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
End of care
Analgesic Use
-Fear of hastening death
-Rule of double effect
-There will always be a “last dose”
If the pt suffers the pain, then what is the purpose to hold the med.
Give morifin to relieve the pain.
If the pt breath stops? its OK, reducing pain is more important
What is the end of life care?
The final phase of a pt illness is when death is imminent. 差し迫った
End-of-life care must consider the needs of the family, as well as those of the patient.
A TYPICAL need of family members is?
a- To avoid expressing their emotions
b- To find meaning in the death of the patient
c- To avoid being present at the patient’s deathbed
d- To be shielded from information about the patient’s changing condition
b- To find meaning in the death of the patient
Choose the true statement about palliative care and hospice
a- Hospice provides palliative care in the patient’s home only.
b- During hospice care, patients may receive treatment aimed at curing their disease.
c- Because hospice provides palliative care, other healthcare providers do not need to know about palliative care.
d- To qualify for hospice, a patient must have a terminal illness and a prognosis of no more than six months to live.
d- To qualify for hospice, a patient must have a terminal illness and a prognosis of no more than six months to live.
When should pain be assessed?
a- Only when the patient complains
b- Only if the family tells you the patient is uncomfortable
c- At each shift change
d- On a regular schedule, with any complaint or appearance of pain, and after administering pain medication
d- On a regular schedule
Which is the most accurate statement regarding spiritual and religious issues?
A- People at the end of life are too preoccupied with pain to consider what happens after death.
B- The interdisciplinary team usually includes a chaplain to assist with any spiritual concerns.
C- You should avoid discussing religion because you might upset the patient.
D- Patients of a different culture from their nurse will never want to discuss their beliefs with you.
B
Which is the best statement about communication:
A- Simple yes/no questions are best.
B- It is better to talk to the family and leave the patient out when discussing end-of-life care.
C- The use of big medical words will make the patient respect you more.
D- Open-ended questions help the patient to express his or her preferences.
D
Palliative care is best provided by:
A- A team of nurses
B- A team of social workers
C- A team of physicians and pharmacists
D- A team of interdisciplinary care providers
A
Which is an effective treatment that may be ordered for dyspnea and pain?
A- Opioids
B- TENS
C- Ibuprofen
D- Oxygen
A- Opioids
Opioids, like morphine, can be effective for pain and dyspnea
Only for end of care, it is OK if the pt breathing stop, reducing pain is more important
A good practice for providing adequate end-of-life care is:
A- Offer hope for a cure to the patient, regardless of prognosis.
B- Ask direct questions about the patient’s symptoms.
C- Try all possible treatments to prolong a patient’s life.
D- Never address end-of-life preferences with patients
B
Which of the following is a key feature of palliative care?
A- One goal of palliative care is to control pain.
B- One goal of palliative care is to cure the patient.
C- One goal of palliative care is to find the cause of disease.
D- One goal of palliative care is to eliminate the source of disease.
A
Which of the following is important for meeting the needs of a dying person’s family?
A- Restrict family members from performing simple care tasks.
B- Make firm predictions about the patient’s exact clinical course.
C- Provide a clear description of what the dying process will look like.
D- Strictly enforce visiting hours and limitations on number of visitors.
C
During a palliative care evaluation:
A- Avoid giving the patient an estimate of “time left.”
B- Help the patient identify possible sources of support.
C- Focus on discussing treatments aimed at curing the disease.
D- Discuss physical symptoms, but avoid discussion of psychosocial needs.
B
The patient who is actively dying:
A- Is always fully aware of his or her surroundings
B- Should be isolated from any visitors
C- Tends to have a somewhat predictable set of signs and symptoms
D- Always has an increased appetite
C
A patient receiving nursing care in a home hospice program can expect which kind of care?
a. The use of high-technology equipment such as ventilators until time of death.
b. Around-the-clock skilled direct nursing patient care until time of death.
c. Pain and symptom management that will achieve the best quality of life.
d. Complete relief of only distressing physical symptoms.
C
Which symptom is most distressing and feared by terminally ill patients?
a. Difficulty breathing
b. Confusion
c. Pain
d Loss of consciousness
C
The terminally ill patient who is near death has loud, wet respirations that are disturbing to the family.
