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Med Surg 1 > end of life care > Flashcards

end of life care Flashcards

1
Q

death

A

cessation of integrated tissue and organ function, manifesting with lack of heartbeat, absence of spontaneous respirations, irreversible brain dysfunction
- part of normal life

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2
Q

nurses impact on pt death

A
  • preventing death without dignity
  • helping pt remain free of distress
  • minimizing suffering for pt. and families
  • observe pt. and families wishes
  • observe clinical practice standards
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3
Q

Patient Self-Determination Act (PSDA)-

A

federal law, compliance is mandatory, ensures that a patient’s right to self-determination in health care decisions be communicated and protected

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4
Q

Advance directive (AD

A

written statement of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor

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5
Q

Durable power of attorney for healthcare (DPOAHC

A

aka healthcare proxy, healthcare agent, or surrogate decision maker, makes health care decisions once the health care provider states that the person is unable to make his or her own health decisions

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6
Q

only time dnr can be override

A

during surgery

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7
Q

hospice

A
  • Model for quality, compassionate care for people facing life-limiting illness or injury
  • Often provided to those with terminal cancer, dementia, end-stage COPD, cardiac disease, neurologic disease
  • not expected to recover
  • less than 6 month to live
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8
Q

Palliative Care

A
  • Philosophy of care for people with life-threatening disease
    Goal is to improve quality of life for patient and family
  • managing pain and illness
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9
Q

cues of end of life

A
  • Symptoms of distress (e.g., respiratory distress, hemorrhage, pain)
  • Weakness
  • Sleeping more
  • Anorexia
  • Changes in organ system function (e.g., cardiovascular function, breathing patterns, and genitourinary function)
  • Level of consciousness (LOC)
  • Changes in vital signs: pulse irregular and decrease, bp drop, restlessness, dim lights

teach family interventions that relieve discomfort and stress

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10
Q

Psychosocial assessment

A

Fear, anxiety
Cultural considerations
Values
Religious beliefs

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11
Q

Psychosocial assessment: HOPE

A

H: Sources of hope and strength
O: Organized religion (if any) and role that it plays in one’s life
P: Personal spirituality, rituals, and practices
E: Effects of religion and spirituality on care and end-of-life decisions

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12
Q

Psychosocial assessment include

A

assess
provide
offer
encourage

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13
Q

Psychosocial assessment : assess

A

Assess patient and family for expectations of the death experience

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14
Q

Psychosocial assessment: Provide

A

Provide with information about the process of death (see pg. 140 for common physical signs and symptoms of approaching death with recommended comfort measures; see pg. 141 for common emotional signs of death approaching)

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15
Q

Psychosocial assessment: offer

A

Offer bereavement counselor or clergy

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16
Q

Psychosocial assessment: encourage

A

encourage saying goodbye

17
Q

Potential for symptoms of distress that would prevent a peaceful death

A 
Pain
Weakness
Breathlessness/dyspnea
Nausea and vomiting
Agitation and delirium
Seizures
18
Q

How we can help pain

A

pain management consists of nonopioid and opioid analgesics

  • Medical Marijuana (Cannabis)
  • nonpharmacologic interventions: message, guided imagery, music, good mouth care
19
Q

How we can help nausea and vomiting

A

assisted with a biphosphate enema

  • mineral oil
  • disimpaction
  • antiemetic agents: zofran
  • removing source of odor, aromatherapy
20
Q

How we can help weakness

A
  • Use of a mechanical or electric bed
  • insertion of a foley catheter
  • limited oral intake which causes dehydration so mouth care is needed
  • aspiration precautions needed
21
Q

How we can help Breathlessness

A
  • pharmacologic interventions used (e.g. morphine sulfate, antibiotics, anticholinergics, benzodiazepines, bronchodilators, corticosteroids, diuretics),
    oxygen therapy,
  • Nonpharmacologic interventions
  • scalpony patch
22
Q

How we can help agitation

A
  • Assess for other reversible cause (pain, urinary retention, constipation)
  • d/c medications that cause delirium, antipsychotic drugs to control psychotic symptoms
  • music therapy
  • aromatherapy
23
Q

How we can help seizures

A
  • Drug therapy used (e.g., Benzodiazepines such as diazepam and lorazepam)
  • pads
  • adivan
24
Q

planning and implementation

A
  • Needs and preferences acknowledged and met
  • Control/management of symptoms of distress
  • Meaningful interactions with family and other loved ones
  • Peaceful death
25
Q

Managing Refractory Symptoms of Distress

A

Palliative sedation may be needed to decrease suffering

  • Promotes comfort
  • Does not hasten death
  • Is different from euthanasia
26
Q

meeting psychosocial needs for family

A
  • Assess what patients and family understand, and what the desired outcomes of care are
  • mourning- outward social expression of loss
  • Greif: emotional feeling related to the perception of loss
  • presence- concept of being with instead of being there
27
Q

5 stages of grief

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
28
Q

meeting psychosocial needs for pt.

A
  • life review
  • reminiscence
  • spirituality
  • religion
29
Q

spiritual needs

A
  • Helps to identify patient’s spiritual needs
  • Consider end-of-life preferences based on cultural beliefs, practices
  • Spiritual or existential distress can occur regardless of one’s religion
  • Acknowledge spiritual pain and encourage verbalization
  • If desired, arrange for counseling, chaplains, spiritual leaders, etc.
30
Q

postmortem care

A
  • If death was unexpected, medical examiner is notified
  • Check agency policy for who pronounces death, and completes death certificate
  • Allow family and caregivers to spend time with the patient if they desire
  • Determine if autopsy is needed or permitted
  • Follow agency procedure for preparing the body for transfer
31
Q

End of Life:Evaluation: Evaluate Outcomes

A
  • The expected outcomes are that the patient with end of life care will:
  • Have needs and preferences acknowledged and met
  • Have control/management of symptoms of distress
  • Experience meaningful interactions with family and other loved ones
  • Experience a peaceful death
32
Q

active euthanasia

A

Not supported by most health professional organizations in the U.S., including the American Nurses Association

33
Q

Physician-assisted death (PAD)

A

Legalized in some European countries

Legally approved in some states within the U.S.

Med Surg 1 (25 decks)

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