End of Life Issues - EXAM 3 Flashcards
Advance Directives
Legal documents stating the wishes of an individual regarding future medical care treatments and/or who should make those medical decisions in the event that the individual is no longer capable of giving personal informed consent.
Living Will
- Provides information of preferences regarding end of life issues: types of care to provide and whether to use various resuscitation measures
- Basis is “if-then” plan and the condition stated as “if” must be dianosed by a physician
Durable Power of Attorney (POA) for Health Care AKA Health Care Proxy
- Legally designates a substitutionary decision maker for medical decisions should a patient be unable to make informed decisions for self
- May be family member or trusted friend
- May diminish family conflict and facilitate the provision of the care that the patient wishes
Physician Orders for Life-Sustaining Treatment (POLST)
Known as MOLST (Medical Orders for Life-Sustaining Treatment) In NY state
- Includes limitations on resuscitation in the event of cardiac or R. arrest, including DNR
- Moves from one care setting to another
- DNR order does not limit other types of care setting to another
- DNR order does not limit other types of care that can be provided (wound care, pain management, antibiotics, O2)
- Based on effective communication of patient wishes, documentation of medical orders on a brightly colored form, and a promise by health care professionals to honor patient wishes
- Must be signed by a physician and reviewed periodically
- Can be revoked or modified at any time
What is the American Nuses’ Association’s stance on the RN role in advance directives?
- Understanding and implementing the laws of advance directives
- Ask and inform each patient about advance directives
- Serve as a patient advocate for patient wishes
Palliative Care VS Hospice/Comfort Care
Palliative care is defined as the active total care of patients whose disease in not responsive to curative treatment. Palliative care focuses on controlling pain and other symptoms, as well as reducing psychological, social, and spiritual distress for the patient and family. Palliative care is the framework for hospice/comfort care because it can start much earlier in the disease process.
Hospice, a concept of care that is traditionally limited to the projected last 6 months of life, if often used interchangeably with comfort care. It provides support, care, and compassion for the dying so that they might live as fully and and as comfortable as possible.
Tips for working dying children
- Be flexible. Straightforward approaches don’t always work with children
- Recognize that many children communicate best through nonverbal means such as artwork or music. They also may be more willing to talk things over with puppets or stuffed animals than with real people.
- Respect both children’s need to be alone and thier desire to share. Allow communication, don’t force it.
- Be receptive when children initiate a conversation. Opportunities to teach may be fleeting, and to capitalize on them, you n eed to respond immediately.
- Be specific and literal in explanations of death. Euphemistic expressions that equate death with sleep or going on a long trip can be very confusing for children.
- Acknowledge that child’s life can be complete, even if it’s breif. Let dying children know that they’ll always be loved and remembered, and help them find a sense of accomplishement and purpose in the lives they’ve led.
- Empower children as much as possible in circumstances concerning their own deaths. Reassure them of continued love and physical closeness, provide adequate symptom relief, and involve them in decisions regarding care as much as possible
Hydration
While IV hydration has been provided routinely to many dying patients, research has called this practice into question.
- Many patients refuse fluids and food when they are dying
- An increase in endorphins, which result from dehydration and decreased nutrition can produce analgesia and anesthesia
- No decrease in comfort has been reported due to dehydration
- IV infusion of D5W contains enough carbohydrate to block the anesthetic effect of ketosis
- Nature restricts fluid intake and accelerates fluid loss; anoerexia, vomiting, dirrhea, wound drainage and bleeding
- Artificial hydration in a paitent with end-stage organ failure worsens peripheral and pulmonary edema, dypnea, acites, edema around tumors, and pleural effusions
Anxiety and Depression
- Encouragement, support, education
- Pharmcological and non-pharmacological interventions
Fear of Pain
- Assure prompt administration of pain medications/side effect managemnt
- Encourage patient participation in discussing pain relief measures
Fear of shortness of breath
- Determine cause of dyspnea
- Opiods, brocnhodilators, O2, anxiety-reducing agents to provide relief
Fear of lonliness and abandonment
- Provide companionshio
- Hold hands, listen, touch
Fear of meaninglessness
- Help patients review their lives
- Remain nonjudemental with patient’s life review
Communication
- Demonstrate empathy and understanding
- Listen and interact in a sensitive way
Anger
- Acknowledge and encourage the expression of feelings
- Do not react on a personal level