fundamentals- chapter 15 Flashcards
1
Q
nurses’ attitudes toward end-of-life care
A
- Death is a universally shared event with all cultures and religions having beliefs and rituals to explain and cope with death, loss, and grief
- It is still taboo to have discussions about death in mainstream North American cultures
- It is normal for nurses to have difficulty dealing with death and dying even if they provide care to critically ill or dying patients regularly
2
Q
change
A
- loss, grief, and mourning are intrinsically linked with life changes
- these are normal and inevitable life transitions
- 6 stages of dealing with life changes (Virginia Satir):
1. status quo
2. introduction of a foreign element
3. chaos
4. integration
5. practice
6. new status quo
3
Q
loss
A
- to no longer possess or have an object, person, or situation
- can be physical (loss of a limb or body function)
- psychosocial (loss of a loved one)
- only the person experiencing the loss can define the value of the loss
4
Q
grief
A
- the total emotional feeling of pain and distress that a person experiences due to loss
- grieving process occurs over time
- person adapts and moves through pain toward recovery or acceptance
- causes physical and emotional symptoms
5
Q
bereavement
A
the state of having suffered a loss by death
6
Q
anticipatory grieving
A
7
Q
dysfunctional grieving
A
8
Q
prolonged grieving
A
9
Q
symptoms of grief
A
- depression, sadness
- fatigue, apathy, lack of interest
- sleep alterations
- loss of appetite
- change in sexual interest
- anxiety, shortness of breath
- feeling helpless, restless, angry, irritable
10
Q
symptoms of grief
A
- forgetfulness, tendency to make mistakes
- confusion, disorientation
- symptoms of the same illness the deceased suffered
- seeing loved one’s presence, hearing loved one’s voice
11
Q
stages of grief
A
- disbelief, yearning, anger, depression, acceptance
- peak within 6 months after the loss
- nurse should reevaluate and create additional nursing plans for patients who continue to score high in these areas after 6 months
12
Q
death
A
- a physiologic event that is typically defined by the absence of spontaneous breathing and heartbeat
- definition of death is now centered on the concept of brain death, which is defined as the absence of brain activity as evidenced by the absence of EEG waves
- brain death is characterized by three findings: coma, absence of brain stem reflexes, and apnea
13
Q
standards of care for the terminally ill
A
- Opportunities provided to spend final moments with people important to the patient
- Families will have opportunity to discuss the patient’s imminent death with the staff
- Family provided private time with the patient
- Family will be provided time to carry out cultural customs regarding the body after death
14
Q
end-of-life care
A
- Consider the terminally ill patient’s preferences
- Try to maintain functional capacity and relieve discomfort
- Control patient’s pain
- Be aware of advance directives and durable powers of attorney
- Make the patient feel safe and secure
- The patient will have ample opportunity to finish business with loved ones
15
Q
rights of the dying patient
A
- Be treated as a person until death
- Caring human contact
- Have pain controlled
- Cleanliness and comfort
- Maintain a sense of hope
- Participate in his care or the planning of it
- Respectful, caring medical and nursing attention
16
Q
rights of the dying patient
A
- Continuity of care and caregivers
- Information about his condition and impending death
- Honest answers to questions
- Explore and change religious beliefs
- Maintain individuality and express emotions freely without being judged
17
Q
rights of the dying patient
A
- Make amends and settle personal business
- Say goodbye to family and significant others in private
- Assistance for significant others with the grief process
- Withdraw from social contact if desired
- Die at home in familiar surroundings
- Die with dignity
- Respectful treatment of the body after death
18
Q
palliative care
A
- goal is to reduce or relieve the symptoms of a disease without attempting to provide a cure
- preserves life while accepting death as a normal and expected outcome
- focuses on symptom management
- patient is still trying to get better
19
Q
hospice
A
helps patients in the end stage of life, and their families, to experience the process of death with the highest quality of life and least amount of disruption as possible
20
Q
the dying process
A
- Some believe there are distinct stages while others belief grief is fluid rather than a linear process
- Individual’s reaction to death may be consistent with the way he coped with difficulties in the past
