EF - End of Life Care Flashcards
1
Q
• end-of-life care,
• aims to
A
relieve client suffering.
2
Q
palliative care / hospice care:
o Both support
A
o improvement of quality of life
3
Q
Hospice Care
A
• provision of medical / psychosocial care
• support clients - terminal illness
4
Q
Hospice Care
• allow them to live last days of life HOW
A
best they can,
long as they can.
5
Q
hospice care provided when
A
treatment - no longer cure / control illness;
6
Q
focus – Hospice Care
A
o providing comfort,
o dignity,
o personal growth as client faces death
7
Q
Originally hospice care - offered clients diagnosed w/ ___________ONLY
A
TERMINAL CANCER
o has grown - to include clients w/ life-limiting illnesses.
8
Q
When enroll in hospice care - asked to select
A
primary caregiver
o usually family member / close friend
9
Q
Hospice Care USUALLY PROVIDED WHERE
A
client’s /family members home
o may also be delivered in other settings, such as a
hospital
extended-care facility
inpatient hospice centers
10
Q
Hospice Care - ADMISSION CRITERIA
A
primary care provider - diagnosis life expectancy < 6 months
11
Q
· Centers for Medicare & Medicaid Services developed specific criteria
A
hospice provider / primary care provider - officially state client terminally ill
client must agree to palliative care as opposed to curing illness
client required to sign statement - choosing hospice care in place of other benefits to treat their illness.
12
Q
· Palliative care - focuses on
A
o relief / prevention of suffering /
o improving quality of life - clients / their families/caregivers.
13
Q
· If client lives beyond 6-months
A
o approved hospice provider - need to recertify client is terminally ill
14
Q
client can stop hospice services
A
at any time
o if their condition improves
o illness goes into remission
15
Q
· Other considerations client / family should considering when enrolling in hospice care
A
o client’s readiness to discontinue treatments aimed at prolonging life
o client’s rate of deterioration despite medical treatment received.
16
Q
• A nurse is admitting a client into hospice care. What is the admission criterion for the length of life expectancy of a client who is admitted into hospice care?
A
o Six months or less.
o client meeting specific criteria, includes a life expectancy < 6 months.
17
Q
Modern hospice care - provided by interdisciplinary team, consisting of
A
o providers,
o nurses,
o assistive personnel,
o social workers,
o spiritual leaders,
o other health care professional services necessary to meet client needs.
18
Q
interdisciplinary team approach - allows for
A
o holistic care of whole person,
o considering client’s mental, social, physical, spiritual considerations w/in dying experience.
o team focuses on –
significance of quality of life rather than
not delaying dying process.
19
Q
· Hospice care - volunteers provide respite care support TO
INCLUDE HELP WITH
A
o family/caregivers,
o including help w/
running errands,
housekeeping,
transportation,
childcare assistance, and
visitation.
20
Q
Other HOSPICE services - include complementary medicine
A
o aromatherapy
o Therapeutic Touch
21
Q
expertise in managing pain / other manifestations - required to
A
serve purpose of hospice care.
22
Q
· acute awareness of intrapersonal / interpersonal undercurrents also necessary DUE TO
A
lot of family shit happening
23
Q
• Hospice care provides supportive services - up to_________following death of the client FOR WHO
A
o For those individuals identified as family and in primary caregiver role.
24
Q
hospice care – holistic - treats whole person including
A
caregivers / family members.
25
client’s family / friends typically serve as
caregivers
o play vital role w/ health care team.
26
• hospice nurse - essential role in education / support of family caregivers.
o assist family caregivers in
meeting client’s daily care needs
administration of medications
help w/ ADL’s.
27
• hospice nurse
o Assist family / caregivers understand
what to anticipate as client’s condition deteriorates,
how to meet changing needs of loved one
what can do - keep client comfortable as client’s condition worsens
28
· hospice nurse - become someone w/ whom caregivers confide regarding
o fears,
o anxiety,
o doubts in caring for client.
o Awareness of caregivers’ possible feelings - doubt / fear
assist nurse in providing care.
