EOL care Flashcards
serious illness
health condition that carries a high risk of mortality and either negatively impacts a person’s daily function or QOL or excessively strains their career
palliative care
focuses on assessment and management of pain and other symptoms, person can still receive curative treatments
hospice care
provided to pts with life expectancy of < 6 months if disease takes its natural course
-main focus is on improving pt and family quality of life
-comprehensive care in variety of settings
hospice settings
-pts private home
-assisted living
-long term facility
-in patient hospice
-hospice residential facility
sudden death
occurs unexpectedly
-MI
-car accident
chronic illness
pts with chronic illness who have periodic crisis and eventually die
-COPD / HF
**steady decline but can live for years
progressive deterioration
pts with illness that cases a prolonged decline ending in death
-alzheimer’s
weeks remaining care
- decrease socialization
- mental status change
- decreased oral intake
- fatigue
- bedbound w/ potential skin breakdown
- decrease function status
days remaining care
- oliguria or anuria
- little / no response to auditory or visual stimuli
- death rattle!!!
- terminal lucidity - rally day : surge of energy before death
- temperature fluctuations
- increase HR
- near death awareness experience - talking to those that have passed
hours remaining care
- cooling / mottling extremities
- bradycardia
- terminal secretions
- prolonged apnea periods, cyanosis, waxy facial experience
- obtundation- dulled LOC
pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage
**most feared symptoms of pts with serious illness
barrier to pain relief - pts
-reluctance to report pain
-sensory impairments compromising communication
-concern about not being a “good” pt
-inability to pay for meds
-fear of addiction
-older = assume pain is normal
barrier to pain relief - healthcare professional
-inadequate knowledge
-pain scales
-lack of continuity of care
-poor communication
-regulation of controlled substances
-potential for addiction
barrier to pain relief- healthcare system
-fail to hold healthcare professionals accountable
-shorter length of hospitals stays
-lack culturally tailored pain scales
-lack policies to document pain assessment
-lack pain mgmt specialist
-restrictive opioid policies
-insurance
-limit access
-pharmacy deserts
acute pain
1-3 months
chronic pain
3-6 months
nociceptive pain
r/t damage of bones, soft tissue, internal organs
-somatic and visceral
neuropathic pain
generally d/t damage of nervous system
-burning , tingling , shooting
OLD CARTS
onset
location
duration
character
alleviating / aggrivating
radiating
timing
symptoms
pain physical exam
- observation
- palpation
- percussion
- auscultate
pain reassessment
15-30 min after IV meds
1 hour after immediate release meds
**reassess using same pain scale as before
acetaminophen (non-opioid)
analgesic and antipyretic
AE = liver dysfunction
**liver dysfunction gets no more than 2,000mg
morphine (opioid)
pts with moderate to severe pain , first line
DO NOT give an unarousable pt a dose of morphine UNLESS pt is EOL and is being kept comfortable!!!!!
sublingual morphine
5mg given every 15min until pt is comfortable
YOU WILL NOT kill them if giving them the correct amount
opioid AE
constipation!!!
sedation
urinary retention
nv/
pruritis
myoclonus
pain plan not working
ADVOCATE!
-increased doses
-different opioid
-additional analgesics
pediatric pain
often mistreated r/t
-fear of addiction
-belief of no pain
-inappropriate knowledge
pediatric pain signs
change in HR / BP / O2
withdrawn, irritable, not engaging
**TALK TO PARENTS they know what is normal
withdrawing care (terminal weaning)
most common withheld medical intervention
pts may exhibit resp distress s/s
improving palliative care
RN must be knowledgeable about benefits
provide compassion
alternative listener
advocate for family and pt
work with interprofessional team
