End of life

Question 1

Describe the ethical and legal issues of advanced directives with a healthcare surrogate

Answer 1

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Question 2

Discuss the nursing management of the dying patient

Answer 2

• Promoting health
• Preventing illness
• Restoring health
• Facilitating coping with illness, disease, death

Question 3

Providing fluids and nourishment during terminal illness is often controversial. Discuss the key
issues in this controversy

Answer 3

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Question 4

Discuss how pain is identified and managed in the unresponsive terminal patient

Answer 4

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Question 5

Discuss the rationale for use of medications such as morphine, haloperidol, glycopyrrolate, and
lorazepam in the treatment of the terminal patient

Answer 5

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Question 6

Identify all potential nursing diagnoses and the related interventions

Answer 6

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Question 7

Discuss nursing care of the patient after death.

Answer 7

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Question 8

Emotional feeling r/t perception of loss

Answer 8

Grief

Question 9

Outward social expression of loss

Answer 9

Mourning

Question 10

Fears about death

Answer 10

• Greatest fear: pain
• Family and patient: life altering
• Financial

Question 11

Spiritual aspects of death

Answer 11

• Christian Views- eternal life thru faith in Jesus Christ
• Jewish Views- good works earn place in heaven
• Muslim Views- good works earn place in a heaven
• Oriental Mysticisms Views- re-incarnation
• Non-religious Views- death – cease to exist

Question 12

Alabama state law for determining death

Answer 12

An individual who, in the opinion of a medical doctor licensed in Alabama, has sustained either

(1) irreversible cessation of circulatory and respiratory functions, or
(2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.
- A certified or authenticated copy of a death certificate purporting to be issued by an official or agency of the place where the death purportedly occurred is prima facie evidence of the fact, place, date and time of death and the identity of the decedent.
- A certified or authenticated copy of any record or report of a governmental agency, domestic or foreign, that a person is missing, detained, dead or alive is prima facie evidence of the status and of the dates, circumstances and places disclosed by the record or report.
- In the absence of prima facie evidence of death under paragraph 2 or 3, the fact of death may be established by clear and convincing evidence, including circumstantial evidence.
- A person whose death is not established under paragraphs 1 through 4, who is absent for a continuous period of five years, during which time that person has not been heard from, and whose absence is not satisfactorily explained after diligent search or inquiry is presumed to be dead. That person’s death is presumed to have occurred at the end of the period unless there is sufficient evidence for determining that death occurred earlier.
- In the absence of evidence disputing the time of death stated on a document described in paragraph 2 or 3, a document described in paragraph 2 or 3 that states a time of death one hundred twenty hours or more after the time of death of another person, however the time of death of the other person is determined, establishes by clear and convincing evidence that the person survived the other person by one hundred twenty hours.

Question 13

Alabama state law for the definition of death

Answer 13

An individual is considered dead if:

• In the opinion of a physician licensed or exempt from licensing or a registered nurse authorized to pronounce death based on acceptable medical standards.
• In the opinion of a mobile intensive care: paramedic, physician assistant, or emergency medical technician authorized to pronounce death
• The individual has sustained irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem. Death may be pronounced in this circumstance before artificial means of maintaining respiratory and cardiac function are terminated.

Question 14

Durable power of attorney for health care

Answer 14

-Designates who makes decisions if individual cannot
-Living Wills
-Designates what decisions the individual desires
MAY BE CHANGED!

Question 15

Medical aspect definition of death

Answer 15

No heart rate (not no pulse), no spontaneous respirations, or irreversible brain dysfunctions

Question 16

DNR

AND

Answer 16

• Do not resuscitate
• Allow natural death
• Doesn’t mean don’t care

Question 17

Law for codes

Answer 17

• All patients are codes unless Health Care Provider orders differently
• No code pts may identify themselves outside hospital by arm band or card.
• Slow codes?? -no

Question 18

ANA Code of Ethics

Answer 18

Dying process does not change the worth or dignity of a person

Question 19

How treat symptoms and maintain comfort

Answer 19

Pain, dyspnea, agitation, N/V, fatigue, weakness, constipation, anorexia, delirium, meds ATC
Weakness and lethargy increases
LOC and ability to communicate decreases- moaning, restlessness
Patient can hear, hearing is the last thing to go

Question 20

5 stages of grief

Answer 20

Denial
Anger
Bargaining
Depression
Acceptance

Question 21

Feeding a dying pt

Answer 21

No glycerin or lemon swabs, just plain water. Offer food/fluids. If can’t swallow – NO – aspiration increases discomfort

Question 22

Death rattle treatment

Answer 22

No suctioning, turn- wash cloth under mouth