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life span > Nurb End of LIfe Cultural and Legal issues > Flashcards

Nurb End of LIfe Cultural and Legal issues Flashcards

0
Q

family meeting, include the patient if able

a. Establish consensus on withdrawal among the medical team members
b. identify the appropriate decision maker, patient, or surrogate: and establish consensus on proceeding among patient/family.
c. document the decision as well as the plan in the medical record

A

Guidelines for withdrawal of life supporting interventions

1. Clarify the decision:

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1
Q
  1. Clarify the decision:
  2. Identify patient/family goals
  3. Review the process with family and patient if awake
  4. Create a calm environment
  5. Principles of symptoms management in withdraw
  6. orchestrating withdrawal of therapies
  7. Removal of mechanic ventilation
  8. After death care
A

Guidelines for withdrawal of life supporting interventions

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2
Q

A. Ensuring comfort

B. visiting loved ones

A
  1. Identify patient/family goals
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3
Q

a. Emphasize comfort consistent with patient goals
b. describe plan
c. reassure to treat signs of distress: adequate analgesia and sedation
d. Address length of survival

A
  1. Review the process with family and patient if awake
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4
Q
  • provide a private room
  • liberalize visiting hours
  • remove lines, tubes, turn monitors off, disable alarms
  • have one iv line I place for administration of sedatives and analgesics
A

Create a calm environment

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5
Q

a. presence of attending physician
b. medications must be immediately available at the bedside
c. administration of medication should be guided by anticipatory dosing
d. medication should be titrate to effect
e. continuous infusion is preferable to bolus dosing

A
  1. Principles of symptoms management in withdraw
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6
Q

gradual not hasten or prolong

a. any medical treatment that is not essential to the comfort of the dying patient may be withheld or withdrawn,
b. not to prolong dying unnecessarily or act to hasten it
c. reason for th gradual withdrawal of therapies over days is to relate distance between the removal of the medical intervention and the patient’s death

A
  1. orchestrating withdrawal of therapies-
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7
Q

-maintain pt comfort

A

. Removal of mechanic ventilation

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8
Q

a. physician should acknowledge and confirm to the family when the patient has died
b. offer reassurance to the family that the decision was appropriate and correct
c. multidisciplinary team should debrief

A

. After death care

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9
Q
  • is a clinical term, is assessed by clinicians in a healthcare setting and applies to one’s ability to make health decisions
A

. Decision making

A. Capacity

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10
Q
  • is a legal term that is decided by the courts, persons may also be declared relevant in area (such as violence) and is not just related to issues of their healthcare
A

decision making

B. competence

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11
Q

-note that oral statements made by the pt prior to listing capacity can be used in decision making, especially if they were documented

A

Advanced directives
Living wills-
Durable power of attorney of health care

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12
Q
  • treatment directives

- appointment directives, health care proxy to represent the pt in decision making

A

Advanced directives
Living wills-
Durable power of attorney of health care

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13
Q
  • there is no ethical or legal distinction between a therapy. However many families and heath care providers find it much more difficult withdraw/ discontinue a therapy than to withhold it to begin with
  • both of these are based on the right of self-determinism. One must balance the benefit vs. burden in the decision making process
A

withhold or withdrawing of life sustaining therapies

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14
Q

: not starting a treatment or therapy

A

withholding

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15
Q

: a treatment or therapy was started and now is to be stopped

A

withdrawing

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16
Q

: artificial feedings, hydration, ventilation, and dialysis

A
  • life-sustaining therapies
17
Q
  • should not be viewed any differently than withdrawal of other life-sustaining therapies.
  • However because the discontinuation of support usually result in death more quickly than the withdrawal of other therapies it can be very upsetting of all involved
A

withdrawal of mechanical ventilation

18
Q

if a therapy is to be initiative it can be done with the understanding that it is a ___, with a specific time frame stating when is should be d/c if unsuccessful. This can serve two purpose 1. Decreases the pts risk of being held hostage if the family and or healthcare providers (HCP) are later reluctant to withdraw the intervention and 2. May help to alleviate guilt of the HCp or family when the time comes to make the decision to withdraw the interventions

A

one option is a trial intervention:

19
Q

particularly as it pertains to the administration of medically proved nutrition and hydration hcp have often been hesitant to withdraw these therapies, fearing that it may be illegal or the same as participating in assisted suicide/euthanasia, it is not the same. Ana code of ethics and position statement reaffirm this

A

withhold or withdrawing of life sustaining therapies

20
Q
  • only meant that hcp is not to attempt cpr if the pt has a cardiac or respiratory arrest
  • general successful attempts at cpr in individuals who are dying is
A

Resuscitation and DNRs

DNR

21
Q
  • conflict arise regarding the benefit of treatment (conflicts of values, disproportionate burden)
  • these often involve communication failures between all parties involved (pt, family, hcp)
A

Medical futility

22
Q
  • such request often signify crisis, such as unrelieved suffering and a plea for help
  • nurses should assess why request has been made
  • often it is due to feeling of no other option
  • Ana prohibits nurses acting to end life. Allows nurse to say to the pt “This view is supported by my profession.”
A

request for assisted suicide/euthanasia

23
Q
  • scope of practice and standards of care
  • codes of ethical conduct
  • guidance for responsible end-of-life/ palliative practice
A

