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NUR 3020 exams > End of Life > Flashcards

End of Life Flashcards

1
Q

leading causes of death

A
  • heart disease
  • cancer (malignant neoplasms)
  • hospital errors
  • chronic lower respiratory disease
  • accidents
  • stroke
  • alzheimer’s disease
  • diabetes mellitus
  • influenza and pneumonia
  • kidney disease (nephritis, nephrotic syndrome, nephrosis)
  • suicide
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2
Q

death

A

cessation of integrated tissue and organ function
- manifested by: lack of heart beat, absence of spontaneous respirations, irreversible brain dysfunction
- often feared as a time of pain and suffering

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3
Q

patient self determination act (PSDA)

A
  • granted people the right to determine the medical care they wanted provided (or not provided) if they became incapacitated
  • documentation of this self determination is accomplished by completing an advance directive (AD)
  • requires that a representative in every health care agency ask patients when admitted if they have written advance directives
  • most ADs have a section where one names a durable power of attorney for health care (DPOA)
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4
Q

parts of advance direction

A
  • durable power of attorney
  • living will
  • DNR form
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5
Q

criteria to make decision of DPOA (3)

A

1) receive information
2) evaluate, deliberate, and mentally manipulate information
3) communicate treatment and preference!

extra: DPOA makes health decisions for patients if they can’t make any themselves, determined by doctor, don’t make the same for financial situations

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6
Q

living will (LW)

A
  • second part of advance directive
  • identifies what one would (or would not) want if he or she were near death
  • treatments include cardiopulmonary resuscitation (CPR), artificial ventilation, and artificial nutrition or hydration
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7
Q

DNR form

A

actual order from a physician or other authorized health care provider who instructs that CPR not be attempted in the event of cardiac or respiratory arrest
- CPR is not meant for patients with chronic illness (eg. end stage renal cancer)

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8
Q

hospice

A
  • type of palliative care, focusing on the comfort at the end of life
  • when pt. enroll in hospice, they have made the decision to forego disease directed therapies and focus soley on the relief of symptoms associated with their illness and the dying process
  • this holistic approach neither hastens or postpones death, but provides relief of symptoms and is provided in a variety of settings
  • hospice care focuses on quality of life, and by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death
  • hospice in the US is not a place but a philosophy of care in which the end of life is viewed as a developmental stage
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9
Q

palliative care

A

interdisciplinary model of care, focusing on symptom mgmt and psychosocial/spiritual support for those with serious, life limiting illnesses
- collaboration w/ other providers (control sx. throughout treatment)
- aims to improve quality of life for people and families through early integration into the plan of care strategies for managing pain and symptoms and for reducing burdensome care transitions through interdisciplinary teamwork, care coordination, clinician-patient communication, and decisional support
- appropriate for patients at any age and at any stage in a serious illness, even while pursuing disease directed or curative therapies, and extending into bereavement for families (comfort care through tx. of active disease, doesn’t equate death)

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10
Q

what consultation services do primary teams consult specialists for in palliative care

A
  • pain mgmt
  • sx mgmt
  • goals of care discussion
  • end of life issues
  • psychosocial distress
  • spiritual or existential distress
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11
Q

hospice vs. palliative

A
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12
Q

ethics in dying: role of nurse in a family meeting

A
  • advocate for pt based on values shared by patient and family
  • act as interpreter when medical jargon is not clearly understood by patient and family
  • respond to emotion expressed in meeting
  • prior to meeting, encourage and assist patient and family w/ developing questions to ask of interdisciplinary teams during meeting
  • express concerns
  • share clinical nursing updates
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13
Q

ethics in dying: how to give bad news?

A

SPIKE
- setting: make sure the setting is conducive as possible (private room)
- patient’s perception: asl what they know of their disease
- invitation: ask what they want to know if this becomes more serious (some people don’t want to know!)
- knowledge: give them the facts they want to know
- exploring/empathy/emotion: allow the patient to express their feelings and worries and provides support
- strategy/summary: develop a plan and follow through with the patient (come back + let patients digest informations)

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14
Q

ethics in dying: patient and family needs

A
  • care for their loved one as a person
  • care to prevent suffering and pain of their loved one
  • availability of clinicians
  • demonstrate collaboration and communication amongst team members
  • appropriate, accurate and understandable information about prognosis
  • permit time to allow families to share concerns
  • direction on what to focus on
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15
Q

