Lecture 2 Flashcards
Palliative Care & Inflammation and Wound Healing
“an approach that improves the quality of life of patients and their families facing the problems associated with a life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”
Palliative care
Body and mind
Symptom management
Psychosocial
Quality of life
Comfort measures
Desires and goals
Pain management
are things we supply to ____________ during palliative care
Patient and family
What are the 3 layers of care?
Palliative care
End-of-life care
Terminal care
Changes to body systems:
Urinary system
Integumentary
Musculoskeletal
Sensory
Gastro Intestinal
Respiratory
Cardiovascular
Physical and psychosocial manifestations of the end of life
Taste, smell, hearing, and sight
Hearing usually last sense to disappear
↓ With disease progression
Blurring of vision
Sinking and glazing of eyes
Blink reflex absent
Eyelids may remain half-open
will occur during…
End of life
Mottling on hands, feet, arms, and legs
Cold, clammy skin
Cyanosis on nose, nail beds, knees
“Waxlike” skin when very near death
skin changes at end of life
↑ Respiratory rate
Cheyne–Stokes respirations
Inability to cough or clear secretions
Grunting, gurgling, or noisy congested breathing
Irregular breathing
Slowing down to terminal gasps
are things that happen at…
End of life
Gradual decrease UO
Incontinent of urine
Unable to urinate
Urinary system changes for end of life
Loss of appetite and thirst sensations
Slowing of digestive tract and possible cessation of function
Accumulation of gas and abdominal distention
Nausea
Loss of sphincter control
Bowel movement may occur before imminent death or at the time of death
Physical Manifestations:Gastrointestinal System
Gradual loss of ability to move
Sagging of jaw resulting from loss of facial muscle tone
Difficulty speaking
Swallowing can become more difficult
Difficulty in maintaining body posture and alignment
Loss of gag reflex
Physical Manifestations:Musculoskeletal System
↑ Heart rate
Later slowing and weakening of pulse
Irregular rhythm
Decrease in blood pressure
Delayed absorption of drugs administered intramuscularly or subcutaneously
Peripheral edema
Physical Manifestations:Cardiovascular System
Altered decision making
Anxiety about unfinished business
↓ Socialization
Fear of loneliness
Fear of meaninglessness
Fear of pain
Helplessness
Life review
Peacefulness
Restlessness
Saying goodbyes
Unusual communication
Vision-like experiences
Withdrawal
Psychosocial Manifestations at the End of Life
____ is a normal reaction to loss
Grief
Anger, guilt, anxiety, sadness, depression, despair, or a combination of these
These are the _______
Stages of grief
_____ & _____ can cause Disruption in sleep, changes in appetite, physical symptoms, and illness
Grief & bereavement
Grief that takes place before the actual death
Anticipatory grief
Period after the death of a loved one during which grief is experienced and mourning occurs
Time spent is individual.
______ and grief counselling are components of patient- and family-centred hospice palliative care.
Bereavement
Beliefs, values, and practices that relate to the search for existential meaning and purpose
Assessment is a key consideration.
Respect the patient’s wishes with regard to spiritual guidance or pastoral care services and make referrals as appropriate.
Spiritual needs
Ways in which people understand and experience death varies across cultures
Understanding care of dying patients and of practices or rituals concerning the care of the body upon and immediately after death
Culturally competent care
_______ & ______ issues affecting end of life care:
Patients and families struggle with many decisions during the terminal illness, such as
Organ and tissue donations
Advance directives
Cardiopulmonary resuscitation
Medical assistance in dying
Legal & ethical issues
The intrinsic value and uniqueness of each person, the person’s right to self-determination, and autonomous decision making
Advance care planning (substitute decision maker)
Process of a patient’s thinking about and sharing one’s wishes for future health and personal care
Advance directives
These are all examples of _____ & _____ issues affecting end-of-life care
Legal & ethical issues
Health care providers should always speak with patients about their wishes for care and treatment
A way to ensure you have a say in health care decisions that lie ahead
Advanced Care Planning (ACP) status (goals of care)
Not to be confused with MAiD
Infrequent and extraordinary intervention
To intentionally produce sedation in order to relieve intractable symptoms in the last days of a patient’s life
The principle of double effect justifies the use of medications that cause sedation as an adverse effect, an unintended harm, as its primary role is to relieve suffering and not to hasten death.
