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life span > Nurb end of life comm loss and final hours > Flashcards

Nurb end of life comm loss and final hours Flashcards

1
Q

: acknowledging vulnerability, intuition, empathy, being in the moment, and serenity and silence.

A

Presence requires

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2
Q

everyone grief is their own, never say that you know how they feel
-setting the right atmosphere: who you want in the room, take to private room, spoke slowly and calmly, say pt died then stop, gave them time does the family want to talk, attentive listening

A

Effective Communication:

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3
Q

: the patients current medical status including the likely course if no treatment, interventions that might improve prognosis, professional opinion about alternatives available to the patient, recommendation from physician

A

disclosure

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4
Q

: take reasonable precautions to ensure that such information is not inappropriately divulged

A

confidentiality

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5
Q

: legal term, practical application of respect of the patients autonomy

A

informed consent

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6
Q

: ability to understand or to make choices, ability to understand relevant information, appreciate the medical situation and its possible consequences, communicate a choice, goal in relation to the recommended treatment options

A

decisional capacity

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7
Q

: frequently concerned that when crucial decision must be made about their medical care, no longer capable of participating in those decisions, solution to the problem, essential that patients discuss these concerns with their family and their health care provider, record in patients record

A

Advanced care planning

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8
Q

from medical paternalism to patient self-determination, requires that all hospitals receiving federal funds must ask patients at the time of admission whether they have advance directives

A

Patient self-determination act:

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9
Q
  • person appointed by a judge to act on behalf of a minor when the court system has determined that the minor requires protective oversight of person and estate, not all state offer
A

Court appointed guardian

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10
Q

-person or organization appointed by the court to care for an adult who cannot care for self or manage life eof decisions

A

court appointed conservator

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11
Q
  • person who is authorized to make a decision on behalf of another who is incapacitated, next of kin have been considered the natural, family members for the consent
A

surrogate

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12
Q
  1. Patient family expectations
    1. Palliative care planning
    2. Verbal and non-verbal communication
    3. Listening/ silence
    4. Presence
    5. Guidelines for encouraging free conversation
A

BARRIERS TO COMMUNICATION
2. Myths/Realities of communication
A. Communication process

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13
Q

A. Family system
B. Financial/educational
C. Physical Limitations
D. Health care professional

A

Factors Influencing Communication

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14
Q
  1. Lack of continuity of care among caregivers

2. Lack of support (physical or emotional) among family members

A

Factors Influencing Communication

Family system

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15
Q

: Financial insecurity/ Anxiety, stress, grief/ Inability to comprehend/communicate

A

Factors Influencing Communication

Financial/educational

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16
Q

Sensory changes, Sleep deprivation, Inability to comprehend/communicate

A

Factors Influencing Communication

Physical Limitations:

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17
Q
  1. Behaviors and communication style be aware
    1. Communication barriers
    2. Family meetings/ breaking bad news
    3. Communication strategies to facilitate end-of-life decision
A

Factors Influencing Communication

Health care professional

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18
Q

: review medical issue and history, coordinate health care team, discuss goals of meeting with team, identify a meeting leader among the health care team, discuss with family members, arrange private quiet and location, minimize distractions

A

Recommendations for conducting a family meeting

1. Prepare for meeting

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19
Q

: intro all in attendance, review med situation, establish goal of meeting “everyone understands and answer all questions”

A

Recommendations for conducting a family meeting

Open the meeting

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20
Q

: ask family question “what do you know about the patient’s conditions” Follow up question: is there anything that isn’t clear that we can help to explain”

A

Recommendations for conducting a family meeting

Elicit family understanding

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21
Q

A. open ended questions= what are your hopes? What are important for the patient?
B. understand ethnic and cultural influences
C. maintains focus on the pts perspectives, can help to relieve guilt that family members may feel over making decisions
D. dealing with decisions that need to be made:
E. close the meeting
follow up on the meeting

A

Recommendations for conducting a family meeting

Elicit Patient and Family Values and Goals:

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22
Q

offer brief summary, ask for any final questions, statement of appreciation and respect for the family, make a clear follow up plan family and how to contact health care team

A

Recommendations for conducting a family meeting
Elicit Patient and Family Values and Goals:
E. close the meeting