NURSE acronym

A
  • name the emotion: sounds like you’re worried about the future
  • understand the emotion: you have been through so much already
  • respect the patient: i am so impressed with how you have dealt w/ ups and downs
  • support the patient: i hope you don’t have any more setbacks and I’m here for you no matter what the future holds
  • explore the emotion: you seem more worried than usual, can you tell me more about what’s different about today than yesterday?
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16
Q

withdrawing/withholding life sustaining therapy (passive euthanasia)

A
  • act of omission (eg. withdrawing/withholding tx) that might prolong the life of a person who cannot be cured by the treatment
  • in this situation, withdrawal of the intervention does NOT directly cause the patient’s death
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17
Q

voluntary active euthanasia

A
  • act by which the causative agent or treatment in the death of a patient is administered directly by another
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18
Q

involuntary active euthanasia

A
  • the action to end the patient’s life is taken without the patient’s consent (health care provider pushing potassium)
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19
Q

physician assisted suicide

A
  • practice whereby a physician provides a means (eg medication) to a patient with the knowledge that the patient will use the means to commit suicide (assisted death)
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20
Q

principle of double effect

A
  • involves taking an action intended to have a good effect, which also has a known harmful effect
  • NOT active euthanasia
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21
Q

most common end of life symptoms that can cause the patient distress

A
  • pain
  • breathlessness/dyspnea
  • weakness
  • nausea and vomiting
  • restlessness and agitation
  • seizures
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22
Q

interventions regarding pain (nonpharm + pharm)

A

nonpharm:
- massage to manipulate the patient’s muscles and soft tissue, which impoves circulation and promotes relaxation
- music therapy based on patient preferences to decrease pain by promoting relaxation
- therapeutic touch by moving one’s hands through the patient’s energy field to relieve pain
- aromatherapy to decrease pain by promoting relaxation and reducing anxiety
- avoid any iatrogenic sources (not ever 1-2 hours, can do less, suction, no VS, etc.)

pharm:
- morphine
- stook softners d/t opioid use (constipation)

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23
Q

interventions regarding breathlessness/dyspnea (nonpharm + pharm)

A

nonpharm:
- elevate HOB and/or position the person on his or her side
- mechanical ventilation (invasive or non-invasive)
- conserve energy, consider a foley catheter
- paracentesis or thoracentesis

pharm:
- oxygenation (need doc. order)
- morphine
- bronchodilators (wheeling, bronchospasm)
- corticosteroids (COPD, asthma)
- diuretics (HF)
- antibiotics

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24
Q

interventions regarding oral secretions or loud, wet respirations

A

nonpharm
- position the patient on his or her side
- place a small towel under his or her mouth collect secretions

pharm:
- atrophine sulfate drops
- scopolamine patches

25
Q

interventions regarding weakness

A

nonpharm:
- teach families about the risk of aspiration (NPO)
- reassure them that anorexia is normal at this stage
- to avoid a dry mouth and lips, moisten them with soft applicators and apply an emollient

26
Q

interventions regarding increased lethargy (n/v)

A

nonpharm:
- spend time sitting quietly with the person
- do not force the person to stay awake
- talk to the person as you normally would, even if he or she does NOT respond

27
Q

interventions regarding n/v

A

nonpharm:
- discontinue enteral feedings, put PEG to drainage
- offer nourishment only when the patient has an appetite or thirst
- avoid NGT decompression
- apply a cool wet cloth on the patient’s face
- avoid ant smells or foods that may induce the symptoms
- aromatherapy as chamomile, camphor, fennel, lavender, peppermint, and rose

pharm:
- antiemetics
- anticholinergics

28
Q

interventions regarding decreased nutrition/fluid

A

nonpharm:
- do not force the person to eat or drink
- offer supplements or protein shakes if tolerated
- assess for any medications causing the problem, or environmental causes (such as unpleasant odors, causing decreased appetite)
- use moist swabs to keep the mouth and lips moist and comfortable, coat the lips with lip balm
- assess for oropharyngeal pain or ulcers causing the decreased appetite

29
Q

interventions regarding severe agitation and restlessness (and delirium)

A

nonpharm:
- assess for underlying cause, acknowledge the family’s distress, educate and reassure
- play soothing music, keep the room dimly lit and use aromatherapy
- do not restrain the person
- apply wet cloths on the patient’s face
- reduce the environmental stimuli
- talk quietly and keep noise level to a minimum

pharm:
- haloperidol
- benzodiazepines (eg. ativan) (can increase agitation)

