FON Ch 25, 38, 40 Grief Death Nd Dying, Hospice Care, L.T.C. Flashcards
Loss
Aspect of self no longer available to a person
Griefwork
Process of morning
Mortality
The condition of being able to die
Stages of dying
Denial Anger Bargaining Depression Acceptance
Obvious losses
Death and divorce
Not so obvious loss
Pregnancy, babies w/challanges
Maturational loss
Consequence of aging, homesickness, leaving for school etc
Situational loss
Job, spouse, home
Personal loss
Childhood experiences, view of loss as crisis, financial impact, accumulated loss experience,
Bereavement
Response to death of a loved one
Mourning
Helps to assist in healing from loss
Nurse role
Active listening
Supportive presence
Educate them on what is expected
Explore ways to help patient make new emotional investments
Unresolved dysfunctional grief
Complicated grieving
Unresolved grief/mourning is delayed or exaggerated response to a perceived, actual, or potential loss
Stuck in grief process
Depressed/ unable to express feelings
Sense of presence
Variable sensations
Smells/visions
Complicated grief (saying)
‘I can’t believe they’re gone’
Exaggerated grief
Becoming overwhelmed by grief
Unable to function
Delayed grief
Normal grief reactions suppressed/postponed
Euthanasia passive
Permitting death by withholding treatments/meds, life support systems, feeding tubes that may extend life
Euthanasia active
Assisting in such a death
Living will
Pt makes preferences for care and tx known to drs. In the event he is not able to do so in the future
POA
Power of attorney one or more persons act in your behalf
Healthcare proxy
Another person who will speak for the person and make decisions regarding the pt care
Communicating w/dying pt
Therapeutic communication
Express respect for patient
Offer support
Careful attention to verbal and nonverbal
Assist patient in saying goodbye
It’s ok if pt does not want to talk
Palliative care
Provide relief from pain and other distressing symptoms
Affirm life and regard life as normal process
Neither hasten/postpone death
Morphine
Can help relax respiratory effort
Not only for dying
Most crucial needs
Control of pain
Preservation of dignity and self worth
Love and affection
Assessing for impending death
Can limit interventions like q 2 hr repositioning
Special supportive care
Perinatal death-facilitate holding the baby
Reality of death
Pediatric death- feelings of parental guilt
Suicide
Gerontologic death
Sudden/unexpected death
S/Sx of imminent death
Pupils dilated and fixed
Cheyenne- stokes respirations
Pulse weaker and more rapid
Bl pressure continues to fall
Profuse diaphoresis
Skin cool and clammy
Death rattle;noisy respirations
Clinical signs of death
Unreceptive and unresponsive
No movement or breathing
No reflexes
Flat ekg
Absence of apical pulse
Cessation of respirations
Postmortem care
ASAP after death to prevent tissue damage or disfigurement
Offer family opportunity to view body
Prepare body and room
Minimize stress of the experience
Body; as natural & comfortable as possible
Institutional settings
Subacute unit
LTAC-long term acute care
Psychiatric
LTC-2 categories of residents
Short term-rehab/skilled nursing
Long term/they live there-Restorative nursing
Least restrictive to most restrictive
Home/community services (hospice daycare)
Assisted living facility
CCRC/ continuing care retirement community
Institutional setting
Omnibus budget reconciliation act (OBRA 1987)
Defines quality of care for LTC
Mandates presence of actual nurses
Administered by healthcare financing administration (HCFA)
Unannounced surveyors
residents assessment inventory (RAI)
Improved care, planning and provisions for LTC residents
Sources of reimbursement
Medicare-65+/disabled
Limited funding toLTC
Medicaid-federally funded state operated program
Medical assistance to people w/low incomes, qualifying conditions
Private pay
What are goals of LTC
Pt. centered individualized OBRA
Prioritize physical and mental status
Quality of life
Residents rights
Interdisciplinary settings
Healthcare professional work together
Meet needs of older adults
Facility managed by administrator and DON
Joint commission:National or. safety
Goals- identify pt. correctly
Use medicine safely
Prevent infection
Fall prevention
Prevent pressure injuries
Palliative vs.curative care
Active tx no longer effective
Supportive measures needed
Assist terminally ill or thru dying process
Offer support and safe passage from life to death
Preserve dignity and important relationships
Quality not quantity of life emphasized
Not all palliative care is hospice care
Criteria for hospice admissions
Illness is terminal w/6months or less
Willingness to forego further curative tx
Seeking only palliative care
Pt and caregiver must understand and agree
Care will be planned according to comfort
Life support measures may not be performed
Knowledge of prognosis
Willing to Participate in planning of care
Goals of hospice
Control/alleviate pts symptoms
Allow pt and caregiver to be involved in care decisions
Provide continuous support to maintain pt/family confidences
Educate and support primary caregivers in chosen settings
Interdisciplinary team
Medical director(mediates between hospice team + medical provider)
Nurse coordinator-(manages pt care, admits pt, assigns team)
Social worth-helps with financial concerns (evaluates psychosocial needs depression anxiety fear)
Spiritual coordinator-(spiritual support)
Volunteer coordinator-respit +relief (trains and recruits volunteers)
Bereavement coordinator-(assess and support bereaved survivor)
Hospice pharmacist
Dietician consultant
Hospice aide-CNA-personal care
Common symptoms of terminally ill
Nausea + vomiting
Tx w/antiemetics
Constipation
Dyspnea and air hunger
Anorexia and malnutrition
Cachexia- weakness and emaciation(thin)
Psychosocial and spiritual issues
Also skin. Weakness, insomnia, depression
Most feared symptom
Pain-priority for symptom management TREAT FIRST can be excruciating, constant , terrifying
Types of pain
Somatic- muscluloskeletal
Visceral-organs
Neuronal-nerves
Nursing interventions
*book/assess pain control and pain level 0-10
Assess understanding of medication administration
Assess side effects
Educate caregiver + pt about other pain control methods
Keep pain diary
Pt + caregiver teaching
Honest and straight forward
Fear of unknown is greater than fear of know
Educate caregiver in symptom management
Hands on care of pt
Caring for body functions
Teaching S/Sx of approaching death
Signs and symptoms of approaching death
Mottled extremities- different colors of paleness
Irregular breathing-Cheyenne-stoke
Restlessness, less urine, incontinence, less appetite and thirst
Bereavement period
Sometimes 1 year after death
Even if family is prepared may be difficult
Hospice staff goes thru grieving period for each pt that dies
Hospice provides support to staff
Ethical issues in hospice care
Withholding/withdrawing nutrition
Support right to refuse tx
DNR orders hopefully wishes known in advance
Nurse: be aware of facilities ethnic policy
Miscellaneous
Future: increase of hospice care
Nursing process for hospice pt and families
Stigma busting work to be done
POLST orders- physician orders for life sustaining tx usually shorter than advance directives
