End Of Life Flashcards
What does palliative care involve
Addresses physical intellectual emotional social and special needs and facilitating patient autonomy access information and choice
Why Use palliative care
Relief from pain and other distressing symptoms
Affirms life and regards dying as a normal process
Intends neither to hasten nor postpone death
Offers a support system to patients and family
What does it integrate
Psychosocial and spirituals aspects of care
When does it begin
When a life threatening condition is diagnosed
What are the top priorities for a loved one with terminal illness
Someone to be sure that the patient’s wishes are honored choice among the type of services the patient can receive
pain control Taylored to the patient’s wishes
emotional support for the patient and family
The goal of palliative care
To relieve pain symptoms and stress of serious illness
Palliative care offered to
Those undergoing curative treatment even at the early stages of a serious and complex illness
The gold standard for end-of-life care
Hospice
What is the central belief of hospice
Each person is entitled to a pain-free death with dignity and that families are entitled to the support necessary to allow that to happen
Kind of approach is hospice based on
Interdisciplinary
What does the team for hospice develop
Individualized care plan to meet each patient’s needs for pain management and symptom control
Are Medicare covered hospice services
Physician services nursing care medical equipment medical supplies drugs for symptom control short term care in the hospital short term respite care home health aide homemaker services PT and OT speech therapy social worker Dietary counseling Bereavement for patients families
What does the right to die concept include
Suicide or voluntary active euthanasia
Where is right to die legal
Montana Oregon and Washington
What can be some disparities in end of life
Geographic racial and ethnic and language
Is palliative sedation therapy
The lowering of patient consciousness using medications for the express purpose of limiting patients awareness of suffering that is intractable an intolerable
What are advanced medical directive’s
Documents containing patient’s oral and written expression’s other preferences about future medical care if they should become unable to speak for themselves
Palliative sedation therapy equated with
Euthanasia
What does federal law require
Hospitals to inform patient that they have the right to complete advanced directive
What are advanced medical directive’s usually in the form of
A living will or medical power of attorney
What was a do not attempt resuscitation order formerly
Do not resuscitate
Where should A do not attempt resuscitation order to be placed
Head or foot of bed refrigerator
How to many older patients choose to end their lives
Refusing food and liquids
When does death occur in refusing food and liquid
Within 15 days
Little pain and suffering
No hunger or thirst experienced
Artificial nutrition and hydration will prolong life by days or weeks but will cause what
Physical and emotional damage
What is essential in end of life care
Honest compassionate communication
Guidelines in communicating about illness and death
Listen make empathetic statements elicit the patients values and goals of care Offer information about prognosis discuss death explicitly maintain cultural sensitivity
What should conversations about death and dying always consider
Pts cultural and ethnic background and spirituality
What is called the fifth vital sign
Pain
Other effects pain has
Physical and emotional
Severe chronic pain cause
Depression anxiety fear decreased appetite impaired sleep thoughts of suicide (often disappear when pain is releived)
What does jcaho require
Hospitals and other healthcare facilities regularly assess monitor and manage pain in all patients
Pain meds should be given what
Freely to relieve pain with the concern of addiction
What should define the goal of pain management
Patient preferences
Who may have a higher pain threshold
Older pts
Why might older pts have a higher pain tolerance
Age related charges in neurophysiology
What may perception of pain be affected by
Cultural considerations
Side effects of opioid therapy
Drowsiness Nassau vomitting Dyspenea Constipation Dry mouth
What the most common fears
Fear of death
fear pain
of dying alone
fear of being a burden
Depression can be caused by
Weak support system
Persistent negative thinking
Increased dysfunction related to the illness
Untreated or under treated pain
What can loss consist of
Physical strength Abilities Mental abilities Relationships Self esteem Body image Independence Control over life plans and lifestyle
What is grief
The normal human response to loss
Is universal individual and unpredictable
Stages of grief
Shocking and numbing
yearning and searching
disorganization and despair
some degree of reorganization
What is bereavement
Being deprived of someone through death and the feeling of desolation that follows
What to consider for family of the dying pt
Time and logistics (24/7 care)
Physical tasks - risk for injury
Financial
Caregiver emotional burden and mental health
Physical health risks for caregiver (respite care)
Signs that death has occured
No respiration or pulse Eyes open but don't move or blink Jaw relaxed and mouth slightly open Bowel and bladder expelled Don't respond to touch or speech
What is pronouncement
Formal process of death being certified by a physician
When should organ donation be discussed
When preparing advance directives
What is palliative care
Refers to patient and family centered care of that optimizes quality of life by anticipating preventing and treating suffering