30
Q

interventions regarding seizures

A

nonpharm:
- decrease stimuli
- avoid any triggers (if any are known)

pharm:
- benzodiazepines
- barbiturates

31
Q

interventions regarding incontinence

A

nonpharm:
- keep the perianal area clean and dry
- use disposable underpads or chux pads and disposable undergarments
- if the person would be more comfortable, consider a foley catheter

32
Q

interventions regarding coolness of extremities

A
  • cover the person with a blanket
  • do not use an electric blanket, hot water bottle, electric heating pad, or hair dryer to warm the person
33
Q

psychosocial interventions for the dying patient and the family

A
  • offer physical and emotional support by “being with” the patient
  • respect cultural preferences
  • be realistic
  • encourage reminiscence
  • promote spirituality and hope
  • avoid explanations of the loss
  • communicate with the patient
  • provide referrals to bereavement specialists
  • teach about the physical signs of death
  • ensure that the patient is receiving palliative care, with an emphasis on symptom mgmt

TIP: NO ADVICE

34
Q

spirituality

A
  • whatever or whoever gives ultimate meaning and purpose in one’s life and includes domains such as one’s beliefs and faith, sources of hope, and attitudes toward death
  • may or may not include belief in GOD
35
Q

religions

A
  • formal belief systems that provide a framework for making sense of life, death, and suffering and responding to universal spiritual questions
  • may have beliefs, rituals, texts, and other practices that are shared by a community
  • spirituality and religion can help them cope with the though of death, contributing to quality of life during the dying process
36
Q

basic beliefs regarding care at end of life and death rituals for hinduism

A
  • this life is a transition between the previous life and the next
  • postdeath rituals: important, bodies are cremated, during the first 10 days after death, relatives must create a new ethereal body
  • karma is the manner through which one reaps benefits and penalties of pas actions, “good karma” leads to good rebirth or release, and “bad karma” leads to bad rebirth or pain and suffering during release
  • health care decisions may be made communally with senior family members as final authority
37
Q

basic beliefs regarding care at end of life and death rituals for Judaism

A
  • dying person is encouraged to recite the confessional or the affirmation of faith, called the shema
  • disclosure is important, most patients want to know the truth
  • according to jewish law, a person who is extremely ill and dying should not be left alone
  • the body should not be left unattended until the funeral, which should take place as soon as possible (preferably within 24 hours)
  • autopsies are NOT allowed by orthodox jews, except under special circumstances
  • body should not be embalmed, displayed, or cremated
38
Q

basic beliefs regarding care at end of life and death rituals for buddhism

A
  • treatment by someone of the same gender is preferable
  • cremation is the most common way of disposing the dead
  • some Buddhist may be unwilling to take pain-relieving medications or strong sedatives, as it is believed that an unclouded mind can lead to a better rebirth
  • buddhists believe that after death there is either rebirth or nirvana (latter being enlightenment that frees the soul from the cycle of death and rebirth
39
Q

basic beliefs regarding care at end of life and death rituals for islams

A
  • based on belief in one god ALLAH and his prophet Muhammad
  • Qur’an is the scripture of islam, composed of Muhammad’s revelations for the word of god (Allah)
  • god has prescribed an appointed time of death for everyone
  • qur’an encourages humans to seek treatment and not to refuse treatment
  • belief is that only allah cures but that allah cures through the work of humans
  • upon death, the eyelids are to be closed and the body should be covered. Before moving and handling the body, contact someone from the person’s mosque to perform rituals of bathing and wrapping body is cloth
  • fasting during the month of ramadan is a pillar of islam
40
Q

basic beliefs care at the end of life and death rituals for christianity

A
  • there are many christians denominations which have variations in beliefs regarding medical care near end of life
  • christians believe in afterlife of heaven or hell once the soul has left the body after death, this believe in eternal salvation sets Christianity apart
  • roman catholic tradition encourages people to receive sacrament of the sick, administered by a priest at any point during an illness. this sacrament may be administered more than onc, not receiving this sacrament will not prohibit them from entering heaven after death
  • people may be baptized as roman catholics in an emergency situation (eg. person is dying) by a layperson. Otherwise, they are baptized by a priest
41
Q

physical signs/symptoms of imminent death

A
  • periods of apne a and cheyne-stokes respirations
  • wet, gurgle “death” rattle as the patient breathes
  • blood pressure decreases
  • peripheral circulation decreases
  • skin is COLD and mottled
  • hypersomnolence (lethargic)
42
Q