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23
Q

document the meeting in chart, follow up any information or reassessment agreed upon during the meeting

A

Recommendations for conducting a family meeting
Elicit Patient and Family Values and Goals:
follow up on the meeting

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24
Q

common understanding of issues, “have you decided what you want and don’t want?”, open ended assessments then specific interventions, offer clear recommendations, coming to an understanding, check understanding of decision s made

A

Recommendations for conducting a family meeting
Elicit Patient and Family Values and Goals:
dealing with decisions that need to be made:

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25
Q
  1. : factual content, style of pt statements, emotional content
A

6 step protocol for breaking bad news

finding out how much the pt know

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26
Q
  1. physical context right
  2. finding out how much the pt know:
  3. find out how much the pt wants to know
  4. sharing medical communication:
  5. responding to the pts feelings
  6. planning and summarizing:
A

6 step protocol for breaking bad news

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27
Q

align, educate, give info in small amounts, use lamen terms, check reception frequently, reinforce the info, blend concerns and anxieties

A

6 step protocol for breaking bad news

4. sharing medical communication:

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28
Q

identify coping of pt and reinforce, other sources of support for the pt

A

6 step protocol for breaking bad news

6. planning and summarizing:

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29
Q

presence during cpr

A 
in or out
introduction
now 
outcome
relationship
option
understanding
time
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30
Q

Family Presence yourself as a nurse, clearly short sentences, use pt name

A

during CPR: in or out

Introduction:

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31
Q

explain pt current status, lamen terms when explaining

A

during CPR: in or out

now

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32
Q

explain the possible results, realistic don’t give false hope, say work die

A

during CPR: in or out

outcome

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33
Q

learn who makes the decisions, next of kin

A

during CPR: in or out

relationship

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34
Q

: assess comprehension, prepare the family for what see and hear, reassure they can leave if they wish

A

during CPR: in or out

understanding

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35
Q

take action, when is it time to go in, alert healthcare team that family is entering the room, if family behavior is disruptive let the family know behavior is making it hard for the healthcare team to do their best work

A

during CPR: in or out

time

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36
Q

Interdisciplinary team, Resolving conflict

A

Team Communication:

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37
Q

: loss for words at least say I am sorry for your loss, it is okay to say I don’t know

A

. Summary

eof

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38
Q
  • be prepared, be brief, tell the truth, listen carefully, be reassuring, be yourself
    : gear info toward dev age younger concrete and older abstract, begin with child experiences
    : begin with basic info
    : look for clues to talk, accept w.e emotion is presented
    : ask to summarize what they heard, clarify misunderstandings
    : books movies, name people who have had it
A 
Talk to children about death:
Begin on the child’s level:
Let the child’s questions guide
Provide opportunities for the child to express feelings
Encourage feedback
Use of other resources
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39
Q

): death is temporary and reversible, death is mixed up with trips and sleep, may wonder what the deceased is doing

A

Children’s understanding of death:

3-5 (preschool

40
Q

think about finality and biologic process of death, death is related to mutilation, spirit gets you when you die, who cares for them if parent die, their actions and words caused the death

A

6-9 death understanding

41
Q

understanding and finality of death, show their feelings they are weak, need to be in control of their feelings, actions and words caused the death

A

12 and older (teenagers):

death understanding

42
Q

experience the world through sensory information: aware of tension and separation, comfort by familiar people

A

Children’s concepts of death:

Infancy 0-2:

43
Q

death as reversible death is not personalized, magical thinking, don’t believe it could happen to them, think they caused death bc wished go away

A

Children’s concepts of death:

Early childhood 2-6:

44
Q

: personalize death, aware death is final, death is caused by and event then later age cause by illness

A

Children’s concepts of death:

Mid childhood 7-12

45
Q

: appreciate universality of death my feel distant, engage in risky behavior

A

Children’s concepts of death:

Adolescence

46
Q

The Grief Process:

A

Loss, grief, mourning, and bereavement

47
Q

physical emotional cognitive and behavioral actions to death

A

Grief:

48
Q

: reaction of the survivor to the death of a family member or close friends

A

Bereavement

49
Q

: grief before loss

A

Anticipatory grief

50
Q

: regular feelings, behaviors, and reactions to loss

A

Normal grief

51
Q

normal grief reactions that do not subside and continue over very long periods of time