Palliative sedation
All persons who are 16 years of age or older and are competent may choose _____ & _______ donation.
Only patients who have sustained a nonrecoverable injury and are on life support may donate, as can MAiD patients.
All patients have the potential to donate
Should be on patient’s medical record.
Organ and tissue donation
Nursing _______ is Holistic
Psychosocial, physical needs
Respect, dignity, and comfort
Focuses on:
What is important for the patient and their family
Management of symptoms of the disease rather than on the disease itself
Management
Varies with:
Patient condition
Proximity of approaching death
Comprehensive or limited to essential data
Document-specific change that brought patient into health care facility
Nursing assessment
Planning requires ______ and ______
Coordination of care
Goals
Patient’s needs
Family and significant others’ needs
Education counseling, advocacy, support
Coordination of care
_____ centre on patient’s abilities to express and share feelings with others
During the last stages of life, involve comfort and safety measures, physical maintenance, and emotional care
Goals
Psychosocial care
Anxiety and grief may be barriers to learning.
Anxiety and depression are often exhibited by the patient.
Are things that happen in the _______ phase
Implementation
Critical for nurse to understand source of ______ and not react on a personal level
Anger
_____ and ____ are common during the end-of-life period
Encourage realistic hope within limits of situation
The patient’s involvement in decision making about care should be supported, to foster a sense of control and autonomy
Homelessness; powerlessness
Common emotion
Nurse assists with coping
Specific ______:
- pain
- shortness of breath
- loneliness and abandonment
- meaninglessness
Fear
Fear of ____________ and abandonment
Do not want to be alone
Fear loved ones cannot cope and will abandon them
Holding hands, touching, and listening are important nursing interventions.
Simply providing companionship allows the dying person a sense of security.
loneliness
Fear of ________________
Leads most to review their lives
Intentions during life, examining actions
Expressing regret
Helps recognize the value of their lives
Life review
meaninglessness
Symptom management and comfort
Priority is to meet physiological and safety needs
Dying patients deserve the same care as for people who are expected to recover.
Physical care
swallowing difficulties
Supply meds with alternative routes
Elevate head of bed
Oral suction
Modified diet, hand feed
Dysphagia
Lacking strength & energy
Assess patient tolerance
Time interventions
Provide rest periods
Help patient identify desired activities
Weakness/fatigue
Assess mucous membranes
Maintain oral care
Ice chips, lubricant on lips
Do not force patient to eat or drink
Dehydration
Shortness of breath
Respiratory assessment
Teach pursed lip breathing
Increase head of bed (HOB) or position pat on one side
Suction as needed
Oxygen administration
Fan or air
Administer expectorant as needed
Dyspnea
sudden, brief involuntary twitching or jerking of a muscle or group of muscles
Assess onset and if it is distressing to the patient
May need medication changes
Myoclonus
Assess for ________ and initiate protocols to prevent breakdown
Assess wounds
Apply heat blankets for warmth not heat
Prevent the impact of shearing forces
Skin breakdown
Extreme loss of body weight (eating disorder)
Assess for contributing factors
Drug modifications
Antiemetics before meals
Favourite foods, smaller meals and more frequently
Culturally appropriate foods
Frequent mouth care
Treat Candidiasis
Anorexia
decrease in size or wasting away of a body part or tissue
Atrophy
results from an increase in cell size
Hypertrophy
enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferation
Hyperplasia
the replacement of one differentiated somatic cell type with another differentiated somatic cell type in the same tissue
Metaplasia
abnormal development of cells within tissues or organs
Dysplasia
“to form backward,” which implies dedifferentiation (or loss of the structural and functional differentiation) of normal cells during tumorigenesis.