signs that death has occurred

A
  • breathing stops
  • heart stops beating
  • pupils become fixed and dilated
  • body color becomes pale and waxen
  • body tempearture drops
  • muscles and sphincters relax
  • urine and stool may be relaxed
  • eyes may remain open, and there is no blinking
  • the jaw may fall opens
  • observers may hear trickling of fluids internally
43
Q

emotional signs and symptoms of imminent death

A
  • withdrawal
  • vision like experiences
  • letting go
  • saying goodbye
44
Q

pronouncement of death

A
  • note time of death
  • identify patient by the hospital identification (ID) tag
  • ascertain that the patient does not rouse to verbal or tactile stimuli (avoid overtly painful stimuli, especially if family members are present)
  • auscultate for the absence of heart sounds, palpate for the absence of carotid pulse
  • look and listen for the absence of spontaneous respirations
  • record the time at which your assessment was completed
  • document the time of pronouncement and all notifications in the medical record (ie., to attending physician)
45
Q

death and postmortem care

A
  • after patient passess, ask family or other caregivers if they would like to spend time with the patient to assist them in coping with what has happened and say their good byes
  • call organ donor within 1 HOUR of death
  • before preparing the body for transfer, ask the physician whether an autopsy will be required (if yes, can’t take anything off)
  • after family or significant others view the body, follow agency procedure for preparing the patient for transfer to either the morgue or a funeral home “not last time they’ll see patients”
  • post moterm kit: shroud and ID tags
46
Q

grieving

A

interventions to assist patients and families in grieving and mourning are based on cultural beliefs, values, and practices
- grief, mourning, berreavement
AVOID ADVICE

47
Q

grief

A

emotional feeling related to the perception of the loss
- patients who are dying suffer not only from the anticipated death but also from the loss of the ability to engage with others and in the world

48
Q

mourning

A
  • refers to individual, family, group, and cultural expressions of grief and associated behaviors
49
Q

bereavement

A
  • refers to the period of time during which mourning for a loss takes place
50
Q

kunler-ross stages of grief and loss

A

1) denial (avoidance, confusion, elation, shock, fear)
2) anger (frustration, irritation, anxiety)
3) bargaining (struggling to find meaning, reaching out to others, telling one’s story)
4) depression (overwhelmed, helplessness, hostility, flight)
5) acceptance (exploring options, new plan in place, moving on)

51
Q

symptoms of grief

A
  • crying
  • headaches
  • difficulty sleeping
  • questioning the purpose of life or their spiritual beliefs
  • feelings of detachment
  • isolation from friends and family
  • abnormal behavior
  • anxiety
  • frustration
  • guilt
  • fatigue
  • anger
  • loss of appetite
  • aches and pain
  • stress
52
Q

grieving interventions

A

nonpharm:
- encourage story telling and reminiscing
- assess for coping skills
- assess for social support
- support groups, bereavement groups, counseling
- assess for signs of complicated grief (unhealthy coping mechanisms)

pharm:
- antidepressants
- anti-anxiety
- sedatives

53
Q

special issues for the nurse: losing a patient

A
  • debrief with staff
  • help with rituals of the patient and family if appropriate
  • discuss the death with friends and family
  • attend the funeral
  • pray or draw strength from spiritual beliefs
  • use relaxation techniques
  • healthy personal habits, including diet, exercise, stress reduction activities (eg. dance, yoga, meditation), and sleep, help guard against detrimental effects of stress
54
Q

what is the most common ethical dilemmas a nurse will encounter

A
  • determining decisional capacity, withholding or withdrawing life-prolonged measures such as: ventilator support, dialysis, artificial nutrition and hydration, requests for hastening death, and concerns related to proxy decision making
55
Q

withfrawing/withholding life sustaining therapy

A
  • an act of omission (eg. withholding or withdrawing treatment) that might prolong the life of a person who cannot be cured by the treatment. in this situation, the withdrawal of the intervention does not directly cause the patient’s death
56
Q

voluntary active enthanasia

A
  • an act by which the causative agent or treatment in the death of a patient is administered directly by another
57
Q

involuntary active enthansia

A
  • the action to end the patient’s life is taken without the patient’s consent
58
Q

physician assisted suicide

A
  • a practice whereby physician provides a means (eg. meds) to a patient with the knowledge that the patient will use the means to commit suicide
59
Q

principle of double effect

A
  • involves taking an action intended to have a good effect, which also has a known harmful effect (NOT ACTIVE ENTHANASIA)

NUR 3020 exams (11 decks)

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