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Geriatrics Exam 2 > Non-Pain 2 > Flashcards

Non-Pain 2 Flashcards

1
Q

Preparing for the last hours of life- for caregivers

A
  • Be aware of patient choices
  • Knowledgeable, skilled, confident
  • Rapid Response
  • Likely events, signs, symptoms of the dying process
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2
Q

How many people die of prolonged illness

A

90%

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3
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
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4
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
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5
Q

Common Signs and Symptom of imminent death- Days to hours

A
  • Maybe surge in energy
  • Breathing grows shallower in chest
  • Maybe apnea- up to 60 sec
  • Gurgling (throat)
  • Eyes maybe teary or dry/shiny
  • Eyes may remain open/not blink
  • Skin grows dusty/blotchy
  • Little observable response to outside environment
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6
Q

Physiological Changes during the Dying Process

A
  • Increasing weakness, fatigue
  • Decreasing appetite/fluid intake
  • Decreasing blood perfusion
  • Neurological dysfunction
  • Pain
  • Loss of ability to close eyes
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7
Q

The things that require the most amount of treatment or prevention a day or two before death

A
  • Respiratory tract secretions
  • Pain
  • Dyspnea
  • Restlessness
  • Agitation
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8
Q

ICHABOD Syndrome

A

I- immobility (less than 20% can stand within 2 days of death)
C- Confusion and Coma (40% are comatose, 30% confused in the 2 days before death)
H- Homeostatic failure (temp, BP, circulation)
A- Anorexia
B- Breathing changes
O- Oral intake decreased/Oservation
D- Dyspnea/Detachment

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9
Q

Weakness/Fatigue general symptoms

A
  • Decreased ability to move
  • Joint position fatigue
  • Increased risk of pressure ulcers
  • Increased need for care- activities for daily living, turning, movement, massage
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10
Q

Decreasing 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
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11
Q

The differences between the body shutting down and starvation

A

Body Shutting Down

  • Loss of Body fluids/electrolyte changes
  • Decreased blood flow/oxygen to GI tract
  • Absence of hunger sensation

Starvation

  • Lack of nutrition
  • Physiological homeostasis
  • Hunger
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12
Q

Artificial Hydration…. should it be used?

A
  • is the patient’s well-being enhanced?
  • What symptoms are relieved by hydration
  • Are other EOL symptoms aggravated?
  • Does hydration improve LOC? (values and goals)
  • What is the impact on well-being, mobility, ability to interact and be with family?
  • What is the burden on the family- caregiver stress, finances
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13
Q

Decreasing fluid intake…

A
  • Oral rehydrating fluids
  • Fears: dehydration, thirst
  • Remind family and caregivers that dehydration does not cause distress and dehydration may actually be protective
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14
Q

Decreasing Blood perfusion

A
  • Tachycardia, hypotension
  • Peripheral cooling, cyanosis
  • Mottling of skin
  • Diminished urine output
  • Parenteral fluids will not reverse
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15
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
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16
Q

Communicating with the unconscious patinet

A
  • Distressing to family
  • Awareness is more important than an ability to respond
  • Assume the patient hears everything
  • Create a familiar environment
  • Include in conversations- by assuring they are present/safe
  • Give permission to die
  • Touch - some want it/some don’t
  • Much depends on the type of relationship to the person
  • Many people “wait” for cues from the people in the room for “permission to die”
17
Q

Two roads to death

A
  • The Usual road- decreasing level of consciousness

- The Difficult road- Restless, confusion, hallucinations- difficult symptoms in general

18
Q

Terminal Delirium

A
  • “The difficult Road to death”
  • Seizures
  • Family will need support, education
  • Medical management
  • — Benzodiazepines
  • — Neuroleptics
19
Q

Changes in Repiration

A
  • Altered breathing patterns
  • diminished tidal volume
  • Apnea
  • Cheyne-Stokes Respirations
  • Accessory muscle use
  • Last reflex breaths (gasping)
20
Q

How to treat/help with changes in respiration

A
  • Fears- suffocation
  • Management- Family support !
  • — help them understand taht breathlessness will happen, and that oxygen may prolong the dying process
21
Q

Loss of Ability to Swallow

A
  • Loss of gag reflex
  • Build-up of saliva, secretions
  • – scopolamine to dry secretions
  • – postural drainage
  • – Positioning
  • – Suctioning is rarely indicated
22
Q

Loss of Sphincter Control

A
  • Incontinence of urine, stool
  • Family needs knowledge, support
  • Cleaning, skin care
  • Urinary catheters
  • Absorbent pads, surfaces
23
Q

Pain in the last hours of life

A
  • There is a huge fear of increased pain
  • Need to assess the patient to know….
  • persistent vs. fleeting expression
  • Grimace or physiologic signs
  • Incident vs. rest pain
  • Distinction from terminal delirium
24
Q

Loss of ability to close eyes

A
  • Loss of retro-orbital fat
  • Insufficient eyelid length
  • Conjuctival exposure- increased risk of dryness, pain , and maintain moisture
25
Q

Dying in Institutions

A
  • “home-like environment”
  • permit privacy, intimacy
  • Continuity of care plans
  • Avoid abrupt changes of settings
  • Consider a specialized unit
26
Q

As expected death approaches

A
  • Discuss status of patient to family and realistic care goals
  • What the patient experiences don’t necessarily equal what onlookers see
  • Reinforce signs, events of dying process
  • Personal cultural, religious, rituals, funeral planning
  • Family support throughout the process
27
Q

Laying out the body

A
  • Can be very helpful for all involved

- lay flat with arms crossed and eyes, mouth closed/chin tucked

Geriatrics Exam 2 (12 decks)

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