Lecture 11

Question 1

What is Browns End of Life tool?

Answer 1

A document to help medical personeel to assess a pts. level of functioning and their prognosis.

Question 2

What are the two primary factors that are considered in a pts outcome?

Answer 2

1) level of fxn

2) prognosis (good or bad)

Question 3

Example of a good prognosis is

Answer 3

Indep. Pts. -not that close to EOL in terms of a cause of a disease, also a stable pts., can even have a terminal disease, just matters level of independence.

Question 4

Example of a bad prognosis is

Answer 4

Crictical condi. Pt.- very close to EOL, very dependent on others for care,

Question 5

What are EOL and ethical issues to think about?

Answer 5

1. ethical principles in medical community aka bioethics
2. legal issues in making decisions for oneself
3. cultural spiritual and family/ helping a patient and their family navigate situations around end-of-life.

Question 6

What is the principle of bioethics?

Answer 6

Described in articles as: ethics of the ordinary in the face of the extraordinary (in other words ethics about ordinary conditions with regards to life and death often in the face of medical and technological advances that really blur the lines about how a person might live and how a person might die)

Question 7

Krival and Coyle 2013 describe autonomy as?

Answer 7

• resepect
• shared decision making
(respecting a patient’s individual self and using their autonomy and our respect for them in making shared decisions) this would be the classic including someone as part of a medical team

Question 8

Krival and Coyle 2013 describe beneficence as?

Answer 8

• active kindess and good
(described as active kindness, not asbstract, gentle kindness, kindness to someone who might be in crisis and kindness that helps facilitate for them the decisions that they might need to make)

Question 9

Non-maleficience

Answer 9

• Hippocratic oath maxim- (do no harm ) so in considering options for a patient we want to make sure that we’re not providing with them or insisting on options that might actually not be beneficial to the patient’s overall health)

Question 10

Justice

Answer 10

• Fair and equitable txt for all pts.

* take into account resources available to the patient, family, to the Medical Center and in and ourselves)

Question 11

Compentence

Answer 11

• the competence of the person who is the patient (can they obtain food for themselves, handle finances, make decisions in their best interest etc).
• definition of competence: the ability to perform an act and understand its impact Ex. a toddler would not be considered competent in the sense of handling their own personal daily affairs, however, a toddler might be able to perform parts of an act like food preparation or choosing what to eat but they may not understand the impact of choosing to not just eat only candy)

Question 12

Competence in lames terms

Answer 12

Competence is really the default status that we award to our patients, so in general we assume that are all of our patients who are awake and alert are competent and that we should respect their wishes. However, there are circumstances that might lead us to think that a patient might not be legally competent. Usually this applies to mental capacity.

Question 13

How is it best to establish competency?

Answer 13

• From observation (can they commu. a choice)
• Psychiatric evaluation (usually for legal cases)
• Could be done relatively informally, as in a checklist (can the person communicate a choice?)
• For legal cases usually a full psychiatric evaluation is completed and psych is called and (testifies their findings about whether or not the person in question has sufficient mental capacity to be considered competent)

Question 14

Care planning and advanced directives

Answer 14

• Develop a plan and advanced directive that will let health care providers know
what kinds of decisions you have made concerning your own health care in the event that you are unable to communicate your wishes. (Incls. Txs pts wants or doesn’t want, and CPR efforts)

• What pts wants in regard to their death. As in organ donation/

Question 15

What is an advanced directive?

Answer 15

a legal standard document that is appropriate for the state you live in, with a notary or two witnesses sign the form stating that they observed that the patient or future patient was competent at the time that they completed the form.

Question 16

What are the advanced directive questions?

Answer 16

1. who would you like to have make decisions for you if you are unable to do so?
2. what kinds of life-saving acts and procedures would you want or not want in terms of sustaining life if you were terminally ill
3. would you want CPR
4. would you want NON po feedingvif you were unable to tolerate povintake safely?
5. if you had a stroke what kinds of medical treatment would you want if you were dependent on others for all of your care ?

Question 17

What is part of an Advanced Directive?

Answer 17

DNR- do-not-resuscitate a DNR order (is something that a patient can put in place if they have a terminal disease if they do not wish to have extreme measures for continuing life)

Question 18

Cultural and Family Issues

Answer 18

• Views on Life: death, aging, medical care, pain, etc
• great resources is everyresource.com (lists the cultures from both alphabetically
from A to Z as well as by geographic regions) gives you overview of some of the basic
tenants or beliefs of people from different cultures.

Asha says that we should be culturally sensitive when discussing the patient’s plans and
wishes for their care. These include:
• religious or spiritual views of life and death
• decisions about their own care

Question 19

What is QOL in regards to dyspaghia pts. talking about?

Answer 19

Term quality of life is usually meant to refer to the everyday nature of a person’s life, living experiences, doing daily task.

Question 20

Lowered QOL

Answer 20

Examples

• adult professionals who suddenly realized they a swallowing problem
• anyone who wants to participate in a holiday dinner who cant.
• infant with swallowing problems

Question 21

What is the SWAL-Q?

Answer 21

questionnaire which asks pt to rate their experiences and their feelings about swallowing.

2nd page addresses questions of how they’re swallowing makes them. Research that has been done has found that many many not all but many patients with despise a report that they have low QOL

Question 22

What is the SWAL-Q?

Answer 22

questionnaire which asks pt to rate their experiences and their feelings about swallowing.

2nd page addresses questions of how they’re swallowing makes them. Research that has been done has found that many many not all but many patients with despise a report that they have low QOL