End Of Life Care Flashcards
What is the definition of end of life care
Term used for issues and services related to death and dying
What doe palliative care do for pt’s
Reducing severity of disease symps
Improve QOL
Decrease economic costs of health care
Alleviate burden of caregivers
Pain control
What is hospice care
A concept that helps a pt die pain free and with dignity
A physician decides to place a pt on hospice care when they feel that the pt has how many months to live
6 months
When a pt is on hospice are they allowed to try new cures or survives for their illness
No
If a pt chooses to seek a cure while they are on hospice, what happens
The pt will be discharged from hospice and able to go seek treatment
Can a pt join or leave hospice at any point
Yes they can
If a pt on hospice goes to the ER and chooses to be admitted to the hospital, what happens to their hospice
they are discharged from hospice but can come back after being discharged from the hospital
Hospice wants to provide the best
Best quality of life
What settings can hospice care be done
Home
Inpatient settings
acute and long-term care facilities
Rehabilitation centers
What are the four levels of hospice care
Routine home care
Inpatient respite care
Continuous care
General pt care
What defines routine home care
Med admin
Daily baths
Hospice pays for meds and DMEs
Full care at home
What is inpatient respite care
It is where the family can choose to put pt in a facility for 5 days to take a break and get rest
What is continuous care
Caregiver stays all day or goes multiple times a day
When giving pain meds to hospice pts are we worried about respiratory distress with those pain meds
No because hospice pts are in lots of pain and need these meds
Why do we want to do a spiritual assessment of pt and family
Want to know these beliefs for comfort
Why should we assess and manage family needs
We always worry about the family and want them to be comfortable along with the pt
We need to teach the family about what management in general
Pain management
What are the four awareness contexts
Closed awareness
Suspected awareness
Mutual pretense awareness
Open awareness
What is the definition of closed awareness
Everyone in family knows pt is dying but do not want the pt to know
So hospice cannot say they are from hospice
What is the definition of suspected awareness
Pt suspects something is going on but the family hasn’t told them anything about what is going one
What is the definition of mutual pretense awareness
Pt and family are aware of pt dying but no one is talking about what’s happening
What is the definition of open awareness
Everyone knows what’s going on (pt and family)
What two DNRs do hospice pts need
In hospital and out of hospital DNRs
What two advanced directives should hospice pts have
A living will
Power of Attorney
What is a living will
This is what pt wants done in case something happens to them
What is a power of attorney
In case pt is incapacitated this distinguishes a person to make medical decisions on their behalf
What is assisted suicide
Where you are given meds to kill yourself but you get to choose when and where. A medical professional does not give you these drugs
Is assisted suicide legal
Yes, but only in some states
What is euthanasia
A medical professional hooks you up to iv and runs the meds that will kill you
Is euthanasia legal
No it is not
For assisted suicide you must have proof of what
Proof of terminal illness
As hospice nurses we need to ask what a pt wants done, like?
Organ & tissue donations
Advanced directive
Resuscitation
Mechanical ventilation
Tube feeding placement
What are barriers to end of life care
Cures for disease
Financial criteria, reimbursement issues
Cultural, social issues
Discomfort with death (family, pt, and med staff)
Psychological, coping responses to death, dying denial
What do hospice pts have to be on in order to have care
Insurance or Medicaid/Medicare
When communicating with a hospice pt we should
Reflect on pwn experiences
Use lay terms, not medical jargon
Respect cultural background
Be fully present in convo
Silence is okay
Allow pt, family to set agenda regarding depth of convo
Allow pt and family time to reflect
Avoid distractions
Avoid impulse to give advice
Avoid canned responses
Ask q’s
Address your and pt’s understanding
We should give culturally competent care by owing what
Understand cultures may have different processes about death
Assess nonverbal cues
Is spiritual care synonymous with religion
No
Does spirituality include religion
Yes
As hospice nurses we must assess the spirituality because
It’s an important care of a dying pt
What physical care do hospice nurses do
Symptom management and comfort
Priority is to meet physiologic and safety needs
Deserve and require same care as people who are expected to recover
As end of life care nurses we should help treat these 5 symptoms
Pain
Dyspnea
Nausea
Weakness
Anxiety
What are signs of approaching death
Refusal of foods/fluids
Urinary output decreases
Weakness, sleep, confusion, restlessness
Impaired vision/hearing-hallucinations
Thick secretions
Cheyenne-Stokes Reparations
CV changes
Integumentary changes - develop mottling, Kennedy terminal ulcer
Third-spacing
As death approaches we need to monitor for
System failure
If pt is alert we need to review body systems to detect
S/S
If patient is alert we need to also asses for what four things
Discomfort
Pain
Nausea
Dyspnea
We need to asses what abilities of pts and family
Coping
We need to pay attention to subtle ___ changes
Physical
We need to advocate for our pt’s what when they are passing
Needs
We need to make sure pt’s psychosocial needs are met like (7)
Anxiety
Depression
Anger
Hopelessness
Powerlessness
Fear
Communication
Pts may have a fears such as (5)
Pain
SOB
Loneliness
Abandonment Meaninglessness
We need to have these four parts of communication
Empathy
Active listening
Silence
Respect cultural differences
What physical care do we do for end of life care
Oxygen
Nutrition
Pain relief
Mobility
Elimination
Skin care
Postmortem care
What concepts go into postmortem care
Pronouncement of death
Allow privacy & as much time as family needs with deceased
When to call medical examiner
Security takes body to morgue
Security releases the body to the morgue
When do we need to call medical examiner
Death upon arrival or death occurs w/in 24 hrs of admission
Death was result of homicide or unnatural means
Absence of a witness
Suicide or suspected suicide
Dies w/o being seen by a licensed provider
Child younger than 6 when death is not expected
What should we document when a pt passes in our care
What time vitals ceases
Who pronounced death at what time
What postmortem care was done
Where are pts clothing and valuables and who did we give them too. If there is not family give belongings to security
What time and who came to pick them up for the morgue
Name of funeral home
Is there going to be an autopsy
Across the dismissal form write deceased
What is bereavement (grief)
3 days after death
Grief is a
Reaction to loss
What is anticipatory grief
Know death is coming. Grieving at diagnoses and then grieving again once family member has passed
What is adaptive grief
Acceptance of the person passing and moving on with life
What is prolonged grief disorder
Family stops living and grieves
Do not live for themselves anymore
What are the 5 stages of grief according to the Kubler-Ross model
Denial
Anger
Bargaining
Depression
Acceptance
What comprises the grief wheel model
Shock
Protest
Disorganization
Reorganization
