End of Life Care

Question 1

When is a person actually dead?

Answer 1

when lungs and heart cease to function

Question 2

Define clinical death

Answer 2

The short interval after cessation of heartbeat and breathing when no evidence of brain function is present

Question 3

What are 4 causes of death?

Answer 3

natural aging, emergencies (trauma, cardiac arrest), MODS (multiple organ system failure), disease related (cancer, aids)

Question 4

What are some goals for end-of-life care?

Answer 4

control symptoms, identify client needs, promote meaningful interactions between the client and significant others, and facilitate a peaceful death

Question 5

A holistic approach that does not hasten or postpone death, but provides relief of symptoms experienced by the dying client while providing emotional and spiritual support to improve the quality of care at the end of life is defined as what?

Answer 5

Palliative Care

Question 6

True or False, An interdisciplinary approach facilitates both quality of life and a good death for clients who are nearing the end of their lives is defined as Palliative Care.

Answer 6

False, Hospice Care

Question 7

What are some common symptoms of a patient at End-of-Life?

Answer 7

pain, dyspnea, agitation, nausea, vomiting, fatigue, weakness, constipation, anorexia, delirium

Question 8

A patient comes into the ER cold, mottled, and cyanotic skin. What would you expect his BP, HR, and RR to be? Increased or decreased?

Answer 8

Decreased

Question 9

As a nurse caring for a patient on comfort care, what are our main goals?

Answer 9

keep patient clean, dry, and odor free. Manage acute symptoms causing most problems

Question 10

Your patient on end-of-life care reports that feels extremely fatigued, what nursing care would you implement?

Answer 10

aspiration precautions, mouth care & moisture for lips, altered routes of medication

Question 11

What rational do you use for altering routes of medication for fatigued patients?

Answer 11

choose least invasive route of medication administration with the most effective treatment

Question 12

True or False, loss of their independence if the symptom that dying patients fear most?

Answer 12

False, Pain is the correct answer.

Question 13

Greg, your patient on palliative care is complaining of dyspnea. What are possible interventions you could implement?

Answer 13

treat primary cause and relieve the psychological distress that accompanies the symptoms, administer medications, administer oxygen, elevate the head of the bed or position patient on the side, and suction fluids from airway prn

Question 14

What are typical medication orders that may be given if a patient complains of dyspnea>

Answer 14

morphine sulfate, diuretics, bronchodilators, antibiotics, anticholinergics, sedatives, oxygen

Question 15

You are a student nurse taking care of a patient on comfort care. Your patient appears restless and agitated. Your nurse instructs you to figure out the underlying cause, administer an antimetic & a sedative, and consult with a spiritual/bereavement counselor. What treatment do you question?

Answer 15

antimetic

Question 16

A major part of caring for patients during the end-of-life is the psychosocial component. What are the 4 components of a psychosocial assessment?

Answer 16

Assess for fear, anxiety, cultural considerations & bereavement, and feelings of client & significant others

Question 17

True or False, grief is an unnatural process to death and dying

Answer 17

False. It is a NATURAL process

Question 18

What are the 5 stages of grief?

Answer 18

Denial, anger, bargaining, depression, and acceptance

Question 19

What is the difference between grief and mourning?

Answer 19

Mourning is external expressions of grief. Grief is internal sorrow.

Question 20

You are the nurse teaching the UAP about physical and emotional support. What are some key points you should make?

Answer 20

Be realistic about the facts of death and dying, encourage reminiscence of client’s life memories and stories, promote spirituality (including religion), foster hope, avoid explanation of loss, provide referrals to bereavement specialists, and communicate with client

Question 21

What are your nursing postmortem care responsibilities as the nurse?

Answer 21

legal considerations (death cert), determination of the need for an autopsy, and transfer of the body, notify MD, get death confirmation, and document your findings

Question 22

During the post-mortem period, what needs to be documented?

Answer 22

patient’s condition just prior to death, presence/absence of advanced directive, who pronounced the death, when was the family notified, and if donor services or autopsy referral made

Question 23

Your patient Miles just died, the family would like to view him, how do you prep the body before viewing?

Answer 23

Close eyes, put dentures in, clean up area, position in resting position, and gather valuables.

Question 24

Miles’ family has just left after viewing his body, what are your next actions?

Answer 24

shroud kit, lines and tubes removed, get body transferred to morgue.

Question 25

What is a shroud kit?

Answer 25

Kit to get the patient ready for transport to morgue: sheet, chin strap, ties, id tag with string ties, and plastic bag to hold person effects.

Question 26

What are some legal issues surrounding end-of-life care?

Answer 26

advanced directives, pronouncement, code or no code, death certificate

Question 27

What is the difference between a durable power of attorney, living will, and advance directive

Answer 27

DPOA- legal document assigning decision making power to another. LW- written instructions for end-of-life care. AD- document prepared by a competent individual specifying what extraordinary actions the person would want when no longer capable of making decisions about personal healthcare

Question 28

In which culture do the family generally make decisions and may request to withhold the dx ?

Answer 28

Hispanic

Question 29

True or False, in the Hispanic culture, vocal expression of grief and mourning are acceptable?

Answer 29

TRUE

Question 30

True or False, in German families members discuss issues with the spouse or older family member, family is valued and is central to the care of terminally ill patients, and open displays of emotion are common and accepted?

Answer 30

False, African Americans

Question 31

A common issue in dying patients is dehydration, what nursing interventions would you implement?

Answer 31

Maintain regular oral care, encourage taking ice chips or sips of fluid, do not force the client to eat or drink, use moist cloths to provide moisture to the mouth, and apply lubricant to the lips and oral mucus membranes.

Question 32

You end-of-life patient, Sara, is having issues with elimination (shes has been incontinent all day). What nursing interventions do you implement?

Answer 32

monitor urinary and bowel elimination, place absorbent pads under the client and check back frequently

Question 33

Sara also appears really weak and fatigued what are your nursing interventions?

Answer 33

provide rest periods, assess tolerance for activities, provide assistance and support prn for maintaining bed or chair positions.

Question 34

Camren, another one of your end-of-life patients, is really restless. What are your nursing interventions for this patient?

Answer 34

maintain a calm soothing environment, do not restrain, limit the number of visitors at the client’s bedside (consider cultural practices), and allow a family member to stay with the client

Question 35

What are some strategies to discuss death with patients and their families?

Answer 35

encourage expression of feelings, determine how much the client and family want to know, is there a spokesperson for the fam, be honest, use problem solving if they asked to help in decision making, if you don?t know what to say.. Listen attentively and use therapeutic communication such as open-ended questions or reflection

Question 36

What are some personal reactions to dying (nurse perspective)?

Answer 36

reliving the event, dreams, increased tobacco use, eating more/less, withdrawal, doubting performance, humor (maladaptive)

Question 37

True or False, legal and ethical issues include organ and tissue donation, advance directives or other legal documents, withholding or withdrawing treatment, and cardiopulmonary resuscitation

Answer 37

TRUE

Question 38

_____ care focuses on caring interventions and symptom management rather than cure for diseases that no longer respond to treatment

Answer 38

Palliative Care

Question 39

______ care provided support and care for clients in the last phase of incurable diseases so that they might live as fully and as comfortably as possible

Answer 39

Hospice Care

Question 40

True or False, only client needs are the focus of any hospice care intervention

Answer 40

False, client and family