29
Nurse - team member - most
direct contact w/ client
o nurse shares information w/ other team members
enabling them - adapt plan of care as needed.
30
• Respite care - provides
brief break for primary caregivers,
o can last - hours, days, weeks.
o Caregivers can request loved one admitted - professional care facility
maximum 5 days.
o provides caregivers opportunity to rest
o knowing loved one cared for by hospice-trained professionals.
31
HOSPICE CARE - nurse in collaboration w/ other team members
o changes care plan to meet specific needs of WHO ELSE BESIDE CLIENT
caregivers
32
• As a nurse caring for a client who is receiving hospice care, what are some interventions you can use in supporting the family and caregivers?
assisting w/ medication administration
activities of daily living,
educating family - what to expect as client’s condition deteriorates
how to meet changing needs of loved one,
explaining to family / caregivers - not unusual - feelings of doubt / fear,
providing emotional support to family/caregivers.
33
Palliative Care
• holistic care provided for clients throughout lifespan - experiencing severe medical illness,
• particularly for clients approaching end of life.
• initially concentrated on lessening client’s distress at end of life.
34
Today - best practice dictates - palliative care be implemented WHEN
earlier in course of life-threatening health events.
35
In past, palliative care - generally provided - ___________
Now provided to ____________
clients w/ cancer diagnosis,
o now offered - clients suffering w/ any life-threatening health event / chronic illness.
36
• Goal - palliative care
· improve quality of life for client / family / caregivers.
37
· Ex’s diseases - palliative care may be appropriate
o advanced stages of cancer,
o refractory cardiac disease (heart failure),
o renal or respiratory failure,
o neurodegenerative conditions
Alzheimer’s disease / Parkinson’s disease.
38
· Palliative care - been shown to
o improve client’s quality of life,
o reduce time in hospital
o improve client satisfaction.
39
· Palliative care differs from hospice care
o palliative care - provided while client still receiving curative treatments.
o palliative care not subject to time constraints.
o Palliative care services may be suitable / provided long before client identified w/ terminal illness.
o Any client w/ life-limiting disease, regardless of projected life expectancy / prognosis - eligible to palliative care.
40
key aspect - palliative care -
holistic approach—caring for client as whole person,
o treating both physical / psychosocial needs.
41
palliative care uses what kind of team approach
interprofessional team approach
o providers,
o nurses,
o other associated health care personnel
o to meet client’s needs.
42
terminal phase of client’s life - referred to as
“actively dying” or “imminent death”.
43
Physiological Changes - when 'actively dying' AKA 'imminent death'
Breathing and Respirations
• dyspnea - shortness of breath
o “death rattle” - retention of secretions in respiratory tract
• Cheyne-Stokes respirations - irregular respiratory rate fluctuating between several quick breaths and periods of apnea.
44
• Dyspnea may be related to
o advanced-stage cancer,
o ascites,
o chronic obstructive respiratory disease - a physical decline in respiratory functioning, CONFIRM
o pneumonia.
45
dyspnea
DIFFICULT OR LABORED BREATHING
46
WHAT IS FIRST MED CHOICE TO TREAT DYSPNEA
WHY?
• Opioids, - morphine,
o increase peripheral vasodilation (widening of the blood vessels),
o permits increased blood flow),
o reduce client’s sense of breathing difficulty,
o decrease anxiety.
47
Oxygen therapy PROVIDES WHAT BENEFIT
relieve dyspnea / provides psychological comfort to client’s family
48
· death imminent, comfort measures INCLUDE
o positioning,
o using fan - facilitate movement of air,
o reducing exertion
o relaxation techniques should be focus.
49
• Anxiolytics such as __________
o relieve
benzodiazepines
50
• Death rattle –
o caused by
accumulation of secretions in lungs / throat,
o causing congestion
o “rattling” sound as secretions become trapped - client unable to clear secretions.
