End of Life Flashcards
An approach that improves the quality of life of patients and their families who face problems associated with life-threatening illness
Palliative Care
Prevent and relieve suffering by early identification, assessment, and treatment of pain and other types of physical, psychologic, emotional, and spiritual distress.
Palliative Care
______ care extends into the period of End of Life care as well as the bereavement period that follows.
Palliative
Palliative care focus of nursing care.
- Relief of ______, including pain.
- Regard dying as a ______ process.
- Affirm life and neither hasten or ______ death.
- Support ______ care and enhance quality of life.
- Offer support to allow ______ to live their lives as actively as possible.
- Offer support to ______ during patient’s illness and with their bereavement.
Symptoms Normal Postpone Holistic Patients Family
Hospice
- Concept of care that provides compassion, concern, and support for ______.
- ______ phase of care for people with an incurable disease.
- Emphasis on ______ management, advance care planning, spiritual and family support including bereavement.
- Team are interdisciplinary: physicians, nurses, pharmacist, dietitians, physical therapists, social workers, CNAs, chaplains, and family members
Dying
Last
Symptom
Admission into Hospice
- Patient must desire the services and agree in ______ that only hospice care can be used to treat the terminal illness.
- ______ physicians certify that the patients prognosis is terminal with less than ______ months to live.
Writing
Two, 6 months (Only 1 needed to re-certify)
End-of-Life Care
______ phase of illness when death is imminent, could be a few hours to several weeks. List goals (4)
Final
Goals (A) Provide comfort and supportive care (B) Improve the quality of patient’s remaining life (C) Ensure a dignified death (D) Provide emotional support to family
Physical Changes at EOL
Sensory - Related to decreased circulation and O2 levels. Discuss changes (3).
- Blurred vision, decreased sense of taste, smell, pain & touch sensation.
- Blink reflex lost - Pt appear to stare.
- Hearing is thought to be last to go.
Physical Changes at EOL
Loss of muscle tone. Discuss changes (2).
- Gag reflex is lost
2. GI & GU failure with loss of sphincter control
Physical Changes at EOL
Circulatory & Respiratory. Discuss changes (4)
- Decreased HR and BP
- Breath sounds may become wet and noisy - “Death Rattle” - mouth breathing & an accumulation of mucus
- Cheyne-Stokes respirations - Alternating periods of apnea and deep, rapid breathing.
- Skin in extremities becomes pale, mottled, and cyanotic, cool to touch.
Supportive Care
Fatigue/Weakness ______ as pt approaches time of death. To minimize skin breakdown, turn pt every ______ hours.
Increases
Two
Supportive Care
Parenteral Fluids may have adverse effects that are not commonly considered: ______ ______. IV lines can become cumbersome and difficult to maintain. Changing IV site can be painful, particularly when pt is cachetic or has no discernible ______.
Fluid Overload
Veins
Cachetic (from Cachexia - Weakness and wasting of the body due to severe chronic illness)
Nutrition at EOL
Most dying pt’s loose their ______. Anorexia may be helpful as the resulting ______ can lead to a sense of well-being and diminish discomfort.
Appetite
Ketosis
Nutrition at EOL
Pt’s body unable to absorb nutrients and clenching of ______ may be only way to express desire to not eat. Educate family of risk of ______. Help families find ______ ways to nurture pt so they can continue to participate and feel valued during the dying process.
Teeth
Aspiration
Alternative
There are two roads to death. Describe the difficult road vs the usual road.
Usual Road: Normal - Sleepy - Lethargic - Obtunded - Semicomatose - Comatose - Dead
Difficult Road: Normal - Restless - Confused - Tremulous - Hallucinations - Mumbling Delirium - Myoclonic Jerks - Seizures - Semicomatose - Comatose - Dead
Psychosocial Manifestations
______ - Period of time following the death of a loved one during which grief is experienced and mourning occurs.
Bereavement
Psychosocial Manifestations
_______ - The reaction to the loss. It is dynamic with both psychologic and physiologic responses.
Grief
Grief
1. ______ - Long before the death occurs
2. ______ - Accepting the death
Prolonged grief disorder - Complicated grief that lasts longer than ______ months.
Anticipatory
Adaptive
Six
List the stages of grief
Denial Anger Barganing Depression Acceptance Hope (HAD BAD)
Denial
Helps protect a person ______ from overwhelming grief. Lasts a few minutes & possible until the person dies.
Emotionally
Refuse to accept Dx - Mistake must have been made - Second opinion - Nothing is wrong - Do not return to Dr.
Anger
Occurs when person ______ she/he is actually going to die. (at self for not getting help sooner or making lifestyle choices that contributed to illness)
Realizes
Person becomes moody, withdrawn, uncooperative or hostile - Yells or throws things - Loses faith in religion - Takes anger out on family and/or healthcare workers
Bargaining
“Make a deal” with someone who has control over his fate (i.e. ______, ______ ______, or ______ ______) Wants to live long enough to accomplish a goal or witness an event (i.e. Birth of child, wedding, anniversary)
God, Healthcare Provider, Family Member
Typically done on a very private basis.
Depression
Occurs when person ______ realizes death will be the end result of the illness.
Fully
The person may - Feel sad - Have regrets about things he was not able to accomplish during lifetime - Feel withdrawn - Talk very little - Openly mourn for his loss
Acceptance & Hope
Occurs when the person comes to terms with the ______ of his impending death and is finally at peace with this knowledge
Reality
Person may - Complete unfinished business and say goodbye (Bucket list) - Plan own funeral - Write poem/letters to be read after death - Desire to talk about death in an effort to help family members accept it
Patient may have ______ about pain, SOB, loneliness, abandonment, meaninglessness
Fears
Spiritual & Cultural Considerations
1. Expression of feelings 2. EOL decisions 3. Communication 4. Visitation 5. Organ/tissue donation
Ask open-ended questions to assess pt’s ______ of illness.
Perspective
Written notice upon admission to HC facility of their decision making rights and policies regarding advance health care directives in their state and in the institution to which they have been admitted is known as the ______.
The Patient Self-Determination Act of 1990
- Facilitate their own health care decisions
- Accept or refuse medical treatment
- Make an advance health care directive
Written statements of a person’s wishes, often known by laypersons as a living will is known as ______.
Advance directive (State specific)
Listing a person or persons to make health care decisions should a patient become unable to make informed decisions is known as _______.
Durable power of attorney for health care
A written document specifying the patient’s wish to die without heroic or extraordinary measures is known as ______.
Directive to physician
What is a POLST?
Physician Order for Life Sustaining Treatment
It can include CPR, IV fluids, Ventilation, Tube feedings etc.
Describe these codes 1. Full code 2. Chemical 3. Electrical 4 New 5. Old
- Initiate all ACLS protocols
- Pharmacologic interventions only
- Defibrillation only
- Allow natural death (AND)
- Do not resuscitate (DNR)
Dealing with Death and Dying (Self)
Grief similar to patient/family
Feelings of inadequacy - inability to effectively relieve pain or suffering
Question your professional calling
Take time for yourself
Talk to supervisor, clergy, peer about feelings
