Geriatrics 9 Flashcards
An older patient with terminal cancer is considering hospice care but is concerned that Medicare will stop payments if the care is provided for longer than 6 months. What can the nurse respond to this patient?
Standard Text: Select all that apply.
1. Medicare does not limit the hospice benefit.
2. Medicare regulations discourage a longer use of the benefit.
3. Hospice costs more than traditional hospital or long-term care.
4. Patient may enroll when the life expectancy is 6 months or less.
5. Hospice supports the family for 6 months after the patient’s death.
1: Medicare law does not limit the hospice benefit.
2: Medicare regulations often discourage a patient from using hospice for longer than 6 months.
4: Patients may enroll when their physician judges their life expectancy to be 6 months or less.
During an assessment the nurse determines that an older patient dying from a terminal illness is experiencing common fears. What fears did this nurse assess in the patient? Standard Text: Select all that apply. 1. Dying alone 2. Loss of consciousness 3. Loss of bladder control 4. Leaving loved ones behind 5. Becoming a burden to others
1: Common fears and concerns of the dying include dying alone.
2: Common fears and concerns of the dying include loss of consciousness.
3: Common fears and concerns of the dying include loss of bladder control.
5: Common fears and concerns of the dying include becoming a burden to others.
An older patient dying of end-stage pulmonary disease and dementia receives narcotic medication for chronic pain. Currently the patient is restless and grimacing. How should the nurse interpret these assessment findings?
- The patient is in pain.
- The patient has an undiagnosed personality disorder.
- The patient needs nonpharmacological pain management approaches.
- The patient is not experiencing any difference in pain level and no adjustments are needed.
1: When an older adult is unable to speak or self-report the level of pain, the nurse should carefully observe the patient for behavioral symptoms of pain that may include restlessness and grimacing.
An older patient dying from a terminal illness reports that the last dose of pain medication provided barely reduced the level of pain. What should the nurse do to help this patient?
- Give the patient pain medication every hour.
- Contact the physician for an adjustment in pain medication.
- Provide the pain medication at the next scheduled dose time.
- Give the patient another dose of the medication even though it is before the scheduled time.
2: Dying patients may need more pain medication than the normal range for the prescribed drug. Organic changes are occurring rapidly within the body and systems are shutting down, decreasing the absorption levels of drugs.
The nurse is planning oral hygiene for an older patient with a terminal illness who has an intact swallowing reflex. Which interventions would be appropriate for this patient? Standard Text: Select all that apply. 1. Offer ice chips frequently. 2. Provide care with soft swabs. 3. Apply petroleum jelly to the lips. 4. Brush the teeth three times a day. 5. Avoid using alcohol-based solutions.
1: Ice chips to relieve the feeling of dryness may be offered as long as the swallowing reflex is present.
2: Oral care with soft swabs should be provided several times a day and whenever the mouth has a foul odor or appears uncomfortable for the patient.
3: Soothing ointments or petroleum jelly may be applied to the lips to prevent painful cracking or drying.
5: Alcohol-based products can be irritating and drying and their use is discouraged.
The family of an older patient dying of liver cancer is concerned that the patient will not eat or drink. The patient is alert and oriented, and expresses no desire to eat. What action would the nurse take?
- Force fluids.
- Consult the dietician for feeding supplements.
- Contact the physician for an order for tube feedings.
- Comply with the patient’s wishes despite the family’s concern.
4: Anorexia and dehydration are common and normal with the patient with a terminal illness. The patient’s wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
An older patient with end-stage renal and heart failure is experiencing odd dreams and is talking with people who are not present in the room. What does this finding indicate to the nurse?
- Pending death
- Ineffective pain medication
- Overdose of narcotic medication
- Normal visual and auditory hallucinations at the end of life
4: Terminal delirium presents as confusion, restlessness, and/or agitation, with or without day–night reversal. Visual, auditory, and olfactory hallucinations may occur during this time. It is important for the nurse to understand that this condition is often irreversible, and that the patient’s experience of the delirium may be very different from what is witnessed by caregivers.
While providing postmortem care to a patient who has died the patient elicits a respiratory sound when turned. What should the nurse do?
- Check for a pulse.
- Reposition the airway.
- Continue with the postmortem care.
- Report to the physician the patient is still breathing.