51
IS DEATH RATTLE INDICATION OF CLIENT DISCOMFORT
o not an indication of client discomfort.
o is indication of approaching death, often w/in hours / days.
o can upset family members / caregivers,
52
WHAT POSITIONING TECHNIQUE CAN HELP RELIEVE DEATH RATTLE
o Turning client’s head to side or rolling client to side - can assist w/ drainage of secretions from throat / lungs.
53
WHAT MEDS CAN HELP DRY UP SECRETIONS CAUSING DEATH RATTLE
oral atropine drops or scopolamine patches
54
WHAT INTERVENTIONS CAN BE DONE TO DRY UP SECRETIONS - DEATH RATTLE
o moist washcloth / oral suctioning - used to eliminate secretions from mouth.
55
WILL DEEP SUCTIONING DRY UP SECRETIONS - DEATH RATTLE
NO - ineffective removing accumulated secretions pooled in lungs.
56
Cheyne-Stokes respirations
visible changes in client’s pattern of breathing
o typically occurs w/in three days of impending death
o client’s rate of respiration becomes irregular
o fluctuating between several quick breaths
o followed by periods of apnea
57
NURSING INTERVENTIONS PROVIDE RELEIF FOR CHEYNE-STOKES RESPIRATIONS
positioning a fan to blow lightly in direction of client.
family should be educated - this type of breathing pattern - typical / expected.
58
· Nurses promote management of pain through means considered
o safe,
o sufficient,
o successful in providing relief
o when client actively dying.
59
Pain - experienced by __________older adult hospice clients w/ cancer.
60%
60
hospice care and palliative care aim
improve end-of-life experience, therefore
o pain management - critical –
61
PAIN MANAGEMENT IS CRITICAL TO ENSURE
ensuring clients receive adequate relief from pain
do not suffer unnecessarily.
62
· Guidelines suggest - combination of approaches - most effective CONTROLLING PAIN AND INCLUDE
o administration of scheduled medications,
o as-needed (PRN) medications, and
o nonpharmacologic interventions.
63
· Clients may experience pain - end of life from
o nerve injury, an
o organ being stretched / compressed, and
o bone pain.
64
not unusual for nurse to hesitate about__________
WHY?
providing pain medication to such clients
o fear of reducing respiratory rate or
o hastening client’s death.
65
• According to American Nurses Association position statement NURSE HAS>>>
o nurse has ethical responsibility to alleviate pain / suffering,
o individualize interventions, and to
o use variety of methods, including interprofessional approaches, to relieve pain.
66
· Pharmacologic treatment - pain includes
nonopioids and opioids.
67
Palliative care guidelines suggest WHAT WHEN ADMINSITERING PAIN MANAGEMENT MEDS
three-step ladder
68
three-step ladder
o nonsteroidal anti-inflammatory drugs (NSAIDs) - nonopioid medications.
o If pain unrelieved / increases in intensity - codeine / tramadol recommended.
o When pain rated as moderate – severe - morphine is prescribed.
69
Nurses - responsible supporting nonpharmacologic interventions - managing pain, INCLUDE
o psychological approaches,
o physical measures,
o integrative therapies,
o interventional techniques.
70
Nurses - responsible supporting nonpharmacologic interventions - managing pain, EXAMPLES OF INTERVENTIONS
o diversion,
o relaxation exercises,
o imagery;
o massage therapy;
o breathing exercises;
o music therapy;
o spiritual practices;
o changes in lighting / noise;
o repositioning;
o heat or cold therapy.
71
As client nears death - nervous system’s ability to regulate
body temperature diminishes,
o causing episodes of both increased / decreased temperature.
72
· Other causes - temperature changes
o infection,
sweating is normal, especially if fever present
o cancer,
cancerous tumor itself - can cause client to have elevated temperature.
o cancer therapy.
Chemotherapy - decreases immune system’s ability to respond to infection,
o can lead to sepsis.
o use of opioids,
o blood transfusion reactions,
o pain,
o hypoxia,
o fear,
o anxiety,
o warm environment
o result in temperature changes.
