L10 Communication and Dying Flashcards
Goals with patients facing death
pt autonomy to set their own goals
therapeutic presence
control function/comfort/pain enough to enjoy remaining time
liberation
giving patient the opportunity to prepare for death by reflection, getting affairs in order, pass on wisdom, write letters
denial
harder to work with these pts
may believe that doing otherwise will cause lose of will to live or hope
paranoia/defensiveness/nervous chatter
need for control
avoid silence
stages of lose
denial
anger
bargaining
depression
acceptance
stages of lose for the caregiver
intellectualization
survival
depression
emotional arrival
deep compassion
hospice
philosophy of care promising pt will die with least amount of pain and focus on quality of life in treatment
can be in home, in a center, not location specific
progression of care for terminal disease
curative care for possible restorative intent
palliative care to control discomfort
hospice for when cure not possible and entering last part of life
how hospice expands the “lived world”
help with transfers, meals, experiencing environment by mobilizing as possible
pain control: massage, exercise, TENS
signs of a dying patient
going 7-10 days without water
30 days without food
lingering response to hearing and touch
breathing changes
incontinence
agitation
mottled limbs as blood sent to center of body
living will
written statement including person’s desires for medical treatment and circumstances where they cannot give consent
advanced directive
appoint person to make healthcare decisions if capacity to consent is lost
instructions for health care decisions
POLST
physician orders of life sustaining treatment
for specific patients with a clear disease progression as a complement to an advanced directive
