End Of Life Flashcards
End of life
Is when there is no cure for a persons disease and the focus is on comfort care and dignity
Palliation
Relief of suffering when a cure is impossible
Terminal phase
Is a phase within end of life when the patient is actively dying
End of life 2
The process of dying is an individualised one, unique because of a person’s life experiences and belief
Goals for end of life
Respect of patient and family wishes
Patient and family feel a sense of control over the situation
Patient is physically comfortable
Patient has spiritual support according to their wishes
Psychological needs
Denial Anger Bargaining Depression Acceptance
Communication
Communication is through presence, compassion, touch, promoting autonomy and honesty
Nurses may facilitate patients being able to express their needs by being open, honest, direct and empathic in their communication
Spiritual needs
Meaningful existence
Ability to find meaning in daily experience
Ability to transcend physical discomfort and prepare for death
Respect for religious beliefs and rituals
Physical needs
Pain Respiratory distress Constipation Poor nutrition intake Anorexia Dehydration Decreased muscle tone
Nausea and vomiting causes
Bowel obstruction Medication Ear infection Kidney/liver failure Increased intracranial pressure Offensive odours Anxiety
Non pharmacological treatment nausea
Review diet Small frequent mela Reduce environmental odours Good oral care Good bowel management Review meds
Pain non-pharma
Hot/cold packs
Positioning
Relaxation
Distraction therapy
Dyspnoea
Upright position
Open windows
Oxygen therapy dries the nasal mucosa and may create more distress
Fan
Constipation non pharma
Encourage fluids
Gentle exercise
Gentle abdominal massage
Insomnia (non-pharma)
Encourage good routines
Address concerning issues
Refer to social worker
Signs of imminent death
Decline in bp Weak pulse Dyspnea and periods of apnea Reduced pupil response to light Profuse perspiration Cold extremities Faecal or urinary incontinence Pallor Reduced level of consciousness No urine Dependent oedema Blurred vision
Decision making
Advanced care planning that is supported by good communication and promotes patient autonomy in regards to paitentwishes is the cornerstone for providing effective for patients transitioning into the end of life stage
Decision making parts
The person must be competent and have the capacity to participate in the decision making process
Process are in place that protect the individuals autonomy when they can no longer explicitly express their wishes
Advanced care directive
Proxy directive
Advanced care directives
Living will
Proxy directive
Enduring power of attorney
Decisions are made regarding end of life
Environment
Funeral
Care options
Medical treatment
Practical assistance from the nurse
Aggressive treatment pf any distressing symptoms
Open and honest communication
Ongoing discussion of patient’s goals
Psychological and spiritual support
Interdisciplinary approach to provide for holistic care
Support pf bereaved families