73
· client’s body temperature can be managed w/
o cold / hot compresses,
o warm sponge baths,
o hypothermia blankets,
o adjusting air conditioning,
o using a fan,
o antipyretic medications,
74
antipyretic medications INCLUDE
acetaminophen, ibuprofen, naproxen, or aspirin.
75
Mottling
expected / ordinary physical change
o occurs hours / days before death.
o upper / lower extremities become cool to touch,
o purple / reddish marbling of skin.
o result of heart’s inability to pump blood effectively,
leading to decreased blood perfusion throughout body.
o often begins in feet and moves up legs.
o indication of impending death.
o client does not feel any discomfort from mottling,
o client but may feel cold.
76
MOTTLINGInterventions
providing warm blankets.
77
Vision and Hearing CHANGES AT END OF LIFE
• Clients may experience hallucinations - sensation something is there when it is not, including
o hearing / seeing those already dead
• can include all senses: hearing, sight, taste, touch, smell (5)
• client may
o hear voices
o see an item / person unseen by others
Ex: client may be seen speaking w/ family member already dead
see places others do not see.
78
When client experiences hallucination - avoid
contradicting what client believes to be true.
o Denying occurrence of hallucinations
cause distress
aggravate client who is actively dying.
79
clients can hear - even if
in deep comatose state,
o talk to them
o provide reassurance—
o can help those who are experiencing hallucinations.
80
ARE Reorientation approaches USEFUL AT COMATOSE STATE OR HALLUCINATIONS
little benefit
• provide support / reassurance, - family may become unsettled when client experiences hallucinations.
81
Interventions aimed at HALLUCINATIONS are to ensure
ensuring client safety / preventing client injury.
82
Providing end of life care - can be
· physically / emotionally demanding
83
preventing / relieving suffering - essential part of medical care for
· dying clients
84
• Increased Temperature
o Manage with
antipyretic medications and warm baths
85
• Mottling
o Purple or reddish marbling of the skin tone
o Managed by
o providing warm blankets
86
• Cheyne-Stokes Respirations
o An irregular breathing pattern with periods of apnea
o Managed by
having a fan blow in the clients direction
providing air movement in some way
see other flash card for other interventions
87
• Hallucinations
o Seeing, hearing, or experiencing something that is not reality
o Manage by
reassurance; avoid denial of the sensations
88
• Death Rattle
o Accumulation of secretions in the lungs and throat
o Manage by
turning the client to their side
89
absence of social contact - leads to
social isolation,
o cause loneliness
o adversely affect health.
90
· Loneliness - emotional condition in which there is perception
o insufficient love,
o closeness,
o social communication w/ others.
91
Social isolation - is
inadequate contact / relationships w/ people.
92
Constant tiredness, pain - influence client’s ability to
socially interact act w/ others.
93
people rely upon social environment -
give meaning to their life,
o separation from family, community, religious / spiritual support system
o can increase client suffering.
94
palliative care services - designed to facilitate
social support - clients whose lives limited by disease.
• provided through home visits, telephone, Internet.
• in-person face-face connections - most beneficial to client,
• other methods of facilitating social support
o social media platforms
o texting to help client actively dying - stay in touch w/ friends/family.
• Members of online support groups
o can validate feelings of isolation
o offer encouragement
o understand what it is like to experience loneliness.
• Volunteers through hospice organization
o can visit w/ clients/family members
o develop enduring relationships for those whose social contacts decreasing near end of life.
95
• support groups - assist family members / caregivers –
o recently lost loved one to
o meet others also experiencing conflict, pain, loss.
96
• Nurse - can assist in prevemting social isolation by
having visitors come at time when client’s pain management / other adverse physical manifestations are controlled,
o should enable client be more comfortable when interacting w/ others.
97
American Nurses Association’s Code of Ethics for Nurses states, ' the nurse practices>>>>
with compassion and respect for the inherent dignity, worth, and unique attributes of every person”.
98
Dignity - regarded everyday necessity essential to
well-being of all clients.
99
Most concerns related to nursing care at end of life - associated w/
o breakdown in communication
o lack of attention / consideration,
diminishes client’s sense of dignity.
