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NUR 333 Funds II > End of Life Care > Flashcards

End of Life Care Flashcards

1
Q

Palliative care

A

paid by insurance, self, Medicare, Medicaid
within hospital
Completed same time as curative treatment
Any stage of disease-time of DX

Prevention, relief and reduction in symptoms of disease

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2
Q

Hospice care

A

paid by Medicare or Medicaid
<6 months of life left
Excludes treatment/cure
Terminal patients
Completed at home

priority-manage pain, quality of life

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3
Q

When can palliative care be started?

A

as soon as diagnosis is given
Along with curative services

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4
Q

interdisciplinary team

A

Nurse
Physician
Pharmacist
Social worker
Chaplain

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5
Q

Communication with hospice care

A

Understanding the diagnosis of less than six months to live

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6
Q

Communication with palliative care

A

Understanding receiving curative treatment, but acceptance of illness stage

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7
Q

types of conversations

A

Family meeting
Nurse family conversation-goals, prognosis, support
Nurse physician conversation-advocate, plan

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8
Q

hard conversations

A

Fear of provoking distress
Lack of training
Don’t know the right words
Feel responsible
Handling outburst

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9
Q

Empathetic response

A

Don’t try to fix the emotions

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10
Q

nurse statements

A

accepting response
Validate feelings
Nonjudgmental

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11
Q

name the emotion

A

“I can see where this is scary”

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12
Q

understand

A

“ I can’t imagine what this is like”

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13
Q

respect the role of caregiver

A

Praise
“ I’m so impressed by…”

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14
Q

Support

A

“ we will be here for you the whole way”

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15
Q

Explore

A

“ tell me more”

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16
Q

“ I wish” statements

A

“ I wish we had more treatments for you”
“ I wish we had a surgery for you”

Demonstrates alignment with patient
Acknowledges it won’t happen

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17
Q

“ I worry” statements

A

“ I worry that waiting another week will…”
“ I worry that without a caregiver…”

Shares possibilities of bad outcome

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18
Q

Advanced care planning

A

Receiving information
Empowerment
Learning
Being in control
Thinking about end-of-life
Fear of confrontation
Worry about burning family
Routine treatment can ease unpleasantness

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19
Q

is advance care planning written, or verbal?

A

Written documents, discussing illness and end of life process

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20
Q

living will

A

Written document of patients wishes of medical treatment if patient becomes unable to communicate it

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21
Q

MOST

A

Portable documents of healthcare provider orders of patients carried by physician

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22
Q

Kentucky Living will

A

healthcare surrogate
No attorney needed
2 witnesses or notarized
Law prohibits relatives from being witness
Treatment wishes
Organ donation

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23
Q

five wishes

A

Advance directive
Legal document for medical treatment, comfort, and care
Must be filled out by patient who is competent
Two witnesses or notarized
Prompted

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24
Q

ethical issues

A

Informed consent
Withdrawing life-sustaining treatment
DNR’s
Artificial hydration/nutrition