Which interventions by the nurse are appropriate at this time? (select all that apply)
a. Position the patient on her side.
b. Place a small towel under her mouth.
c. Use oropharyngeal suctioning to remove the secretions.
d. Administer an ordered anticholinergic drug to dry up the secretions.
e. Teach family members how to use the suctioning device whenever needed.
a. Position the patient on her side.
b. Place a small towel under her mouth.
d. Administer an ordered anticholinergic drug to dry up the secretions.
Which interventions after a patient’s death are appropriate to perform? (select all that apply)
a. Remove the body to the morgue or funeral home immediately after death.
b. Follow agency policies to remove all tubes and lines from the body.
c. Make sure that the physician has completed and signed the death certificate.
d. Provide privacy for the family and significant others with the deceased.
e. Allow family and/or significant other to perform religious and cultural customs.
b. Follow agency policies to remove all tubes and lines from the body.
c. Make sure that the physician has completed and signed the death certificate.
d. Provide privacy for the family and significant others with the deceased.
e. Allow family and/or significant other to perform religious and cultural custom
A hospice patient is deteriorating and the family is concerned about his restlessness and agitation. Which intervention is the nurse prepared to perform?
a. Notify the primary health care provider and request orders for transfer to the hospital.
b. Determine if the patient is in pain, provide, analgesics, and make the patient as comfortable as possible.
c. Initiate IV hydration to provide the patient with necessary fluids.
d. Encourage the family to assist the patient to eat in order to gain energy.
B
The most common treatment of pain in a terminally ill patient is administration of which kind of therapy?
a. Opioids
b. Steroids
c. Nonsteroidal antiinflammatory agents
d. Radiation treatments
A
End of life care
Pain
- We lose indicators, hard to assess the pain
- Ask the family if there is any sign they can notice that the pt seems uncomfortable
- *Before treating, rule out**
- Maybe pain from constipation?
- Maybe delirium?
- Maybe pressure injury?
- Maybe mucositis?
Terminal Secretions
“death rattle” 24-48h before death
A type of noisy breathing from retained secretions that sounds like snoring or rattling during the inspiratory and expiratory phases of respiration
End of life care
Pain
- We lose indicators, hard to assess the pain
- Ask the family if there is any sing they can notice that the pt seems uncomfortable
- *Before treating, rule out**
- Maybe pain from constipation?
- Maybe delirium?
- Maybe pressure injury?
- Maybe mucositis?
Mucositis
When mouth or gut is sore and inflamed
Poor oral or dental health
End of life period
Psychological need
Experience great loss
Fear and anxiety are common
-Fear of uncontrol pain and suffering
-Fear of abandonment
We are here to take care of the process
End of life period
Spiritual
- Seeking meaning?
- Hope
- Role of religion
End of life period
Social culture
- Death experience
- View of death
- Social custom
- How to talk about death
- Affect decision making
- *We always respect whatever pt’s decision**
An 80 years old female patient is receiving palliative care for heat failure The primary purpose of her receiving palliative care is(are)? SATA
a. improve her quality of life
b. assess her coping ability with diseases
c. have time to teach patient and family about disease
d. focus on reducing the severity of disease symptoms
e. provide care that the family is unwilling or unable to give
a,d
For the past 5 years, Tom has repeatedly asked his mother to donate his deceased father’s belonging to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband.
What type of grief is Tom’s mother experiencing?
a) adaptive
b) Disruptive
c) Anticipatory
d) Prolonged
d
The family attorney informed the pt’s adult children and wife that the patient did not have an advance directive after he suffered a serious stroke.
Who is responsible for making the decision about EOL measures when the pt cannot communicate his or her specific wishes?
a) Notary and attorney
b) Physician and family
c) Wife and adult children
d) Physician and nursing stuff
C
What is the advance directive?
Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time.
患者自身で医学的な決定ができない状態（意識喪失や昏睡状態など）になった場合に治療やケアを受けるかどうかについて患者の希望を記載した法的書類
The home health nurse visits a 40 years old pt with metastatic breast cancer who is receiving palliative care. The pt has pain at level 7. In prioritizing activities for the visit, what should the nurse do first?
a) Auscultate breast sound
b) Give as-needed pain medication
c) Check pressure points for skin breakdown
d) Ask family about pt’s food and fluid intake
A nurse has been working full time with terminally ill pt for 3years. He has been expressing sadness since 4 of his pt died on the same day. To optimize the quality of his nursing care, he should examine his own
a) full-time work schedule
b) past feeling toward death
c) pattern for dealing with grief
d) demands for involvement in pt care
C
optimize – 最適化