Standard of Professional Nursing Practice

24
Q
  • order what we are doing, if you stop breathing we will let it happen instead of sounds a lot softer than we aren’t going to do anything
  • have to have an order from a physician to not do CPR, only intervention to not do
  • should not be anything in language of a slow code, medication only code/ either have full code status or no code
A

Position statement: DNR and AND-

1. and

25
Q
  • Comfort care no longer receiving fluid no IV, feeding tube
  • needs to be distinguished, doesn’t mean we won’t keep from eating or drinking, have to be able to swallow on their own
  • dying patient have the right to refuse food and fluid: they will eat little or not at all
A

Position statement: for going nutrition and hydration

26
Q

mouth care if very important-swab, saline rinse, lip moisturizer, ice chips
*if you disagree any of wishes have someone else fill your place

A

-Comfort care:

Position statement: for going nutrition and hydration

27
Q

-person approaches death a natural slowing down of the body’s physical and mental systems occurs
-because the needs of the body are changing the need for food and fluids naturally decreases as the person nears the end of life
-it is not unusual for the sense of taste to diminish and or the person to begin to have difficulty swallowing
-body systems slow the need for caloric intake also diminishes
-normal process near the end of life
food that has fueled healing in the past may now only bring about discomfort and possibly even pain

A
  1. Food and Fluid near the end of life
28
Q
  • when person is nearing the eof adding artificial food and fluids is not likely to make the person stronger or prolong their life and may cause uncomfortable symptoms
  • when a person with a temporary or chronic illness is expected to recover and cant swallow or properly digest food and fluids, a feeding tube or intravenous fluids may help
A

when are artificial food and fluids considered?

29
Q
  • may make some symptoms worse because the body systems are slowing and cannot process the food and fluids it does not need
  • feeding tube may put a person an increased risk for pneumonia, and may also cause pain N/V
  • tubes for food and fluids are potential sites for infection
  • in a person who is dying it may increase fluid in the lungs create difficulty in breathing cause N/V and urinary incontinence
A
  1. what may happen if artificial fluid and nutrition are given near the end of life?
30
Q
  • dehydration from being unable to take in food or fluids does not affect the dying patient in the same way as a healthy person who feels thirsty on a hot day
  • lack of fluids seems to produce a natural anesthetic effects often allowing for a reduction of pain medication
  • dehydration will reduce urine output and often provide a decrease in awareness of pain and other uncomfortable symptoms. It may help contribute to a peaceful comfortable death for many persons
  • near of eof, if the person is unable to take any food or fluids, they will gradually become weaker and sleep more
A
  1. What happens if artificial food and fluids are not given near the eof?
31
Q
  • usually the person does not experience thirst or hunger
  • if a person has thirst, it will only last a day or so and ice chips or small sips of fluid with good oral care should relieve this symptom
A

Will the person nearing death who does not receive artificial food and fluids be thirsty?

32
Q
  • person is awake it may be comforting to offer ice chips if they can be tolerated
  • person will also benefit from frequent oral care with a soft brush or sponge to relieve any dryness in the mouth, saline spray to the mouth may also be comforting
  • moisten the person’s eyes or use a warm damp cloth over there a few times each day
  • moisten the person’s lips and use lip balm to prevent dryness
  • use lotion without alcohol added to maintain skin comfort
A

What can be done to provide comfort?

33
Q

who is considered family? (may not be blood) Who are the caregivers? Who makes decisions? Who is included in discussions? Is full disclosure acceptable? (tell them everything about pt condition)

A

Role of the family:

Cultural and Spiritual Considerations in End-of-Life Care

34
Q 
A. Ethnicity
B. Race
C. Gender
D. Age
E. Religion and spirituality
F. Sexual orientation
G. Differing abilities 
H. Financial status
I. Place of Residency
J. Employment
K. Educational Level
L. Cause of death
A
  1. Components within culture
35
Q
  • sensitive to issues
    A. Components of cultural competence
    B. Interdisciplinary care
A

Cultural Competence

36
Q
  • system of shared symbols, provides security integrity belonging, constantly evolving, making meaning of illness, not limited to race or ethnicity *Ask
    B. Experience of end of life in cultural contents
    C. Increasing US diversity
A

Culture

37
Q 
A. Country of origin
B. Identification
C. Major supports
D. Decision-making
E. Languages/communication
F. Religion
G. Nutrition
H. Economics
I. Health beliefs
A
  1. Components of Cultural Assessment
38
Q

A. understanding own culture

B. Evaluate cultural beliefs of co-workers

A
  1. Self-Assessment

culture

39
Q
  1. Use of interpreters
  2. Conversational Style
  3. Personal space
  4. Eye Contact
  5. Touch
  6. Time orientation
  7. View of healthcare professionals
  8. Auditory versus visual learning styles
  9. Narrative interviews
A
  1. Cultural considerations of communication

A. Communication

40
Q
  • know families want to protect or pt doesn’t want to know, don’t have to change long held beliefs, there is a way to end the silence, can say as much and as little as they want, family dynamics will learn recognize pt who want to know and who don’t
  • call a family meeting, open discussion, not there to make decision, there to let them know it is okay discuss the situation if they desire
  • Should always use dead, dying, or death never use passed away or gone when speaking to a family/ it helps them to come to the realization of the situation
A
  1. Cultural considerations of communication

Role of the family

life span (23 decks)

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