Death n dying Flashcards
Which one requires prognosis, hospice or palliative care?
Hospice
- specialized subtype of pallitative care
- improve QOL, more end of life (last months)
NOT palliative care
Palliative care
specialized medical care for people w/ serious illnesses
- goal: improve QOL 4 pt and family
Palliative care fills in the GAPS
- what does it mean
Goals of care
Adv directives
Psycho-social spiritual
support
Sx control
How many doctors can recognize dying
50%
How long does the active dying process usually take?
hours - days
Changes during dying process
- Muscle relaxation
- eyes, mouth - Bedbound from weakness and fatigue
- Changes in skin color and Temp
- Loss of bowel sounds
- Cardio, Neuro, Resp.
Changes most apparent to family when loved one dying? 2nd + 3rd?
1. Breathing!!
- Altered lvl of consciousness
- Decreased appetite/ fluid intake
How can anorexia be protective during dying?
Lack of intake = ketosis state = endorphins release
*pts are not starving
Is there evidence that artificial nutrition/hydration improves quality of life or prolongs life?
no
- artificial fluids may be harmful –>
fluid overload, edema, dyspnea, secretions
- parenteral fluids will NOT reverse
Neurologic changes of dying
- Loss of ability to swallow
- Loss of sphincter control
- Decreased level of consciousness
- Terminal delerium (not reversible)
- agitation
- hallicinations
- restlessness
- moaning/groaning
Pharmacologic Mx of terminal delirium
Neuroleptics
- Haloperidol
- Chlorpromazine
How many pts have moderate-severe pain in last few days of life?
> 50%
- warrants trying opioids
- most pts are undertreated
Death rattle aka
Amphoric Breath Sounds
Due to build up of saliva/mucous (fluid overload) - suctioning does not work bc fluid is deeper in airways, not mouth - DO NOT ADD OXYGEN Wet sounding noise
Tx for SOB/Dyspnea
Opioids first line
- can also help with pain
