End of Life Care Flashcards

Question

non-pharm interventions regarding severe agitation and restlessness (and delirium)

Answer 1

Assess for underlying cause, acknowledge the family’s distress, educate and reassure Play soothing music, keep the room dimly lit and use aromatherapy Do not restrain the person Apply wet cloths on the patient’s face Reduce the environmental stimuli Talk quietly and keep the noise level to a minimum

Answer 2

Haloperidol Benzodiazepines

Answer 3

Decrease stimuli Avoid any triggers (if any are known)

Answer 4

Benzodiazepines Barbiturates

Answer 5

Keep the perineal area clean and dry Use disposable underpads or chux pads and disposable undergarments If the person would be more comfortable, consider a Foley catheter

Answer 6

Cover the person with a blanket Do not use an electric blanket, hot water bottle, electric heating pad, or hair dryer to warm the person

Answer 7

Offer physical and emotional support by “being with” the patient Respect cultural preferences Be realistic Encourage reminiscence Promote spirituality and hope Avoid explanations of the loss Communicate with the patient Provide referrals to bereavement specialists Teach about the physical signs of death Ensure that the patient is receiving palliative care, with an emphasis on symptom management

Answer 8

This life is a transition between the previous life and the next Postdeath rituals are important. Bodies are cremated. During the first 10 days after death, relatives must create a new ethereal body Karma is the manner through which one reaps benefits and penalties of pas actions. “Good karma” leads to good rebirth or release, and “bad karma” leads to bad rebirth or pain and suffering during release Health care decisions may be made communally with senior family members as final authority

Answer 9

The dying person is encouraged to recite the confessional or the affirmation of faith, called the Shema Disclosure is important, most patients want to know the truth According to Jewish law, a person who is extremely ill and dying should not be left alone The body should not be left unattended until the funeral, which should take place as soon as possible (preferably within 24 hours) Autopsies are not allowed by Orthodox Jews, except under special circumstances The body should not be embalmed, displayed, or cremated

Answer 10

Treatment by someone of the same gender is preferable Cremation is the most common way of disposing of the dead Some Buddhists may be unwilling to take pain-relieving medications or strong sedatives, as it is believed that an unclouded mind can lead to a better rebirth Buddhists believe that after death there is either rebirth or nirvana – the latter being enlightenment that frees the soul from the cycle of death and rebirth

Answer 11

Based on belief in one God Allah and his prophet Muhammad. Qur'an is the scripture of Islam, composed of Muhammad's revelations of the Word of God (Allah) Death is seen as the beginning of a new and better life God has prescribed an appointed time of death for everyone Qur'an encourages humans to seek treatment and not to refuse treatment. Belief is that only Allah cures but that Allah cures through the work of humans Upon death, the eyelids are to be closed and the body should be covered. Before moving and handling the body, contact someone from the person's mosque to perform rituals of bathing and wrapping body in cloth Fasting during the month of Ramadan is a pillar of Islam

Answer 12

There are many Christian denominations, which have variations in beliefs regarding medical care near end of life Christians believe in an afterlife of heaven or hell once the soul has left the body after death, this believe in eternal salvation sets Christianity apart Roman Catholic tradition encourages people to receive Sacrament of the Sick, administered by a priest at any point during an illness. This sacrament may be administered more than once. Not receiving this sacrament will NOT prohibit them from entering heaven after death People may be baptized as Roman Catholics in an emergency situation (e.g., person is dying) by a layperson. Otherwise, they are baptized by a priest

Answer 13

Withdrawal Vision-like experiences Letting go Saying goodbye

Answer 14

Periods of apnea and Cheyne-Stokes respirations Wet, gurgle ”death” rattle as the patient breathes Blood pressure decreases Peripheral circulation decreases Skin is cold and mottled Hypersomnolence

Answer 15

Breathing stops Heart stops beating Pupils become fixed and dilated Body color becomes pale and waxen Body temperature drops Muscles and sphincters relax Urine and stool may be released Eyes may remain open, and there is no blinking The jaw may fall open Observers may hear trickling of fluids internally

