End of Life Care (Palliative)

Question 1

What therapeutic use of non-pharmacological pain management can cause rebound edema?

Answer 1

ice. - reduced circulation and edema, then can cause a rebound edema effect

Question 2

What non-pharmacological pain management is meant to be used to heal quicker?

Answer 2

Rest, however the longer one goes without it, the more difficult it is to use.

Question 3

What does the acronym POLICE stand for?

Answer 3

Position: make sure limb is in functional position
Optimal loading: you use the limb as tolerated (good for healing)
Ice
Compression
Elevation

Question 4

What is the main nursing intervention associated with pain management?

Answer 4

-individualized
-monitor for efficacy and SE

Question 5

How can cultural and religious perceptions influence pain?

Answer 5

Culture: inability to perform set roles expected of them = surrendering their role can cause psychological distress
Religious/spiritual: blaming God or feeling that they deserve to be punished so denies treatment.

Question 6

What process is a natural process for ct. to experience when a serious procedure or traumatic injury occurs?

Answer 6

Grieving process

Question 7

Who should be educated about pain management strategies?

Answer 7

pt and family/caretakers

Question 8

What is the goal of education of pt. and their loved ones?

Answer 8

Keep pt. as independent as possible; ROM; stretching; mobility; exercise

Question 9

What is the priority when someone as a geriatric bypass when it comes to mobility?

Answer 9

Get them moving ASAP. Sitting up in chair the first day. Walking back and forth to the bathroom the second day.

Question 10

What is a good way to explain opioid use to a client in fear but in need?

Answer 10

pain receptors are calling out, “help me, I’m in pain”. These are opiate receptors. Once pain medication is taken the receptors are calmed and pain is decreased.

Question 11

What are the odds of having addiction to opioids if used short-term

Answer 11

rare- if one feels they may need resources at any point during treatment we do have members of the care team who can begin tapering off. If experiencing high rates of pain, tapering off is not advisable.

Question 12

Besides side effects and efficacy, what else should be assessed as a potential SE?

Answer 12

idiosyncratic effects (abnormal)

Question 13

FLACC scale stands for?

Answer 13

Faces
Legs
Activity
Crying
Console ability

Question 14

Who is the Wong Baker Faces scale best used for?

Answer 14

Ethnic population with dif. cultures. shows faces of cultures that may relate better to how their culture would show pain

Question 15

What is the pain rating scale most commonly used?

Answer 15

numerical scale (1-10)

Question 16

What should be explained to pt. and their loved ones about the PNS?

Answer 16

being in a peaceful state ignites healing

Question 17

—– —— is pain that is chronic back pain that is resistant to relief

Answer 17

intractable pain

Question 18

What should be assessed for in ct.s with cancer?

Answer 18

-body image disturbance: no hair, very thin, maybe they have had a body part removed
-comping mechanisms: what seems to work for them
-support system/resources: cancer survivor peer coaches
-make referrals to interdisciplinary team as needed

Question 19

Pattern of contractions:

Answer 19

45-60 seconds of discomfort followed by 3-5 minutes of relaxation

Question 20

What can help prevent fear in pregnant ct.s?

Answer 20

Preparation through labor classes

Question 21

What type of imagery can be helpful for a woman in labor?

Answer 21

The rose bud blooming as the baby comes out.

Question 22

Which position is best for labor?

Answer 22

Any position that is not supine

Question 23

Why is supine position not recommended for labor?

Answer 23

puts pressure on the spine and can make the baby’s heart rate go down

Question 24

When may opioids be acceptable for the mother during labor?

Answer 24

If she hasn’t slept. If given to close to delivery however, can suppress the babies hr

Question 25

What is something to consider when it comes to administering opioids to a mother in labor?

Answer 25

If a baby is still in the womb, the baby will metabolize the opiates as the mother would while in the placenta, however, once removed the baby will not metabolize with a mature system= causes issues

Question 26

What should be monitored in a mother in a labor with an epidural?

Answer 26

bladder distension- lacks urgency to void *epidural numbs motor neurons

Question 27

What is the focus of end of life care?

Answer 27

physical and psychosocial needs for the ct. and their family

Question 28

three goals of end of life care:

Answer 28

-provide comfort & supportive care during the dying process
-improve the quality of their remaining life
-ensure a dignified death

Question 29

When is death considered to occur?