100
· Nurses can support clients’ dignity
o managing client manifestations,
pain / respiratory issues;
o advocating independence,
o privacy,
o social assistance;
o providing care w/ an optimistic attitude;
o listening;
o providing correct information;
o demonstrating caring behaviors including empathy.
101
· Other needs to preserve client dignity include
spiritual
everyday concerns
102
spiritual needs to preserve dignity include
client’s need to be acknowledged as a person until they die
client’s need to be told truth about illness.
Spirituality more than religion
it is attempting to be present,
to acknowledge client’s viewpoint sincerely,
provide holistic care - emphasizes dignity before everything else.
103
everyday concerns to preserve dignity include
illness contributes to loss of control,
• lessens sense of dignity.
104
Control refers to
client’s perception / ability to take care of life situations.
• essential to involve clients in decision-making process
• ask for input about how they desire to be cared for
• how they would like to die.
105
Nurses should advocate for client when client
unable to handle matters themselves,
o includes being truthful w/ family members / caregivers.
106
· Spirituality - difficult to define because
universally recognized definition is lacking.
107
“religion” / “spirituality” often used
interchangeably, BUT
o mean different things.
108
Religion - based on
• specific beliefs / values shared w/in a community in worship of higher power.
o For some religion includes spirituality / relationship w/ God / higher power;
for others, it does not.
109
Spirituality speaks to
person’s existence
o centered on significance / purpose of life.
o about relationship w/ others, nature, higher power.
110
· Spiritual happiness - several benefits for clients,
o improved quality of life;
o better handling of illness, diagnosis, manifestations;
o averting depression, hopelessness,
o wish to hasten death.
111
· not uncommon - clients - end of life TO REVISIT >>>>
o revisit faith / spirituality
o make happiness priority while looking forward to peaceful death.
112
Spirituality can offer clients - approach to coping w/
impending death,
• provides hope for life after death.
113
• If clients do not believe in afterlife,
o may experience worldly / horizontal hope,
people / things - offer meaning in assisting person in reaching end-of-life goals.
Ex: clients may hope to be pain-free when die or
to repair damaged relationships before they die. CONFIRM
114
end of life imminent - not unusual - clients change
what they hope for when actively dying.
115
spiritual care - part of nurse’s role - TO ENSURE
delivering holistic, client-centered care.
o nurse must be sensitive to avoid offending client and maintain the client–nurse relationship.
116
Before offering spiritual care - essential to ask clients if
they desire spiritual care.
117
nurse should demonstrate WHAT QUALITIES IN CARING FOR CLIENT / FAMILY
understanding, warmth, compassion
o this approach - improves relationship / communication between nurse /client,
o both of which - critical when providing spiritual care.
118
If clients identify a religious affiliation with their spirituality, it is essential to
· accommodate their religious beliefs.
119
Accommodating religious beliefs includes
· making contact with religious figures and other followers within their religious group.
120
Nonreligious spiritual care should be offered to those clients who
· do not identify religious beliefs with spirituality.
121
• Although nurses can provide spiritual care, in-depth spiritual counseling should be provided by
spiritual leaders.
122
• When a client is actively dying, health care providers, family, and caregivers are instrumental in providing
“good death” for the client.
123
definition of “dying well” is
different for every client, as various factors influence the perception of a “good death”.
124
• Fundamental aspects relate to recurring topics that many clients believe to be essential for a “good death”
o pain management,
o planning for death,
o closure at the end of life,
o clear decision making, and
o contributing to others.
125
Elements that influence clients’ perception of death include
culture, religion, age, life events, illness, and financial concerns
126
Nurses affect lives - dying people –
o applying personal views of what constitutes “good death.”
o Need to recognize own personal beliefs
risk of using them in forming own perception - good / bad death.
127
role of nurse - end of life
provide client-centered care
encompasses client, family, caregivers.
supports client comfort
serve as resource - clients / family members
decisions prior to end of life during in dying process.
128
Managing illness of clients in hospice care - includes integration -
· spiritual services.
