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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
Q

Influences of end-of-life

A

ethnicity
Intracultural aspects
Family relationships
Class/socioeconomic status
Generation

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26
Q

death with dignity, medical Aided dying (MAID)

A

competent, terminally, ill upon request, counseling, interviewing
Receives lethal dose of medication to end own life

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27
Q

What is MAID not?

A

palliative sedation
Euthanasia
Pain medication

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28
Q

weeks-months-years

A

social withdrawal
Decreased food interest and appetite
Sleep extremes
Disorientation
Restlessness
Decreased senses
Incontinence
Decrease BP
Increased HR
Weight loss

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29
Q

hrs-days-weeks

A

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

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30
Q

Is there a difference in morphine and hastened death?

A

No difference in survival

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31
Q

Morphine related toxicity

A

drowsiness
Confusion
Altered LOC
Prior to respiratory depression

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32
Q

anticipatory grief

A

Prior to death
Mirrors morning
Tangible and intangible losses

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33
Q

bereavement

A

Post Mortem

34
Q

Loss oriented grief

A

Breaking bonds/ties
Intrusion of grief
Denial/avoidance

35
Q

Restoration oriented grief

A

attending to life changes
Distractions
Still denial/avoidance
New roles in relationships

36
Q

Who is the patient’s biggest advocate in discharge planning?

A

Nurse

37
Q

what can poor discharge planning lead to?

A

Medication mismanagement
Health declines
Safety issues
Readmission

38
Q

Considerations with discharge planning

A

enough time to teach and return demonstration
Assistant/help at home
Learner type
Have caregiver at bedside to hear instructions

39
Q

What are difficulties with discharge planning?

A

lack of time
Demand of room
Family hesitancy
Social issues/transportation

40
Q

When is it appropriate to discharge the patient?

A

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
Q

Grief

A

Present in loss, dwelling

42
Q

dysfunctional grief

A

Deep grieving for years
Reliance on alcohol or drugs
Physical symptoms

43
Q

Hopelessness

A

feeling lost
Unable to cope
Feeling abandoned

44
Q

lack of knowledge

A

I don’t know why this is happening
Is this normal?

45
Q

Risk for loneliness

A

sense of isolation
Difficulty establishing contact with others

46
Q

priority hypotheses

A

life-threatening
ABC’s – respiratory, heart
Immediate concern-thoughts of suicide

47
Q

what type of grief involves thoughts of suicide?

A

Dysfunctional grief

48
Q

goals for grief

A

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
Q

Multidisciplinary team

A

Family
Primary HCP
Hospice nurse <6 months
Social worker/case manager
Spiritual care provider

50
Q

medicine reconciliation

A

Review home meds
Review hospital meds
Anticipate new meds -why, route, NA, SE
How to Obtain meds-insurance, copay
Teach back

51
Q

diagnosis

A

Give brief description
Explain how we treated in hospital
Special recommendations
When to call HCP
Went to seek immediate emergency attention

52
Q

example of when to call HCP

A

Incision is red painful
Need pain meds

53
Q

example of when to seek immediate health attention

A

Trouble breathing
Chest pain
Stroke symptoms

54
Q

Procedure/surgery

A

give brief description
Home care
Follow up care
When to seek medical attention
Carry card, wear med alert bracelet

55
Q

Diet

A

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
Q

activity

A

What they can/can’t do
What to do if new mobility issues
If stairs are present
Living situation-house layout

57
Q

Case management/social services

A

durable medical equipment
Home care
Assisted care
Wound care
Aide
PT/OT/SLP
Financial
Homelife – running water, electricity

58
Q

Follow up appointment

A

within one week
Specialty: living distance from facility, satellite, location, telehealth
Who to contact of questions, phone number
Transportation to, and from

59
Q

Assessment of caregiver

A

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
Q

Grief assessment tools

A

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
Q

Physical changes in end-of-life

A

weakness and fatigue
Increase drowsiness and sleeping
Decreased responsiveness
Decreased oral intake
Decreased swallowing reflex
Surges of energy
Constipation, diarrhea, incontinent

62
Q

S/sx of impending death

A

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
Q

s/sx of death

A

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
Q

relevant cues for grieving

A

Obtained from patient and family interview
Observation
Medical record
Signs and symptoms

Example – still crying after five years

65
Q

irrelevant cues for grieving

A

Not contributing to Grief

Example – gender of deceased

66
Q

most important cues of grieving

A

Findings of unexpected grieving
Reactions and processes of patient

67
Q

immediate concern cues of grieving

A

Unsafe or suicidal thoughts

68
Q

masked grief

A

Person is unaware that behaviors conceal grief process

69
Q

chronic grief

A

Normal grief over a long period of time with no progress getting better

70
Q

delayed grief

A

Postponed grief as person, avoids the reality and pain of loss

71
Q

exaggerated grief

A

Maladaptive or self-destructive behavior
Alcohol and drugs

72
Q

Advanced directive

A

Advanced declaration by a person of treatment preferences, if he/she is unable to communicate their wishes
Copy must be kept in record

73
Q

care environment interventions

A

Encourage favorite belongings
Allow visitors
Avoid unnecessary changes/procedures
Provide psychological and spiritual comfort
Promote dignity and peace

74
Q

care of imminently dying patient

A

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
Q

postmortem care

A

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
Q

documentation of death

A

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
Q

Prep body after death

A

two nurses or nurse and tech
confirm donor and autopsy
Remove medical equipment from room
Prepare for family viewing
Cleanse, body, comb hair

78
Q

Bill of rights

A

Respect advanced directive, and personal preferences
assess and support services, like hospice and support groups
having dignity and respect

12 total “ rights”

79
Q

bereavement care

A

Follow up calls, cards
Compassion
Active listening

80
Q

does palliative care hasten or prolong death?

A

No

81
Q

Stages of dying (kubler and Ross)

A

Denial
Anger
Bargaining
Depression
Acceptance

NUR 333 Funds II (9 decks)

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