End of Life Care (Final)

Question 1

Loss

Answer 1

undesired change or removal of a valued object, person, or situation

Question 2

Category of Losses

Answer 2

actual
perceived
physical
psychological
external
environmental
loss of significant relationships

Question 3

Grief

Answer 3

physical, psychological and spiritual responses to loss

Question 4

Mourning

Answer 4

action associated with grief

Question 5

Bereavement

Answer 5

mourning and adjustment time following a loss

Question 6

Major Theorists of Grief

Answer 6

Engel
Bowlby
Rando
Worden
Kubler-Ross
Stroebe and Schut
Klass, Silverman and Nickman
Neimeyer

Question 7

Factors Affecting Grief

Answer 7

significance of loss
support system
unresolved conflict
circumstances of the loss
previous or multiple losses
spiritual/cultural beliefs and practices
timeliness of death
developmental stage of bereaved

Question 8

Types of Grief

Answer 8

uncomplicated (normal)
dysfunctional/complicated (chronic, masked, delayed)
disenfranchised
anticipatory

Question 9

Physiological Stages of Dying

Answer 9

1-3 months prior to death
1-2 weeks prior to death
days-hours prior to death
moments prior to death

Question 10

Palliative care

Answer 10

holistic comfort care
provided over long period of time
once they reach stage of disease where cure is not possible or they refuse further treatment
do not have to be actively dying!!

Goals: increased pt and family satisfaction, improved symptom control, cost saving

Question 11

Hospice care

Answer 11

holistic care of dying clients (likely to die within 6 months)
pain management is priority

Question 12

Legal and Ethical Considerations

Answer 12

advance directives
power of attorney (POA)/ durable POA
DNR
organ donation

Question 13

Assessment for terminally ill client and family

Answer 13

knowledge base
history of loss
coping abilities and support systems
meaning of the loss/illness
depression or grief
physical assessment
cultural and spiritual assessment

Question 14

Nursing Interventions

Answer 14

grief work facilitation (counseling, spiritual support, support group, anxiety reduction)

coping enhancement (emotional support, relaxation therapy, forgiveness facilitation)

Question 15

Helping Families of Dying Patients

Answer 15

explore coping mechanisms
remind family members and significant others to take care of themselves
ask directly if family wants to be present at time of death
acknowledge feelings of family
do not intrude at moment of death

Question 16

Final Days and Hours Before Dying

Answer 16

surge of energy
difficulty swallowing, dry mucous membranes
irregular respirations and dyspnea
clammy, cool skin and weak pulse
retained urine and feces (incontinence)
facial drooping
vision may blur
restless and agitated or coherent and energized

Question 17

Barriers of EOL Communication

Answer 17

fear of one’s own mortality
unresolved personal grief issues
lack of experience with death and dying
fear of expressing emotion
fear of not knowing an answer to a Q
not knowing whether or not to give an honest answer
not understanding family culture
keeping physical distance
insensitivity