Death & Dying Flashcards
What are the five goals of palliation?
- Irretractable nausea and vomiting
- Affirm life; neither hasten nor postpone life
- Regard dying as a normal process
- Offer support to patients to live as actively as possible until death
- Offer support to family
What is the share/care model?
All interdisciplinary teams work together to provide excellent care
Define end of life care
Care given in the last months, weeks, and days of life
What is the overall statement for all Canadians at end of life?
Canadians should be able to die with dignity, free of pain, and in a location of their choice
What five basic things do all patients and families need at end of life care?
- Trust in treating physicians
- Advanced level of care choices
- Effective communication
- Continuity of care
- Provide death with dignity
Provide the definition of death
Permanent loss of function that cannot resume spontaneously and will not be restored through intervention
What are the six signs that need to be present to pronounce/verify death?
- Absence of a palpable pulse (feel for one min)
- Absence of breath sounds
- Absence of heart sounds
- Absence of respiratory effort
- Absence of BP
- Individual is unresponsive (pupils are fixed w/ no reaction)
What are Cheyne-Stokes?
Respirations are an irregular pattern of breathing characterized by alternating periods of apnea and deep breathing - common in end of life
Why are breath sounds wet and noisy at end of life?
This is due to terminal secretions that are caused by mouth breathing and cannot be cleared through coughing or repositioning
What is the difference between grief and bereavement?
Grief - reaction to loss
Bereavement - a state of loss; the period after the death if a loved one during which grief and mourning occurs; its duration is dependent on a variety of factors
What is grief work? What is it replacing?
There is a large shift from the 5 stages of grief to the concept of grief work now, which focuses on grief/loss being a constant in our life but how we adapt and accept it
What is adaptive grief?
Grief that helps the person accept the reality of death; a healthy response
If no order/advanced care plan, you always proceed with an ___ response
R1 - full resuscitation
What is palliative sedation? Does it differ from MAID?
The patient is hooked up to a continuous infusion of midazolam – titrate the dose until the patient is in an unconscious state and they stay in this state until they pass
It is different than MAID
What is the principle of double effect?
Justifies the use of medications that cause sedation as an adverse effect (an unintended harm) as its primary role is to relieve suffering and is not intended to hasten death
Are tissues and organs automatically donated, unless the family objects?
Yes
What is a deceased donor? What can they donate?
Death has occurred, not as many organs are recoverable
Typically only tissue - bones, muscle, eyes, skin, valves
What is a living donor? What can they donate?
A donor who is alive
Typically kidney donation
Who can pronounce an expected vs an unexpected death? What action do they require?
Expected - an RN can pronounce death; must listen to apical heart sounds for one minute
Unexpected - physician
What is and who signs the certification of death? What colour ink does it require?
Legal medical document signed on the unit by MRHCP (most responsible health care provider – i.e., physician)
Black ink