- Elisabeth Kübler-Ross promoted research into dying and death and identified five stages of coping with death
21
Q
stages of coping with death (Kubler-Ross)
A
- denial
- anger
- bargaining
- depression
- acceptance
people can move back and forth between the stages, sometimes getting stuck in one of them
22
Q
hope
A
- an inner positive life force
- a feeling that what is desired is possible
- takes many forms and changes as the patient declines
23
Q
hope and the dying process
A
- at first there is hope for a cure
- then a hope that treatment will be possible
- next a hope for the prolonging of life
- finally hope for a peaceful death
24
Q
comfort care
A
identifying symptoms that cause the patient distress and adequately treating those symptoms
25
assessment
- Baseline assessment and continuing data collection essential to identify the problems and needs of the patient and family
- Pay special attention to assessing pain: location, nature, what makes it better or worse
- Emotional condition
- Can often be observed during the interaction
- Anxiety, agitation, confusion, depression may be obvious
26
nursing diagnoses
- vary for the dying patient depending on disease process
- certain nursing diagnoses are common at some point to most dying patients
27
planning
- giving the patient control is a first priority
- planning should be a team effort
- all members of the team should be aware of the patient's goals and needs
28
implementation
Interventions should be implemented for:
- Anticipatory guidance
- End-stage symptom management
- Pain control
- Dyspnea and respiratory distress
- Constipation, diarrhea
- Anorexia, nausea, vomiting
- Dehydration
- Delirium
- Impaired skin integrity
- Weakness, fatigue, decreased ability to perform activities of daily Living
- Anxiety, depression, agitation
- Spiritual distress, fear of meaninglessness
29
evaluation
- based on patient-specific outcomes
- desired outcomes depend on which nursing diagnoses are pertinent to the patient's situation
- degree of comfort obtained for the patient should be evaluated
30
physical signs of impending death
- Physically weaker
- Spends more time sleeping
- Body functions slow
- Appetite decreases
- Urine output decreases; urine more concentrated
- Edema of the extremities or over the sacrum
- Pulse increases and becomes weak or thready
- Blood pressure declines
- Skin of the extremities mottled, cool, and dusky
- Respirations become shallow and irregular
31
psychosocial and spiritual aspects of dying
- As individuals approach death, their spiritual needs take on greater importance
- Do not impose your religious beliefs on dying patient and family; instead assist patients to find comfort and support in their own belief systems
- Be aware of remarks you make in the presence of unresponsive patients because they DO hear
32
advance directives
- Spells out patients’ wishes for health care when they may be unable to indicate their choice
- POST form can be filled out by nurse and signed by doctor. is not a true advance directive but can function as one
- Durable power of attorney for health care
- A legal document that appoints a person (health
care proxy) chosen by the patient to carry out his
wishes as expressed in an advance directive
33
euthanasia
ending another's life to end suffering (voluntary or involuntary)
34
passive euthanasia
patient chooses to die by refusing treatment
35
active euthanasia
- administering a drug or treatment to kill the patient
- not legal or permissible
36
assisted suicide
- making available means to end patient's life (such as a weapon or drug), knowing that suicide is their intent
37
adequate pain control
- Nurses advocate for compassionate end-of-life care
- Cornerstones of end-of-life care that can eliminate the need for a person to choose euthanasia or suicide
- Knowledgeable and skillful symptom management
- Relief of suffering
- Promise of presence, of not abandoning the
patient
38
organ and tissue donation
organs that can be transplanted:
- kidneys, livers, hearts, and lungs
tissues that can be transplanted:
- corneas, bone, and skin
- Tennessee Donor Services
39
postmortem (after death) care
- coroner = person with legal authority to determine cause of death
- a death certificate is completed by the physician, the undertaker, and a pathologist if an autopsy is done
- the nurse is responsible for postmortem care
- UAP can assist with bathing
- family members may assist with or perform the preparation of the body or the nurse may prepare the body for the family to come say goodbye and for removal to the morgue or undertaker