A

Complicated grief

1. chronic grief:

52
Q

chronic grief
delay grief
exaggerated grief
masked grief

A

Complicated grief

53
Q

normal grief reactions that are suppressed or postponed,survivor consciously or unconsciously avoids the pain of the loss

A

delay grief:

54
Q

survivor resorts to self-destructive behavior such as suicide, drugs, alcohol

A

exaggerated grief:

55
Q

: survivor is not aware that behaviors that interfere wit normal function are a result of loss

A

Masked grief

56
Q

. Risk factors: sudden losses: heart attack, stroke, tragic death,
Violent death: suicide, homicide/ multiple losses/ child loss

A

complicated grief

57
Q

loss cannot be openly acknowledged or socially sanctioned, not recognized by employers, biological family,

A

Disenfranchised grief:

58
Q

At risk: aids partners, ex-spouses, step parent child, terminated pregnancy

A

Disenfranchised grief:

59
Q

mourn, grieve based on their development level, in spirts, act out=behavioral changes
- Based on age and developmental level

A

Children’s grief:

60
Q

nervousness, uncontrollable rages, frequent sickness, accident proneness, antisocial behavior, rebellious,hyperactivity, nightmares, depression, memories fading in and out, excessive dependency on remaining parent

A

Symptoms of grief in younger children:

61
Q

difficulty concentrating, forgetfulness, poor school work, insomnia, social withdraw, over dependence or regression, talk of attempted suicide, nightmares, frequent illness, depression, alcohol or drugs, sexual promiscuity, compulsive behavior

A

Symptoms of grief in older children:

62
Q
  1. Notification/shock
  2. Experience the loss
  3. Reintegration
A

Stages and tasks of grief

63
Q

A. Who it includes
B. When it occurs
C. Nursing assessment of grief

A

. Grief Assessment

64
Q
  1. Type of grief
  2. Grief reactions
  3. Stages and tasks of grief
  4. Factors that affects the grief process
  5. Caregiver assessment
A

C. Nursing assessment of grief

65
Q

-Plan of care, Attitude, Cultural practices, What to say, Children and parents

A

Bereavement Interventions

66
Q
  1. Decrease in sense of loss
  2. Is advance directive in place?
  3. Emotional support
  4. Encourage verbalization
  5. Assist with role changes, education and/or resources
  6. Encourage life review
  7. Educate the patient/family about dying process
  8. Encourage patient/family to complete unfinished business
  9. Provide presence, active listening, touch and reassurance
A

Anticipatory grief

67
Q
  1. Presence, active listening, touch, silence
  2. Identify support systems
  3. Use bereavement specialists, bereavement resources
  4. Normalize grief process and individual differences
  5. Individualize the grief process
  6. Actualize the loss and facilitating living without the deceased
  7. Identify and express feelings
  8. Disenfranchised grief- acknowledgement
  9. Public funerals, memorial services, rites, rituals and traditions: private rituals
  10. Spiritual Care
  11. Recognizing developmental stage of children
  12. Identify need for additional assistance and making referrals
A

Grief interventions

68
Q 
A. Witness to futile treatments
B. Moral Distress
C. Personal death awareness
D. Cumulative loss
E. stages of adaptation for the nurse
F. Factors influencing the nurse’s adaptation process
A

The nurse: death anxiety, cumulative loss, grief

69
Q
  1. Professional education
  2. Personal death history
  3. Life changes
  4. Support system
A

The nurse: death anxiety, cumulative loss, grief

70
Q
  1. Balance

2. Assessing support systems: formal, informal, instructor

A

Systems of support for healthcare provider

71
Q

medical futility- prolonged suffering, denial of palliative care services, nurse experience moral distress

A

Compassion fatigue nurses witness:

72
Q
  • can take a toll, burn out from setting, death on frequent basis
A

Cumulative loss

nurses

73
Q

: finding meaning in your work, balance, assessing support systems, spiritual support, education in eof care, self-care strategies

A

Systems of support

nurses

74
Q
  • nursing does not end with the death of patent
    A. Bereavement care continues after death
    B. Assessment with ongoing intervention
    C. Recognize own grief
    D. Bereavement care is interdisciplinary
A

