End Of Life (Fundamentals 10, Burke 13) Flashcards
Loss
any potential, actual or perceived situation when valued object or person has changed or not accessible.
Maturational
naturally occurs over time. Death due to aging. occurs as person moves from one developmental stage to the next
Situational
in response to external events beyond person’s control
Categories of LOSS
1) significant other
2) aspect of self
3) external object
4) familiar environment (moving)
Grief
- Intense PSYCHOLOGICAL responses that occur after loss
- necessary, normal, natural adaptive responses
Mourning
- Period of TIME in grief.
- Physical outward appearance (cultural aspects, i.e., Italians wear black for ever, Asians where white, Catholics wear veils etc.)
Bereavement
- Period of GRIEF after death of loved one
- emotional aspect of suffering
Stages of Grief
SHOCK: feeling of emotional numbness
REALITY: painful experience after one consciously realizes the loss
ACCEPTANCE/RECOVERY:
Type of Grief
- UNCOMPLICATED: Normal
- ANTICIPATORY: before expected loss (waiting for sick grandma to die)
- DYSFUNCTIONAL: intense, persistent pattern that is not reconciled.
- DISENFRANCHISED: can’t grieve openly (i.e. side chick can’t grieve for married man)
Factors affecting Loss/Grief
- Developmental Stage (teens, toddlers, adult, elderly)
- Religion/Culture
- Relationship w lost object (sentimental value, significant other v acquaintance)
- Cause of death (tragic surprise, long term illness)
Nursing Care to grieving client
- determine personal meaning of loss
- encourage clients to feel it (let it out)
- assess client progress through stage of grief
- renew patients ability to do ADLs alone
Goals for those in Grief
- accept loss
- verbalize feelings of grief **
- share grief w significant others
- renew activities and relationships
Implantation of Goals
- spend time listening
- demonstrate acceptance
- non judgmental attitude
- provide reassurance, support and counseling resources
Death
last stage of life
PSDA
Patient Self Determination Act
Always ask patient about Advanced directives. (i.e. living will, Health care proxy, DNI/DNR)
legal means to specify circumstances under which life sustaining measures should or should not be rendered.
Advance Directives
- written instructions of client wishes
- includes durable POA for health care and living will.
Stages of Death/Dying
Elizabeth Kubler Ross
1) Denial
2) Anger
3) Bargaining
4) Depression **NORMAL in this case
5) Acceptance
EOL care consists of
- control of symptoms (comfortable as possible)
- ID of needs
- promotion of interaction
- facilitation of peaceful death
Palliative Care
relief of symptoms
care delivered by interdisciplinary team to manage psychological, social, spiritual needs
Hospice
- less than 6 months to live
- Death with dignity
- no technology unless it is palliative
- i.e. morphine drip to slow breathing and for pain
2 biggest fears of dying
- dying alone
- dying in pain
How to communication and demonstrate acceptance
hold clients or family hand and say “ I will not leave you” etc.
Physiological Needs of Dying
- Respiration
- fluid/nutrition
- mouth,eyes, nose
- mobility
- skin care
- eliminations
- comfort
- physical environment
Signs of Impending Death
- lungs can’t provide adequate gas diffusion (LOW O2)
- LOW perfusion of heart and vessels (cold hands/feet)
- brain shuts down
- Cheyne Stokes respirations (death rattles, loud breathing)
Physical signs of Death
- absence of hearbeat
- cease respirations
- mottling of skin (patchy)
- eyelids slightly open
- jaw relax, slight open mouth (tie post mortem)
- no reponse to name, touch, sound
- eyes fixed on certain spot, no blinking
- release of bowel/bladder contents (GI shut down)
- LOW output, due to LOW intake
Nurse care after death
- treat body w respect
- bath, clean gown
- remove dressings/tubes
- body w elevated head
- dentures in denture cup (send w body)
- comb hair
Legal Aspects
- MD certifies death (EMT, MEDIC only if it’s obvious like decapitation)
- Autopsy
Shadow Grief
- loss of energy, spark, joy or meaning
- detachment from surroundings
- powerlessness
- UP smoking/drinking
- unusual forgetfulness
- constant criticism of others
- trouble completing projects
- outbursts of anger
- surrendering hobbies/interests
How do you prevent mottling of the face?
elevate head post mortem.
Reasons for Autopsy
- unaccompanied death
- suspicious death (family not required to give consent)
- crime (family not required to give consent)
- If doc has suspicion of malpractice by nurse, family must give consent.
Gate Control Theory
whichever sensation makes it out the gate to the brain, is the sensation the body feels. (i.e. Icy Hot to distract brain and make it feel less of main pain. )
Salicylates
- NSAIDs, nonsteroidal anti-inflammatory drugs. ASPIRIN
- treatment of mild to moderate pain
- inhibit synthesis of prostaglandin and other mediators in the process of inflammation and have anti-inflammatory, antipyretic and analgesic properties.
- Salicylates can be used to reduce fever, pain and inflammation such as in arthritis.
Salicylates Toxity
- Nausea
- vomiting
- diaphoresis
- **-tinnitus (8th cranial nerve damage)
- vertigo,
- hyperventilation,
- tachycardia,
- hyperactivity.
As toxicity progresses,
- agitation,
- delirium,
- hallucinations,
- convulsions,
- lethargy,
- stupor
severe toxicity
-Hyperthermia
When administering pain meds, when should you initiate?
BEFORE pain is bad.
Steroids, Opiates
Problems
?? Tylenol drug class and toxity?
analgesics (pain relievers) and antipyretics (fever reducers).
relieves pain by elevating the pain threshold, by requiring greater amount of pain to develop before a person feels it.
reduces fever through heat-regulating center of the brain. tells the center to lower the body’s temperature when the temperature is elevated.
Toxicity???
Pain Threshold
point which person recognizes pain (varies little mi people)
Pain Tolerance
Amount and duration one can stand before seeking relief. (varies among all)
Type of Pain meds
- Analgesics: relieve reduce pain
- non opioods: pain releif not derived from Opium (Tylenol)
- Opiods
- adjuvant analgesics
Non Opiod/ NSAIDs
Mild Pain, NSAID
Act on peripheral nervous system
reduce pain by interfering w prostoglandin synthesiss (ibuprofen, aspirin, ketorolac)
There IS an analgesic ceiling
Opiods
- Mild - Severe pain
- analgesia by binding to opioid receptors in CNS (brain, spinal cord)
Types:
Agonist: morphine, hydromorphone, codeine
Antagonist: buprenophine, nalbuphine
Nurse responsibility in Perinatal care
Make sure family sees body of deceased baby to ensure acceptance and knowing it’s real.
Types of Pain
Neuropathic: diabetic neuropathy, numbing, tingle
Cutaneous: sharp, cut, skin
Somatic: deep muscle
Active vs Passive Euthanasia
z
5 aspects of human function
physical, emotional, intellectual, socio-cultural, spiritual
Morbidity
about sickness and disease
Mortality
about death
