end-of-life care

Question 1

criteria for hospice care

Answer 1

Admission into hospice care is dependent upon the client meeting specific
criteria in addition to having a health care provider make a diagnosis of a
life expectancy of fewer than six months

Question 2

what is hospice care

Answer 2

• The administration of medical care to support the client who has a terminal illness, so they can live the last days of their life as best as they can, as long as they can.
• Provided when treatment will no longer cure or control the illness.
• Originally offered only to clients diagnosed with terminal cancer but has grown to include any client with a life-limiting illness.
• Interprofessional, holistic care that treats the whole person, including caregivers and family members.

Question 3

what is palliative care

Answer 3

• Holistic care provided throughout the lifespan for clients experiencing severe medical illness and particularly for clients approaching end of life.
• Goal is to improve quality of life for the client as well as the family and caregivers.
• Initially concentrated on lessening client suffering at end of life, but current
  best practice dictates it be implemented earlier in the course of life threatening health events.

Question 4

difference between palliative care and hospice care

Answer 4

• Palliative care is different from hospice care, as palliative care is provided while the client is still engaging in curative treatment methods.

Question 5

physiological changes at the end of life

Answer 5

• Physiological changes at the end of life follow a familiar pattern of signs and symptoms. The terminal phase of a client’s life is characteristically referred to as “actively dying” or “imminent death.”

Question 6

breathing and respiration alterations at the end of life

Answer 6

• Dyspnea: shortness of breath
• Retention of secretions in the respiratory tract, also known as “death rattle”
• Cheyne-Stokes respirations: an irregular respiratory rate fluctuating between several quick breaths and periods of apnea

Question 7

pain at the end of life

Answer 7

Experienced by nearly 60% of older adult hospice clients who have cancer
* Occurs because of nerve injury, organs being stretched and compressed, and/or bone pain

Question 8

temperature alterations at the end of life

Answer 8

• Ability of the nervous system to regulate body temperature diminishes, causing clients
  to experience both increased and decreased temperature.
• Also caused by infection, cancer, and cancer therapy.
• Mottling occurs hours or days before death, with the upper and lower extremities
  becoming cool to the touch. Mottling occurs as result of the heart’s inability to pump
  blood effectively, leading to decreased blood perfusion throughout the body.

Question 9

vision and hearing changes at the end of life

Answer 9

Clients may experience hallucinations or
report hearing and seeing those who have
already died.

Question 10

what is dignity

Answer 10

• Dignity is regarded as an everyday necessity, essential to the well-being of all clients. Most complaints related to nursing care at end of life are associated with a lack of caring.
• As clients near the end of life, illness contributes to a loss of control, which
  lessens their sense of dignity.

Question 11

what is good death

Answer 11

• When a client is actively dying, health care providers, family, and caregivers are responsible for providing a “good death” for the client. This generally includes pain management, planning for death, closure at the end of life, clear decision making, and being able to contribute to others.

Question 12

postmortem care

Answer 12

Physical care performed after death to prepare a body for viewing, autopsy,
or release to funeral home.
* Includes washing the body, accounting for the client’s possessions, removing invasive
devices such as intravenous catheters
and indwelling catheters, and placing
identification tags in at least two areas
(toe, arm, outside of body bag, etc.).
* Also includes documenting the date and time of death, the name of anyone notified, location of belongings, and where the client’s body is moved (funeral home name).

Question 13

organ and tissue donation

Answer 13

• As organ and tissue donation is voluntary, the donor must give authorization before death, or a surrogate can give permission when the client has not previously
  consented.
• A nurse is not allowed to begin a dialogue about organ or tissue donation with the client or a family member. Only health care
  professionals who have completed a course provided or endorsed by an organ procurement organization (OPO) are permitted to initiate the request of the client or surrogate.
• The nurse’s role is to assist families who are dealing with this challenging decision.