End of life care Flashcards
Medication for restless and mild agitation?
Midazolam- benzo used for sedation and to alleviate anxiety and restlessness
Priorities for patients at end of life?
Pain/symptom management, family coping strategies/needs, and spiritual support resources
Is decreased appetite a normal part of dying?
Yes
What is best way to maintain patient comfort r/t pain at end of life?
Around clock analgesics (pain will get out of control if PRN dosing)
Do DNR orders need to be discussed with MRP before they can be put on a patients chart?
Yes
What is palliative care?
Approach to care that improves quality of life of pt/fam who are facing life threatening illness. It prevents and relieves suffering through early intervention, correct assessment and treatment
What is end of life care?
Ensure peaceful and meaningful death by providing compassionate care, relieving S+S, supporting quality of life, and guiding pt/families through the dying process
Bereavement vs grief?
B- period after death of loved one where they experience grief and mourning. Time spect in this stage is based on the individual
G- normal reaction to loss, can be anger/guilt/sad/depression/despair, disruption in sleep/change in appetite/physical symptoms
What is anticipatory grief?
Grief that takes place before actual death
Spiritual needs at end of life?
Assessment of their needs is key to respect their wishes. Assess their beliefs/values/practices and make referrals as appropriate
MAID criteria?
Must have serious illness in advanced state of decline that can’t be reversed
Assessment of end of life patient?
Focus on comfort care and supporting fam. Can do brief review of body systems, pain assessment, and assess for constipation/nausea/dyspnea. Usually do this once per shift
Physical assessment characteristics of end of life pt?
Coolness of extremities (mottled or discoloured skin), increased sleeping (b/c of decreased metabolism), decreased appetite, incontinence (perineal muscle relaxes), congestion (unable to cough secretions well- place on side, don’t suction in the mouth), breathing pattern change (irregular, cheyne stoke- periods of apnea), restlessness, and disorientation (speak soft and reorient)
S+S of end of life?
Decreased sensation and perception of pain/touch, mottling, cold/clammy skin, cyanosis on nose/nails/mouth, decreased UO, in continence, BM may occur before/at time of death, increased RR, cheyne stoke resp, inability to cough/clear secretions, congested breathing. Increase in HR then slowly decrease, weakening pulse, irregular rhythm, and decreased BP. Blinking will be absent/eyes can glaze
Death rattle vs cheyne stoke resp?
DR- loud wet respirations at end of life
CSR- apnea alternating with periods of rapid breathing
Nursing interventions at EOL?
Symptoms management/comfort, meet physiological needs, psychosocial (comfort, prepare fam), may need O2/nutrition/pain relief/mobility/skin care
What to do for pain?
Use meds like cannabis (reduces pain but only for refractory cancer pain) or opioids. Can also initiate music therapy, massage, and aromatherapy
What to use for respiratory secretions and breathing?
O2 therapy, bronchodilators, morphine (alters perception of air hunger-dyspnea and reduces pulmonary congestion), atropine (decreases resp secretions)
What is hyposcyamine given for?
SC administration of fluids in small amounts in dehydrated adults
What characterizes death?
Irreversible cessation of circulatory/resp function (no HR or RR for a full minute), cessation of functions of entire brain, and vital organs/systems cease to function
What happens after patient is pronounced dead based off of physical assessment?
Prepare body for immediate viewing of family and allow for time alone/privacy
How to prepare a dead body?
Close eyes/mouth, remove dentures, removes tubes/dressings (anything put in by hospital staff), wash body as needed, pillows to support head
What is advance care planning?
Pt and fam discuss EOL care and clarify their values/goals and express it in a advanced directive
What is a living will?
Identifies what one would want/not want if death if near (like CPR, DNR, artificial ventilation or nutrition)