3: When the body is moved or the extremities repositioned, the body may produce respiratory-type sounds or the chest may appear to rise and fall. This can be alarming, but is only the sound of air leaving the lungs.
An older patient is not breathing well and has cold, mottled skin. The patient has a living will and requests comfort measures only. What should the nurse do to care for this patient?
- Ask the family what they want to be done for the patient.
- Contact the physician for orders to control the patient’s breathing.
- Provide personal hygiene and skin care as outlined in the care plan.
- Withhold pain medication, hygiene, and nutrition until the patient dies.
3: Comfort measures only indicate that the patient does not want extraordinary measures to sustain life. This does not mean that nursing care ceases but that nursing care to provide patient comfort is intensified and maintained through the end stages of the patient’s life.
The family of an older patient with a terminal illness has been aware of the patient’s pending death and is present when the patient dies. The family’s reaction to the patient’s death was very emotional and demonstrated a state of disbelief. How should the nurse interpret this family’s behavior?
- Irrational behavior
- Expression of anger
- Maladaptive coping of the family
- Normal shock when experiencing the loss of a loved one
4: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. There is disbelief that death has occurred and may be marked by shock, emotional dullness, and restless behavior that may include stupor and withdrawal. It may include physical characteristics such as nausea or insomnia.
The nurse is planning care for an older patient who is dying. Which interventions will ensure the patient dies with dignity?
Standard Text: Select all that apply.
1. Relieving suffering
2. Controlling pain and symptoms
3. Making decisions for the patient and family
4. Clarifying goals of treatment and the patient’s values
5. Communicating patient needs between healthcare providers
1: The nurse who helps the patient die comfortably and with dignity will relieve suffering for the patient.
2: The nurse who helps the patient die comfortably and with dignity will control pain and symptoms.
4: The nurse who helps the patient die comfortably and with dignity will clarify the goals of treatment and the patient’s values.
5: The nurse who helps the patient die comfortably and with dignity will communicate the patient’s needs between the healthcare providers.
The nurse, caring for an older patient who is nearing death, has never taken care of a dying patient before. What is the first thing that the nurse must do prior to caring for this patient?
- Confirm the patient’s code status.
- Review the facility’s policy on postmortem care.
- Confront personal feelings and fears about death.
- Confirm that the family has made funeral arrangements.
3: Nurses must be confident in their clinical skills when caring for the dying, and aware of the ethical, spiritual, and legal issues they may confront while providing end-of-life care. Many feel that the first step in the process is confronting their own personal fears about death and dying. By addressing their own fears, nurses are better able to help patients and families when they are confronted by impending death. The nurse may then be more objective in recognizing and respecting the patient’s and family’s values and choices that guide their decisions at the end of life.
The health status of an older patient with liver disease is rapidly deteriorating. There is no documentation on the medical record regarding the patient’s care wishes. What should the nurse do to ensure the patient receives care that is desired at the end of life?
- Ask social services to provide an advance directive for the patient to complete.
- Talk with the patient regarding what the patient wants after the hospitalization ends.
- Call a meeting with the patient, family, and primary care physician to discuss care goals.
- Discuss the patient’s dire situation with the family and find out what their wishes might be.
3: If unsure of a patient’s wishes for care at the end of life, a team meeting with the key decision makers such as the patient, family, and primary care physician should be held. This ongoing open discussion about goals of care will help the patient and the family receive the best possible care at the end of life.
An older patient who is terminally ill is receiving hospice care at home. What suggestion should the hospice nurse make in preparation for the patient’s death?
- Discuss being admitted to a hospital.
- Suggest transferring to a long-term care facility.
- Recommend admission to an inpatient hospice setting.
- Find out what the patient needs to be comfortable at home.
4: Most Americans express a preference to die in their own homes. The hospice nurse should find out what the patient needs to be comfortable at home during death.
The hospice nurse has provided a presentation to long-term care nurses on barriers to excellent end-of-life care. Which statement made by a participating nurse indicates that additional teaching is needed?
- “Most patients have good pain control when they die.”
- “Referrals to hospice or palliative care often aren’t made.”
- “When a client is dying, there can be disagreements about the goal of care.”
- “In general, healthcare professionals have difficulty in being honest with patients when discussing a poor prognosis.”
1: Although not all deaths involve pain and suffering, there are deficiencies in the way end-of-life care is currently provided in the U.S. healthcare system. Barriers include lack of knowledge regarding pain and symptom control.