129
· Hospice spiritual leaders –
o professionals who provide services - various settings to clients, families, staff.
o offer spiritual care - people - all religions / denominations.
130
· If client - member of religious organization
o spiritual leader - follow end-of-life rituals associated w/ that specific religion.
• Spiritual services include
o spending time listening to client,
o performing religious ceremonies, and
o prayer.
131
· nurse’s role - collaborate w/ other members of hospice care team to
o provide support for client, family, caregivers.
o address spiritual needs of client by
working w/ team to ensure client’s religious / spiritual needs met.
132
Culture - social structure that shapes
client’s views, behavior, preferences.
133
· Quality of care - enhanced when nurse acknowledges client’s
o perspectives, experiences, values.
134
• Nurses knowledgeable about distinctions of culture
o more effective in
managing client’s pain
o assisting family in adjusting to dying process.
135
In some cultures - deemed improper / culturally insensitive to
talk about impending death
o before nurse discusses poor prognosis w/ client / family,
o essential to understand beliefs / culture of individual.
136
culture / religion - significant role in client’s
health care decisions,
o nurses should keep in mind
o they can impact both evaluation / treatment of pain / palliative care.
137
Pain - client’s religious / cultural beliefs
· should guide nurse in pain management.
138
Many cultures - do not agree w/ use of
· opioids,
139
several myths associated w/ use opioids can
influence client’s / family willingness to agree to use
o Ex: using opioids is same as euthanasia,
o suggests death is imminent, is
o addictive, and
o will leave fewer options available in future if prescribed early on
140
nurse should educate client / family - dosage
opioids can be increased,
• no limit on amount a client can receive.
•
141
Alternative pain management therapies should be included - as long as
not detrimental to client.
142
LEP
LIMITED ENGLISH PROFICIENCY
utilize translator to communicate w/ a client w/ limited English proficiency (LEP).
143
• may be convenient to use family member - translator, BUT
o doing so → miscommunication.
o EX: culture - shuns talking about death
o family translator may hesitate - translate word “death” -
o Family members - used only in emergencies
family members may alter information during exchange.
144
· not uncommon - assistive personnel / housekeeping staff t asked to interpret, BUT
o may lack necessary medical terminology - translate accurately.
145
• smartphone application only applications authorized by employer should be used, BECAUSE
o will have been evaluated by employer / deemed compliant w/ Health Insurance Portability and Accountability Act.
146
LEP clients - legal right
provided w/ language services
147
Under U.S. law, health care organizations required to provide interpreter services
· LEP clients.
148
Legally / ethically, nurse obligated provide_____for LEP clients
qualified interpreters
149
culturally competent care – end of life care-requires
evaluate client’s cultural needs.
150
Individual clients’ beliefs sometimes differ from
espoused by their culture,
151
cultural views influenced by
client’s history, experience, education.
152
• evaluate cultural needs of client,
o nurse can ask following essential questions:
o “What cultural rituals do you adhere to in coping with death?”
o “How is the deceased person’s body handled?”
o “What are the family’s views regarding what happens after death?”
o “What are the family roles in coping with death?”
o can learns specific information - provide nursing care - individualized for client / meets client’s cultural needs.
153
Postmortem care
physical care performed after client died to - prepare body for
viewing,
autopsy, or
release to funeral home.
• performed by nurses - closed doors.
• following organization’s policy,
• universal interventions apply.
154
Postmortem care - nurse documents
date / time of death,
name of anyone notified,
location of client’s belongings, and
where client’s body is moved (e.g., funeral home name).
155
Postmortem interventions include
o washing body,
o making sure client’s possessions accounted for, and
o placing identification tags
minimum - two areas (toe, arm, outside of body bag).
o removal - invasive devices (ie. intravenous catheters / indwelling urinary catheters) - vary according to specific policy of health care agency
156
• Nurses spend great deal time w/ client / family,
o developing bond that,
o when ended, results in feeling of loss.
o Providing postmortem care allows
o nurse time to achieve closure.
