer 24

• give mouth care q2-4 hrs
• keep lips and tongue moist
• cause: pt less willing to maintain PO intake

Question 25

What are Cheyne Stokes respirations ?

Answer 25

irregular respiratory rate
- fluctuations in several quick breaths to periods of apnea

Question 26

What should the priority be with patient that are experiencing hallucations ?

Answer 26

reorientation at this time is little benefit if they are actively dying
- focus should be on pt safety, and preventing pt injury

Question 27

What are guidelines for body after death ?

Answer 27

• elevate HOB (prevent discoloration of face)
• ask family if they want to participate in any special requests
• remove all equipment, tubes, indwelling lines (unless autopsy)
• cleanse body
• cover with clean sheet, head on pillow, close eyes, leave dentures in, cover signs of trauma

Question 28

What are the 6 stages of cognitive learning ?

Answer 28

• knowledge
• comprehension
• application
• analysis
• synthesis
• evaluation

Question 29

What is cognitive learning ?

Answer 29

thinking domain

Question 30

What is affective domain ?

Answer 30

based on emotions and involves the pt’s feelings
- pt evaluate their values, beliefs, and attitudes to process educational material

Question 31

What is psychomotor domain ?

Answer 31

use of fine and gross motor skills in learning
- stoma care

Question 32

What are examples of cognitive teaching strategies ?

Answer 32

• lecture
• question and answer
• discussion

Question 33

What are some examples of affective teaching strategies ?

Answer 33

• discussion
• role play

Question 34

What are some examples of psychomotor teaching strategies ?

Answer 34

• demonstration
• return demonstration
• games

Question 35

What are the steps of the nursing process ?

Answer 35

1. assessment
2. diagnosis/pt problem
3. planning
4. implementation
5. evaluation