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25
Influences of end-of-life
ethnicity Intracultural aspects Family relationships Class/socioeconomic status Generation
26
death with dignity, medical Aided dying (MAID)
competent, terminally, ill upon request, counseling, interviewing Receives lethal dose of medication to end own life
27
What is MAID not?
palliative sedation Euthanasia Pain medication
28
weeks-months-years
social withdrawal Decreased food interest and appetite Sleep extremes Disorientation Restlessness Decreased senses Incontinence Decrease BP Increased HR Weight loss
29
hrs-days-weeks
early-bedbound, decreased eating and drinking, increased sleeping, delirium Mid-decrease mental status, obtunded Late- death, rattle, not responding, but still breathing, fever, apnea, mottled extremities
30
Is there a difference in morphine and hastened death?
No difference in survival
31
Morphine related toxicity
drowsiness Confusion Altered LOC Prior to respiratory depression
32
anticipatory grief
Prior to death Mirrors morning Tangible and intangible losses
33
bereavement
Post Mortem
34
Loss oriented grief
Breaking bonds/ties Intrusion of grief Denial/avoidance
35
Restoration oriented grief
attending to life changes Distractions Still denial/avoidance New roles in relationships
36
Who is the patient’s biggest advocate in discharge planning?
Nurse
37
what can poor discharge planning lead to?
Medication mismanagement Health declines Safety issues Readmission
38
Considerations with discharge planning
enough time to teach and return demonstration Assistant/help at home Learner type Have caregiver at bedside to hear instructions
39
What are difficulties with discharge planning?
lack of time Demand of room Family hesitancy Social issues/transportation
40
When is it appropriate to discharge the patient?
discussed with team and nurse decides Safe discharge plan Disposition in tact Place to go to after Can appeal if nurse and patient don’t feel they are ready.
41
Grief
Present in loss, dwelling
42
dysfunctional grief
Deep grieving for years Reliance on alcohol or drugs Physical symptoms
43
Hopelessness
feeling lost Unable to cope Feeling abandoned
44
lack of knowledge
I don’t know why this is happening Is this normal?
45
Risk for loneliness
sense of isolation Difficulty establishing contact with others
46
priority hypotheses
life-threatening ABC’s – respiratory, heart Immediate concern-thoughts of suicide
47
what type of grief involves thoughts of suicide?
Dysfunctional grief
48
goals for grief
Affective coping Psycho social adjustment to life Accommodates grief Except reality of loss Maintains meaningful relationships Experiences resolution of grief with plans for a positive future
49
Multidisciplinary team
Family Primary HCP Hospice nurse <6 months Social worker/case manager Spiritual care provider
50
medicine reconciliation
Review home meds Review hospital meds Anticipate new meds -why, route, NA, SE How to Obtain meds-insurance, copay Teach back
51
diagnosis
Give brief description Explain how we treated in hospital Special recommendations When to call HCP Went to seek immediate emergency attention
52
example of when to call HCP
Incision is red painful Need pain meds
53
example of when to seek immediate health attention
Trouble breathing Chest pain Stroke symptoms
54
Procedure/surgery
give brief description Home care Follow up care When to seek medical attention Carry card, wear med alert bracelet
55
Diet
specifics of diet, not just name Foods that are good/bad Consul dietitian Plan grocery list Talk through favorite foods, may need to modify for healthier options
56
activity
What they can/can’t do What to do if new mobility issues If stairs are present Living situation-house layout
57
Case management/social services
durable medical equipment Home care Assisted care Wound care Aide PT/OT/SLP Financial Homelife – running water, electricity
58
Follow up appointment
within one week Specialty: living distance from facility, satellite, location, telehealth Who to contact of questions, phone number Transportation to, and from
59
Assessment of caregiver
General health checkup Focused, physical, mental, emotional symptoms Assess nutritional status Sleep evaluation Ability to maintain work and family roles Maintenance of dental in visual health Access social net work Support system evaluation
60
Grief assessment tools
relationship to deceased and quality of relationship Type of loss: expected, sudden, traumatic, disease based Current coping strategies Available support system Financial status History of previous Family assessment Satisfaction with current relationships
61
Physical changes in end-of-life
weakness and fatigue Increase drowsiness and sleeping Decreased responsiveness Decreased oral intake Decreased swallowing reflex Surges of energy Constipation, diarrhea, incontinent
62
S/sx of impending death
Decrease urine output- dark urine Circulatory changes in extremities, nose, fingers – color changes Cyanosis, pallor, mottling Decreased blood pressure Increased or decreased heart rate Apnea, labored, or irregular breathing cheyne Stokes Pulmonary congestion – death rattle
63
s/sx of death
no heartbeat or respirations Involuntary release of stool or urine No verbal response Decreased body temperature Partially shut eyelids Jaw may drop open skin color-bluish, waxen Rigor mortis-stiffening of joints
64
relevant cues for grieving
Obtained from patient and family interview Observation Medical record Signs and symptoms Example – still crying after five years
65
irrelevant cues for grieving
Not contributing to Grief Example – gender of deceased
66
most important cues of grieving
Findings of unexpected grieving Reactions and processes of patient
67
immediate concern cues of grieving
Unsafe or suicidal thoughts
68
masked grief
Person is unaware that behaviors conceal grief process
69
chronic grief
Normal grief over a long period of time with no progress getting better
70
delayed grief
Postponed grief as person, avoids the reality and pain of loss
71
exaggerated grief
Maladaptive or self-destructive behavior Alcohol and drugs
72
Advanced directive
Advanced declaration by a person of treatment preferences, if he/she is unable to communicate their wishes Copy must be kept in record
73
care environment interventions
Encourage favorite belongings Allow visitors Avoid unnecessary changes/procedures Provide psychological and spiritual comfort Promote dignity and peace
74
care of imminently dying patient
bathing as needed Oral care every 2-4 hrs, lip balm Skin care N/D/C Dehydration/nutrition – ice chips, or preferred food, if allowed, moist towel Assessment for new sx Pain– SL drops, suppositories Breathing Anxiety
75
postmortem care
Confirmation of death Pronouncement of death Federal and state law – organ, donation, autopsy, tubes remain/not Documentation of death Cultural aspects of care Prep body after death
76
documentation of death
Name Date and time HCP Findings of physical exam Preparation of body Personal items Time of transfer and destination Who is notified of death Location of body tags
77
Prep body after death
two nurses or nurse and tech confirm donor and autopsy Remove medical equipment from room Prepare for family viewing Cleanse, body, comb hair
78
Bill of rights
Respect advanced directive, and personal preferences assess and support services, like hospice and support groups having dignity and respect 12 total “ rights”
79
bereavement care
Follow up calls, cards Compassion Active listening
80
does palliative care hasten or prolong death?
No
81
Stages of dying (kubler and Ross)
Denial Anger Bargaining Depression Acceptance

NUR 333 Funds II (9 decks)

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