management of selected non pain II Flashcards
1
Q
preparing for the last hours of life
A
- time course unpredictable
- any setting that permits privacy, intimacy
- anticipate need for medications, equipment, supplies
- regularly review the plan of care
2
Q
Common signs and symptoms of imminent death (1-3 months)
A
- withdrawal from the world
- turning inward
- less communication with the world
- increased reflection
- decreased nutritional intake
3
Q
Common signs and symptoms of imminent death (1-2 weeks)
A
- altered states of consciousness
- dreams/visions/conversing w seen/unseen
- maybe restless/agitated/wanting up/down
- may want to remove clothing
- maybe quiet/resting deeply
- eyes appear unfocused/dreamy
- sleeping/waking hours prolonged
- not eating/maybe drinking
- then may request an occasional meal
4
Q
common signs and symptoms of imminent death (days to hours)
A
- maybe surge in energy
- breathing grows shallower in chest
- maybe apnea (up to 60 seconds)
- gurgling (throat)
- eyes maybe teary or dry/shinny
- eyes may remain open/not blink
- skin grows dusky/blotchy
- little observable response to outside environment
5
Q
physiological changes during the dying process
A
- increasing weakness, fatigue
- decreasing appetite/fluid intake
- decrease blood perfusion
- neurological dysfunction
- pain
- loss of ability to close eyes
6
Q
ICHABOD syndrome
A
- I = immobility
- C = confusion and coma
- H = homeostatic failure
- A = anorexia
- B = breathing changes
- O = oral intake decreased/observation
- D = dyspnea/detachment
7
Q
weakness/fatigue
A
- decreased ability to move
- joint position fatigue
- increased risk of pressure ulcers
- increased need for care
- -> activities of daily living
- -> turning, movement, massage
8
Q
decreased appetite/food intake
A
- fears: giving in, starvation
- reminders:
- -> food may be nauseating, anorexia may be protective, risk of aspiration, clenched teeth express desires, control
- help family find alternative ways to care
9
Q
Body shutting down vs starvation
A
- BODY SHUTTING DOWN (dehydration)
- -> loss of body fluids/electrolyte changes
- -> decreased blood flow/oxygen to GI tract
- -> absence of hunger sensation
- STARVATION
- -> lack of nutrition
- -> physiological homeostasis
- -> hunger
10
Q
Locus of sensation
A
- Thirst and taste are in mouth (keeps lips and mucous membranes; taste has a lot to do with smell)
- Hunger is in stomach (note impact of altered O2 and blood flow)
11
Q
Decreasing fluid intake
A
- oral rehydrating fluids
- Fears: dehydration, thirst
- Remind families, caregivers
- -> dehydration does not cause distress
- -> dehydration may be protective
- Parenteral fluids may be harmful
- -> fluid overload, breathlessness, cough, secretions
- Mucosa/conjunctiva care (keep them moist)
12
Q
decreasing blood perfusion
A
- tachycardia (try to keep up), hypotension (blood pressure can’t be maintained)
- peripheral cooling, cyanosis
- mottling of skin (lacing pattern)
- diminished urine output (not good blood flow to kidneys)
- parenteral fluids will not reverse
13
Q
Neurological dysfunction
A
- decreasing level of consciousness
- communication with the unconscious patient
- terminal delirium
- changes in respiration
- loss of ability to swallow, sphincter control
14
Q
Two roads to death
A
- Normal = sleep > lethargic > obtunded > semicomatose > comatose > death
- DIFFICULT = restless > confused > tremulous > hallucinations > mumbling delirium > myoclonic jerks > seizures > semicomatose > comatose > death
15
Q
decraesing level of consciousness
A
- the usual road to death
- progression
- eyelash reflex