Conclusion loss grieving and berevament

75
Q

provide support to staff and patients/families, interpersonal competence, being present, bearing witness, interdisciplinary care
B. Dying is an individualized, personal experience
C. The nurse as advocate- no typical death

A

Final Hours

A. The nurse, dying and death:

76
Q

= with present and listening, education, and support in any practice setting
A. Open, honest communication as death approaches
B. The dying older adult

A

Patient and family preparation through advocacy, communication

77
Q

signs, symptoms, and nursing interventions/

  • sleepy lethargic obtunded semicomatose comatose dead
  • rest confused tremulous hallucinations, myoclonic jerks seizures
  • pain control, palliative sedation for difficult road
A

Two roads to death:
easy
hard

78
Q 
A. Determining prognosis
B. Psychological and spiritual symptoms
C. Artificial nutrition and hydration at the end of life
D. Frequency of common symptoms
E. Physical signs and symptoms vary
A

two roads of death

79
Q
  1. Fear of the dying process, abandonment, unknown
  2. Nearing death awareness
  3. Withdrawal from family, friend and/or caregivers
  4. Increased focus on spiritual issues
A

two roads of death

psychological and spiritual symptoms

80
Q
  1. Confusion, disorientation, delirium:
  2. Unconsciousness:
  3. Weakness/fatigue:
  4. Surge of energy
  5. Drowsiness/sleeping: edu family
  6. Restlessness/agitation:
  7. Fever
  8. Bowel changes
  9. Decreased oral intake:
  10. Incontinence
  11. Pain:
A

Physical signs and symptoms vary

81
Q

implement safety measures, speak clearly, home care respite care for caregiver, assess cause and treat

A

Confusion, disorientation, delirium:

intervention and symptom

82
Q

: continue to speak to patient while doing care, educate family, peaceful settings, family say what they need to say, spiritual needs

A

Unconsciousness intervention and symptom

83
Q

increase assistance with adls, equipment, rom, respite care for family, social work for anticipatory grief, increase support, answer questions honestly

A

Weakness/fatigue: intervention and symptom

84
Q

common in final hours, multiple causes

A

Restlessness/agitation: intervention and symptom

85
Q

increased because progression, assess frequently, adjust meds, listen to concerns

A

pain intervention and symptoms

86
Q

A. Assessment and management of pain is critical
B. Opioids
C. Accumulation of metabolites
D. Myoclonus-up dose of opioids

A

Pain during the final hours of life

87
Q

-Sedation, Treatment, Comfort measures/emotional support

A

Intractable pain and other symptoms at the end of life

88
Q

A. Universal symptoms of imminent death
B. Management of symptoms related to imminent death
C. The death vigil

A
  1. Imminent Death
89
Q
  1. Decreased urine output
  2. Cold and mottled extremities
  3. Vital sign changes
  4. Respiratory congestion including respiratory bubbling
  5. Death rattle
  6. Delirium and confusion
  7. Restlessness
A

imminent death universal symptom

90
Q
  1. Family desires/preferences: pain control, comfort care, do they want to be present
  2. Common fears
  3. Nursing interventions- never jump in to assess for death wait till family is ready
  4. Honor culture
A

The death vigil

91
Q 
A. Communicating the death
B. Signs and symptoms of death
1. Absence of heart beat/ respiration
2. Pupils fixed
3. Color and Body temperature drops
4. Muscles, sphincters relax
A
  1. Death
92
Q

A. Preparing the family
B. Nursing responsibilities for care after death
C. Death of a parent: Care for the child

A

Care immediately following death

93
Q
  1. Removal of tubes, medical supplies and equipment
  2. Bathe, dress and position the body
  3. Plans for burial/embalming
  4. Removal of the body
  5. Assistance with phone call and notification of other healthcare providers
  6. Destroy medications (when death occurs at home)
  7. Assist with funeral arrangements, as needed and requested
  8. Initiate bereavement support
  9. Organ/tissue transplantation
A

Nursing responsibilities for care after death

94
Q

A. Allow to verbalize feelings; refer at risk staff
B. Organize memorial services and rituals
C. Serve as role model

A

Supportive staff eof

94
Q

Process it takes to deal with. The void, adapting to changes

A

Mourning

life span (23 decks)

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