157
Health care personnel providing direct client care - constrained from introducing dialogue regarding
organ / tissue donation w/ client / family.
o policy protects nurse from an alleged conflict of interest
158
OPO
ORGAN PRODCUREMENT ORGANIZATION
159
• Health care professionals - completed course provided / endorsed by organ procurement organization (OPO) –
o best suited to
initiate ORGAN / TISSUE request of client / surrogate.
160
· When client / family member voluntarily requests to initiate organ/tissue donation, .WHAT DOES NURSE DO
o nurse makes a referral to OPO.
o organ procurement coordinator (OPC) will contact client / surrogate to discuss the option of donation
161
OPC ROLE IN ORGAN / TISSUE DONATION
o organ procurement coordinator (OPC) will contact client / surrogate to discuss the option of donation.
OPC answers all questions, clarifies misinformation.
nurse should be prepared
discuss issues involved
educate client / surrogate when requested
162
NURSES ROLE ORGAN / TISSUE DONATION
assist families who are dealing w/ this challenging decision.
163
ORGAN / TISSUE DONATION VOLUNTARY - DONOR MUST DO WHAT
give authorization before death,
o surrogate can give permission when client not previously consented to organ/tissue donation.
164
· nurse can support client / family IN ORGAN / TISSUE DONATION SITUATIONS BY
o facilitating meeting w/ OPC in quiet setting;
o evaluating religious / cultural beliefs,
which can influence knowledge / ideas about donation;
o providing accurate information to alleviate mistaken beliefs;
o telling family do not know answer to a question
letting them know will find the answer;
allowing time for the discussion of client and family feelings; and utilizing other interprofessional team members, such as the chaplain, when needed.
165
· Because nurse often spends extended amount of time w/ client, it is NOT UNUSUAL FOR
bond to develop,
intensifying nurse’s feelings of loss when client dies.
166
Common physical manifestations nurse may experience in response to grief include
feeling of tightness in the chest
inability to breathe,
muscle discomfort,
headaches,
agitation,
sleep disturbances,
gastrointestinal problems, and
heart palpitations.
167
· Psychological manifestations include nurse may experience in response to grief include
anger,
irritation,
unhappiness,
sleeplessness,
exhaustion,
difficulty staying focused, and
altered eating patterns.
168
· strategies to cope w/ death of client.
SELF CARE
TALKING TO OTHER NURSES / HEALTH CARE PROFESSIONALS
169
more experienced nurses who can provide understanding
/ coping methods;
• being present for the family;
• attending client’s funeral,
• can provide closure; and
• seeking professional help.
170
Summary
Summary
171
· Hospice care embodies
the holistic approach to client care and includes the family and caregivers as part of the care team.
172
· Palliative care can be provided while clients are
actively seeking curative treatments.
173
· Knowledge of the physiological changes that occur during the dying process enables the nurse to utilize
appropriate interventions to provide comfort and support.
174
· Pain management (including pharmacologic and nonpharmacologic) is an integral aspect of
client care.
175
· As loneliness and social isolation can negatively affect the dying client, the nurse should facilitate interventions that
provide social support.
176
· Including the client and their family/caregiver in decision making assists with
maintaining the client’s dignity while providing a “good death” for the client.
177
· A major role of the nurse during hospice care is to provide
client comfort and serve as a resource for the family/caregiver as well as the client.
178
· Awareness of cultural diversity allows the nurse to
manage client care more effectively.
179
Self-care strategies can be used by the nurse to
cope with the physiological and psychological manifestations that arise following the loss of a client.
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Cheyne-Stokes respirations
Breathing pattern of cycles that begin with rapid, shallow breaths, increase to deep breaths, ending with periods of apnea.
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death rattle
Sound produced as a result of an accumulation of secretions in the lung and the throat leading to congestion; secretions become trapped as the client is unable to clear the secretions.
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dyspnea
The sensation of difficult or labored breathing.
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hallucinations
A sensation that something is there when it is not; includes all five of the senses.
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hospice care
Care services for clients and families that focus on comfort and support; not curative when it is determined the client has less than six months to live.