Answer 16

Note time of death that the family or staff reported the cessation of respirations Identify the patient by the hospital identification (ID) tag; note the general appearance of the body Ascertain that the patient does not rouse to verbal or tactile stimuli. Avoid overtly painful stimuli, especially if family members are present Auscultate for the absence of heart sounds; palpate for the absence of carotid pulse Look and listen for the absence of spontaneous respirations Record the time at which your assessment was completed Document the time of pronouncement and all notifications in the medical record (i.e., to attending physician). Document if the medical examiner needs to be notified (may be required for unexpected or suspicious death). Document if an autopsy is planned per the attending physician and family If your state and agency policy allows an RN to pronounce death, document as indicated on the death certificate After the patient dies, ask the family or other caregivers if they would like to spend time with the patient to assist them in coping with what has happened and say their good-byes Call organ donation within 1 hour of death Before preparing the body for transfer, ask the physician whether an autopsy will be required After the family or significant others view the body, follow agency procedure for preparing the patient for transfer to either the morgue or a funeral home In the hospital, a postmortem kit is generally used with a shroud and identification tags

Answer 17

is the emotional feeling related to the perception of the loss. Patients who are dying suffer not only from the anticipated death but also from the loss of the ability to engage with others and in the world

Answer 18

refers to individual, family, group, and cultural expressions of grief and associated behaviors

Answer 19

refers to the period of time during which mourning for a loss takes place

Answer 20

Denial Anger Bargaining Depression Acceptance

Answer 21

Crying Headaches Difficulty sleeping Questioning the purpose of life or their spiritual beliefs Feelings of detachment Isolation from friends and family Abnormal behavior Anxiety Frustration Guilt Fatigue Anger Loss of appetite Aches and pains Stress

Answer 22

Encourage story telling and reminiscing Assess for coping skills Assess for social support Support groups, bereavement groups, counseling Assess for signs of complicated grief

Answer 23

Antidepressants Anti-anxiety Sedatives

Answer 24

In caring for patients at the end-of-life, questions of right and wrong may arise in relation to treatment options The ANA’s Code of Ethics for Nurses provides a framework for the nurse to support patients, with guiding principles being the patient’s right to self-determination and the nurse’s adherence to professional nursing standards The most common ethical dilemmas a nurse will encounter are determining decisional capacity, withholding or withdrawing life-prolonging measures such as: Ventilator support, dialysis, artificial nutrition and hydration, requests for hastening death, and concerns related to proxy decision making

Answer 25

As illness progresses, patients, families, and clinicians may believe that without artificial nutrition and hydration, patients who are terminally ill will starve, causing profound suffering and hastened death, however: The use of artificial nutrition and hydration (tube and intravenous fluids and feeding) carries considerable risks and generally does not contribute to comfort at the end-of-life Similarly, survival is not increased when patients who are terminally ill with advanced dementia receive enteral feeding No data supports an association between tube feeding and improved quality of life in these patients

Answer 26

Health care recognizes the right to choose for or against medical treatments when a patient is of sound mind and can relay a rationale for or against treatments. Further, patients may choose to withdraw or withhold life-sustaining treatments and allow natural death if such therapies are not aligned with their wishes When faced with a progressive life-limiting illness, some cannot fathom suffering at the end-of-life and explore options to hasten death In its 2013 position statement on Euthanasia, Assisted Suicide, and Aid in Dying, the ANA acknowledged the complexity of the assisted suicide debate but clearly stated that nursing participation in assisted suicide is a violation of the Code for Nurses

Answer 27

: (aka passive euthanasia) An act of omission (e.g., withholding or withdrawing treatment) that might prolong the life of a person who cannot be cured by the treatment. In this situation, the withdrawal of the intervention does not directly cause the patient's death

Answer 28

An act by which the causative agent or treatment in the death of a patient is administered directly by another

Answer 29

The action to end the patient's life is taken without the patient's consent

Answer 30

A practice whereby a physician provides a means (e.g., medication) to a patient with the knowledge that the patient will use the means to commit suicide

Answer 31

Involves taking an action intended to have a good effect, which also has a known harmful effect. This is not active euthanasia

Answer 32

During the pandemic, symptom management at the end-of-life has required revisions due to logistical challenges such as medication shortages and preservation of personal protective equipment Due to high risk of infectious transmission, family members may not be permitted to see loved ones at the end-of-life Family meetings are primarily virtual, where proxies must make difficult decisions such as resuscitation and intubation, and even removal of life support Meanwhile, health care providers are struggling from high physical workload demands while simultaneously experiencing moral and psychological distress

Answer 33

Nurses might learn how to help family members grieve, but seldom learn how to deal with their own feelings of sadness or loss Debrief with staff Help with rituals of the patient and family if appropriate Discuss the death with friends and family Attend the funeral Pray or draw strength from spiritual beliefs Use relaxation techniques Healthy personal habits, including diet, exercise, stress reduction activities (e.g., dance, yoga, meditation), and sleep, help guard against the detrimental effects of stress

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End of Life Care Flashcards

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