Anaplasia
Hypoxia/ischemic injury
Heat and cold
Radiation
Electrothermal injury
Mechanical trauma
Chemical injury
Microbial injury
Immunological
Neoplastic growth
Normal substances
Are all causes of _______
Lethal cell injury
Programmed cell death
Apoptosis
Death of body tissue
Not normal in developed tissues; serious when many cells involved
Necrosis
The skin and mucous membranes
Mononuclear phagocyte system
Inflammatory response
Vascular response
Cellular response
Neutrophils
Monocytes
Lymphocytes
Eosinophils and basophils
Formation of exudate
Healing
Immune System
All help defend against _____
injury
Exudate formation
- Serous, catarrhal, fibrinous, purulent, hemorrhagic
Clinical manifestations
- Redness, heat, swelling pain
- Fever
- Prodrome, chill, flush, defervescence
Types:
- Acute
- Subacute
- Chronic
Inflammatory response
Labile cells – divide constantly (skin bone marrow, mucous membranes, lymphoid organs)
Stable cells – retain their ability to regenerate but only if the organ is injured (pancreas, liver, kidney, bone cells)
Permanent cells – no regeneration (neurons, cardiac muscle cells
Regeneration
Primary intention
Initial phase
Granulation phase
Scar contraction
Secondary intention
Tertiary intention
Repair
divide constantly (skin bone marrow, mucous membranes, lymphoid organs)
Labile cells
retain their ability to regenerate but only if the organ is injured (pancreas, liver, kidney, bone cells)
Stable cells
no regeneration (neurons, cardiac muscle cells
Permanent cells
Cause (surgical/nonsurgical)
Underlying pathology
Duration (acute or chronic)
Level of contamination
Depth of tissue (superficial; partial thickness; full thickness)
Wound classification
Adhesions
Contractures
Dehiscence and evisceration
Excess granulation tissue
Fistula formation
Infection
Hemorrhage
Formation of hypertrophic scars and keloids
Collaborative care
Drug therapy
Nutritional therapy
Complications of the Healing process
Nursing implementation
Health promotion
Prevention of infection
Minimize inflammation
Adequate nutrition
are important to ensure reduction in _____ and promote _____
Inflammation; healing
Acute intervention
Observation and vital signs
Fever
Rest
Ice and heat
Compression and immobilization
Elevation
Are important to prevent _____ and promote _____
Inflammation; healing
(a) cleaning and debriding the wound to remove debris and dead tissue from the wound bed,
(b) controlling inflammation and treating infection to prepare the wound for healing, and
(c) providing moisture balance for healable wounds, and moisture reduction for nonhealable and maintenance wounds
Purpose of wound cleaning
Types of _____:
Surgical
Autolytic
Bio-surgical
Mechanical
Enzymatic
Debridement
No deterioration of the ulcer stage
Reduction or elimination of the factors that lead to pressure injuries
Improved nutritional status
Increased mobility
Not development of an infection in the pressure injury
Healing of pressure injuries
No recurrence
Goals for pressure injuries
______ is an uneasy feeling caused by a source that is not easily identified.
Frequently related to fear
Anxiety
Management of ______:
Pharmacological
Nonpharmacological interventions
Anxiety
all tissues, including the skin, are closed with suture material after completion of the operation
primary intention
a wound will be left open (rather than being stitched together) and left to heal by itself, filling in and closing up naturally
secondary intention
delayed primary wound healing after 4–6 days. This occurs when the process of secondary intention is intentionally interrupted and the wound is mechanically closed. This usually occurs after granulation tissue has formed.
tertiary intention
the result of a contractile wound-healing process occurring in a scar that has already been reepithelialized and adequately healed
scar contraction