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mottling
Physical change of the skin marked by purple or reddish marbling; caused by the heart's inability to pump blood effectively, leading to decreased blood perfusion throughout the body.
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palliative care
A multidisciplinary care approach that is focused on the management of symptoms for chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.
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postmortem care
Physical care performed after the client has died; includes washing the body, accounting for the client's possessions, removing invasive devices, and placing identification tags on the body.
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respite care
A service or agency that provides primary caregivers with a short-term break from the responsibilities of client care.
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A nurse is caring for a client who has a terminal illnes and states that they want to experience a "gooddeath." Which of the following actions should thenurse take?
Determine the client's definition of a "good death."
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2. A nurse is discussing the benefits of palliative care with a newly licensed nurse. Which of the following information should the nurse include?
Palliative care improves The client's quality of life.
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3. A nurse is caring for a client who has a terminal illness and reports feeling isolated from family and friends. Which of the following actions should the nurse take?
Assist in scheduling friends and family to visit.
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4. A nurse is reviewing hospice care services with a group of newly hired nurses. Which of the following information should the nurse include?
Hospice care is an interdisciplinary team effort.
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5. A nurse is caring for a client who is actively dying. The client's caregiver asks the nurse about the client's noisy respirations. Which of the following information should the nurse include? (Select all that apply.)
They can be an indication of approaching death.
Turning the client's head to the side can assist with drainage.
Medications can be administered to help dry up the secretions.
The client is unable to clear the secretions themselves.
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6. A nurse is discussing hospice care services with the caregiver of a client who is terminally ill. Which of the following information should the nurse include?
Nursing support will be provided in meeting
the client's daily needs, including the administration of medications.
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7. A nurse is teaching a client about hospice care. Which of the following information should the nurse include? (Select all that apply.)
"You must have a terminal illness."
"You accept palliative care for comfort."
"The health care provider must officially
state that you are terminally ill."
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8. A nurse is caring for a client who is actively dying and notes the client's feet are purple and marbled. Which of the following findings should the nurse expect?
Mottling is visible on the client's legs.
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9. A nurse is grieving following the death of a client who had a terminal illness and is having difficulty sleeping and concentrating. Which of the following actions should the nurse take?
Participate in an exercise program.
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10. A nurse is discussing the concept of spirituality with a newly licensed nurse. Which of the following information should the nurse include?
Spirituality focuses on the significance and purpose of life.
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11. A nurse is caring for a client who is nearing the end of life. Which of the following responses by the nurse supports the client’s dignity? (Select all that apply.)
"What would you like to know about your medications?"
"What can I do to help you feel more independent?"
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12. A nurse is planning care for a client who is terminally ill and speaks a different language than the nurse. Which of the following actions should the nurse take?
Use the health care facility's interpreter services.
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13. A nurse is discussing palliative care with a client who has colon cancer. Which of the following information should the nurse include?
Palliative care uses a holistic approach.
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14. A nurse is caring for a client who is actively dying and is discussing pain management with the client's caregiver. Which of the following information should the nurse include?
A combination of approaches is suggested to manage pain symptoms.
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15. A nurse is providing postmortem care for a client. Which of the following actions should the nurse take? (Select all that apply.)
Document where the body is being moved.
Include the name of anyone notified in the medical record.
Document the date and time of death.
Ensure the client's belongings are accounted for.
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16. A nurse is caring for a client who is actively dying. The client's caregivers state they are interested in donating the client's organs. Which of the following actions should the nurse take?
Make a referral to an organ procurement organization.
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17. A nurse is caring for a client who is actively dying. Which of the following actions should the nurse take for alterations in breathing pattern?
Educate the family about the expected respiratory changes.
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18. A nurse is discussing culturally competent care with another nurse. Which of the following information should the nurse include?
It is culturally insensitive to talk about impending death in some cultures.
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19. A hospice nurse is caring for a client who is hallucinating and talking to someone who is not there. Which of the following actions should the nurse take?
Ensure client safety and prevent injury.