Answer 29

When all vital organs and systems cease to function.

Question 30

What are the two irreversible cessations that even when one is “alive” they are considered to be dead?

Answer 30

1. irreversible cessation of circulatory & respiratory function (machines are breathing for them)
2. irreversible cessation of the entire brain including the brain stem (brain dead)

Question 31

What is the sensory system physical manifestations of dying when it comes to hearing?

Answer 31

Usually the last sense to go. Always talk as if the patient is there and can understand what is being talked about. Any private conversations that are inconsiderate, even with the family, needs to occur outside of the room.

Question 32

What is the sensory system physical manifestations of dying when it comes to touch?

Answer 32

decreased sensation & perception of pain/touch

• beneficial when needing to reposition a ct.

Question 33

What is the sensory system physical manifestations of dying when it comes to taste and smell?

Answer 33

decreased with disease progression (let them eat what ever they want)

Question 34

What is the sensory system physical manifestations of dying when it comes to vision?

Answer 34

-blurring of vision & glazing of eyes
-blink reflex absent and eyelids remain half open (even when sleeping)

Question 35

What are the physical manifestations of dying when it comes to the integumentary system?

Answer 35

-mottling on extremities (red/purple marbling)
- cold clammy skin
-cyanosis on nose, nail beds, knees

Question 36

What are the physical manifestations of dying when it comes to the respiratory system?

Answer 36

-increased resp. rate
-Cheyne-Stokes breathing (periods of apnea & deep rapid breathing)
-inability to cough or clear secretions causing grunting, gurgling, or noisy congested breathing
-irregular breathing, gradually slowing down to terminal gasps

Question 37

What are the physical manifestations of dying when it comes to the urinary system?

Answer 37

gradual decrease in output
-incontinent of urine or inability to urinate

Question 38

What are the physical manifestations of dying when it comes to the gastrointestinal system?

Answer 38

-slowing of GI tract, leading to absent bowel sounds (no motility)
-accumulation of gas
-distention & nausea
-incontinence due to loss of sphincter control
-BM may occur before imminent death/ at time of death

Question 39

What are the physical manifestations of dying when it comes to the musculoskeletal system?

Answer 39

-gradual loss of ability to move
-sagging of jaw resulting from loss of facial muscle tone
-swallowing can become more difficult
-difficulty maintaining body posture/alignment
-loss of gag reflex (can aspirate)
-for pt. on large doses of pain meds (opioids) may see jerking

Question 40

What are the physical manifestations of dying when it comes to the cardiovascular system?

Answer 40

-increased heart rate (later = slower & weakened pulse/ thready)
-irregular rhythm
-decreased BP

Question 41

6 things a dying person may NEED:

Answer 41

-express feelings
-share worries and concerns
-talk (some things they may not want to talk about with family)
-me, as a therapeutic presence
-silence is OK- “therapeutic silence”
-therapeutic touch

Question 42

What will influence the care I provide for someone who is dying?

Answer 42

My personal attitude about death

Question 43

What do I do if someone is no code?

Answer 43

Monitor but don’t report

Question 44

What may the family of a dying person require?

Answer 44

-a private area to talk & make decisions
-may just need me to listen

Question 45

The focus of family members of a dying person is often on the pt. and they often neglect their own needs. What can I offer them?

Answer 45

-pillows, blankets, and a place to sleep
-meals if necessary
-Chaplain

Question 46

What is important to do with any information shared by loved ones about the dying pt.?

Answer 46

Ask if it is okay for me to share and report with the oncoming staff/healthcare team

Question 47

—— ——- is the active total care of individuals whose disease is not responsive to curative treatment (example: end stage COPD)

Answer 47

palliative care

Question 48

What is the focus of palliative care?

Answer 48

controlling pain & other symptoms

Question 49

—- —— is care provided when a pt. is terminally ill that provides compassion & support for the dying pt. & family

Answer 49

hospice care

Question 50

How long does hospice care support families of a dying pt?

Answer 50

one year after the pt. death anniversary

Question 51

What is the core belief of hospice and palliative care?

Answer 51

-Every person has the right to die pain-free and with dignity and that our families will receive the necessary support to allow us to do so.