End of life care Flashcards
End-of-life care include?
- Physical support
- Emotional support
- Social support
- Spiritual support
What are the criteria for required admissions to hospice?
-Life expectancy is determined by the 2 healthcare provider (less than 6 months)
- Patient and family preferences for disease-modifying treatment
- Caregiver’s opinions about future hospitalizations
- Something they do, but do not require*
- -Caregiver referral(照会) to a bereavement support group*
What is Palliative care?
-Any point in the disease diagnosed
-Clinical Settings
-Concurrent with Disease-Modifying Treatment
(life-prolonging treatment)
-Some insurance reimbursement, but usually not
The major difference between palliative care and hospice care
Palliative care allows a person to receive a)__________ treatments.
Hospice is provided once a person decides to b)________ curative treatments.
a) curative
b) forgo
What is Hospice care?
Care to disease— Stop
Pain management—Continue
-Six months or less of life
(support for the dying process)
-Cessation of Disease-Modifying Treatment 停止
(If they get injured, they can still get surgery)
-The pt can out hospice and come back in anytime
-At clinical or home
- Covered by Medicare and Medicaid
- Hospitalizations not covered by insurance
Role of the nurse
1) LISTEN!!
2)Conduct holistic assessments
physical, psychological, social, spiritual
Grief?
Grief is what we think and feel on the a)__________ when someone we love dies.
It is the b)__________ feelings and b)_________responses.
Grief is the normal reaction to loss
a) inside
b) high individualized
c) emotion
- Bereavement?
- Mourning?
1 ) Period of grief and mourning that occurs after a loss
2) Outward, social expression of grief and loss
We mourn by talking, crying, journaling
Type of grief
Anticipatory
- The normal mourning process
- Expecting loved one’s death
- This is also normal
- Typically involves more anger
Type of grief
Delayed
- Emotional reaction to loss doesn’t happen right away
- Somehow the reaction is postponed
- The death was sudden or unexpected, shock and denial can cause
Type of grief
Complicated
- Ongoing, heightened state of mourning that keeps healing
- Intense sorrow(悲しみ）, pain
Type of grief
Disenfranchised
- When others avoid talking to someone about a painful loss
- Cliché that minimizes that loss
- When this happens, the visible evidence of the grief tends to disappear from public sight
Nurse’s Role with Loss and Grief
- Grief is never predictive, everyone takes a different journey
- No judgment
- Find which stage at the pt, and support
- Cultural, religious practices
- Practical help
- Provide privacy
Things to avoid saying to who lost loved one
I’m here to support you is the best response!
- “I know/can imagine/understand how you feel…”
- “You’ll get over this.”
- “You are so lucky to have had so much time together.”
- “At least your loved one’s suffering is over, and he/she is in a better place.”
- “Your loved one lived a really long and full life.”
The Dying Person’s Bill of Rights
1: I have the right to be treated as a living human until I die.
2: I have the right to maintain a sense of hopefulness, however, changing its focus may be.
3: I have the right to express my feeling about my approaching death in my own way.
4: I have the right to participate in decisions concerning my care.
5: I have the right to not die alone.
6: I have the right to be free from pain.
7: I have the right to have my questions answered honestly.
If you don’t know, it is OK to say “I don’t know” but also say that “I am not the person to provide the information, so let me ask the doctor”
Illness Trajectories 4types
1) Sudden death
2) Terminal illness/can’t be cured and is likely to lead to someone’s death
3) Organ failure/gradually worse, never be reverse
4) Frailty/aging-related syndrome of physiological decline
End of life symptoms
- Dyspnea/50% off pt
- Pain
- Confusion
- Agitation
- Fever
- Constipation
- Incontinence
- Decreased intake
- Terminal secretions
Nursing Assessment
Psychological
- Experience great losses
- May become introspective
- Fear and Anxiety Common
- Fear of uncontrolled pain and suffering
- Fear about dying process
- Fear of abandonment
- Fear of the unknown
Nursing Assessment
Social
- Death experience
- Views of death
- Social customs
- How to talk about death
- Impacts relationships
- Affects decision-making
Nursing Assessment
Spiritual
- Seeking meaning?
- Hope and/or despair?
- Role of “religion”
- Do they have a spiritual leader?
Nursing Diagnosis and Planning
Preferences
- Where death occurs
- Who will with present
- How the death will occur
- Opinions of the current plan of care
- Definition of quality of life
- Decision maker
When pt is dying….
Artificial Hydration/Nutrition
Pt decrease intake because the body no longer need them
=Organ and kidney shots down
More burden than benefit- nausea, vomiting, distension
Family member are worry about this, so need to education
Mucositis
When mouth or gut is sore and inflamed
Poor oral or dental health
