elnec Flashcards
serious illness
high risk mortality and either negatively impacts daily function, quality life, or strain caregiver
sharing prognosis
must do this to ensure the pt is able to take the opportunity to achieve life closure
serious illness
need to focus on pain and symptom management more to ensure the pt is cared for and not just trying new technology to cure
palliative care
**not end of life care
focuses on expert assessment and management of pain, other s/s, caregiver needs, and coord care. attends physical, functional, psych, practical, and spiritual conseq of serious illness
what’s important to pt, family, and caregivers and congruent w/goals and care tx
**must advocate for the pt
social workers
psychosocial assessments, counselors, family care
adult- varies stage life, grief and loss of children
np
consult for pt and families
symptom, pain, anxiety management
goals of care
needs of families and needs of pts
chaplain
spiritual needs pt, families, staff
physician
clinician, educator, directing cirriculum
rn role
presence - compassion
care coordination
comm skills - listening
evidence-based practice
quality of life model
physical
social
psychological
spiritual
continuum of care
disease-modifying tx and palliative care
hospice care - 6 mo or less
death and bereavement support - prove to family 12 mo or longer if needed
hospice
spec palliative care with life expectancy measured in months, not years
how do people die
sudden death
steady decline
chronic illness
progressive deterioration
hospice team
homemakers and hospice aids nurses physicians chaplains social workers bereavement counselors speech, OT/PT volunteers
hospice vs palliative care
palliative care = serious illness and in any setting, can receive disease-modifying tx, different financial payments and circumstances
hospice last 6 mo life and usually at home, specific financial option with medicare (medicare hospice benefit)
8 domains of palliative care
structure and process of care physical aspects of care psychological and psychiatric aspects of care social aspects of care spirit, relig, existential aspects of care cultural asp care care pt nearing end of life ethical and legal aspe of care
barriers to communication
- fears surrounding death - avoidance, not knowing answers, expressing emotions leads to avoidance of tough topics
- lack of personal experience w/death
- HCP insensitivity
- provider sense of guilt over failure to pt
- desire to support
- disagreement w/ pt and family decisions
- lack of knowledge and understanding of pt culture
- personal grief hcp experiencing
- ethical concerns
culture
cultural considerations super important - pull up chair and ask whats important to pt and family
cultural humility - acknowledge own biases and value may interfere w pt values
pain
whatever the pt says it is - subjective barriers - HCP - healthcare system - pt, families, society
unable?
- pain ass in advanced dementia (PAINAD)
- pediatric - face, legs, activity, crying, consolidation (FLACC)
tx n/v
anticholinergic - tx motion sickness
antihistamine- intestinal obstruction, incr intracranial pressure,
steriods- cytotoxic-induced emesis
prokinetic agents- gastric stasis or ileus
benzos- nausea w/anxiety
5-HT3 receptor agonists post op n/v
med cause constipation
opiates antidepressants antacids chemo serotonin antagonist antiemetics
bereavement
period grief and mourning that occurs after loss
mourning
outward, social expression of loss
affects survivors physically, psychologically, socially, and spiritually
types grief
anticipatory- before loss acute- normal disenfranchised- loss not validated or recognized complicated
