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Nursing Theory (Level 4) > Nursing theory > Flashcards

Nursing theory Flashcards

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1
Q

Is a healthcare services and supports for people who are expected ro progress toward death because of a serious illness?

A

Palliative care

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2
Q

Part of palliative care but is specific to care that a person receives in the last days and hours of their life (hospice care).

A

End-of-life care

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3
Q

Aims to reduce suffering and improve quality of life for people who are living with life-limiting illness through the provision of:

-Pain and symptom management

  • Psychological, social, emotional, spiritual, and practical support.

-support caregivers during the illness and after the death of a person they are caring for.

A

Palliative approach to care

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4
Q

Approach to care that places the person receiving care, and their family, at the centre of decision making.

A

Person-and family-centered approach to care

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5
Q

-Focus on QUALITY rather than QUANTITY

-Life affirming but death accepting

-Effective communication at all levels
-Respect for autonomy and choice
-Effective symptom management
-Holistic, multi-professional approach
-Caring about the person and those who matter to that person

A

Principles

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6
Q

-Body and mind
-Symptom management
-Psychosocial
-QOA ( Quality of Life)
-Comfort Measures
-Desires and Goals
-Pain management

A

Person-Centered Care

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7
Q

Is a subjective symptom, ranging from tiredness to exhaustion, that is out of proportion to recent activity.

Occurs as result of disease, emotional state and/or treatment, may be acute or chronic.

A

Fatigue

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8
Q

-Advance aging-Frailty
-Cancer, tumor, Cardiac disease (CHF)
Dementia (end-stage)
-Liver failure (end-stage)
-Metabolic disorders
-Sleep disorders (insomnia)
Etc.

A

Fatigue Causes

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9
Q

O-nset
( When did you start feeling fatigued? How long it last? How often it occurs?)

P-rovoking/ Palliating
( Wht brings it on? What makes it better? What makes it worse?)

Q-uality
( What does it feel like? Can you describe it?)

R-egion/Radiation
(Not applicable)

S-everity
( How severe is the symptoms? From scale of 0-10)

T-reatment
( What medication are you currently using?, Do you have any side effects from meds? )

U-nderstanding
(What do you believe is causing the symptom? How is it affecting ypu and your family?)

V-alues
( What overall goals do we need to keep in mind as we manage this symptom? Are there any beliefs, views or feelings about this symptom that are important to you and your family?)

A

Fatigue Assessment

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10
Q

Is the unpleasant subjective sensation of being about to vomit.

May occur in isolation or in conjunction w/ other gastrointestinal and/or autonomic symptoms. (Ex. pallor, cold sweat, salivation).

Nausea and vomiting affects 40-60% of those receiving palliative care.

A

Nausea

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11
Q

-Fear, pain (cerebral cortex)
-Motion sickness, cerebral tumors ( vestibular apparatus)
-Vagus/ splanchnic nerves
-Gastric irrittion, GI distention
-GI tract
-Chemoreceptor triger zone ( Drugs metabolic)

A

Nausea Causes

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12
Q

-Limit spicy foods w/ strong odours
-Use small, frequent, blnd meals and snacks througout the day
-Suggest small amounts of food every few hours
- Sip water, suck on ice chips, etc. It is important to stay hydrated throughout the day even when not feeling thirsty.

-Sit upright or recline w/ head elevated for 30-60 mins after meals.

If vomiting, limit all food & drink until vomiting stops; wait 30-60 mins. after bomiting, then initite sips of clear fluid.

-Encourage frequent oral hygiene
-Offer antiemetics at regular intervals

A

Nausea Treatment

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13
Q

Unpleasant physical or emotional experience r/t potential or actual tissue damage; subjective and may be experienced acutely or chronically.
( Pain is what pt. says it is)

A

Pain

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14
Q

Recognition that pain can be experiencwd from more than solely physical causes, including psychological, social and spiritual causes.

A

Total pain

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15
Q

Sharp, aching, throbbing pain

A

Nociceptive Pain Quality

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16
Q

Shooting, buring, tingling, painfully numb

Allodynia/hyperalgesia

A

Neuropathic

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17
Q

-Generally tolerated bu the pt. and does not interfere w/ quality of life (QOA)

-Patient can be easily distracted from the pain

-Generally does not interfere w/ activities of daily living ( ADL’s)

A

Mild Pain

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18
Q

-Patient states they cannot manage pain

-Pain is interfering with quality of life (QOA)
-Patient feela it is difficult to concentrate b/c of pain

-Hard to distract from pain
- Pain is interfering w/ function and ADL’s

A

Moderate Pain

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19
Q
  • Patient is in acute distress or discomfort
  • Pt. Is completely focused on pain
  • Pt. is unable to complete activities
  • Pain dominates QOA
  • Pain onset is sudden and acute
    -Acute exacerbation of previous levels
  • Pain may present at a new/ different site
A

Severe Pain

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20
Q

-Moaning or groaning at rest or w/ movement

  • Failure to eat, drink, or respond to presence of others

-Grimacing or strained facial expressions

A

Pain Characteristics in Cognitively-Impaired Older Persons

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21
Q

-Guarding or not mocinh body parts

-Resisting care or noncooperation w/ therapeutic interventions

-Rapid heartbeat, diaphoresis, change in VS

A

Pain mannerisms in Cognitively-impaired Older Persons

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22
Q

Patient’s inability to communicate due to:

-Delirium
-Dementia
- Aphasia ( speechless)
-Motor weakness
-Language barriers

A

Reasons for Undertreatment of Pain

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23
Q

-Acetaminophen, adjuvant and analgesics and NSAIDS should be considered at the lowest effective dose.

  • If there’s no significant response in one week drugs should be stopped.
  • Meperidine and pentazocine should not be used.

-Long term use of NSAIDs requires gastric mucosa protection.

A

Mild Pain Treatment w/ Non-opiods

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24
Q

-Morphine starting dose is usually 5 mg PO 4h w/ 2.5 -5 mg PO q1h prn for breakthrough pain.

-Hydromorphone

-Oxycodone

A

Moderate Pain Treatment
for Opiod Naive Patients

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25
Q

-Oral: Morphine 5-10 mg PO q4h and 5mg PO q1h prn or hydromorphone 1 -2 mg PO q4h and 1mg PO q1 to q2h prn.

Subcu/IV: Morphine

A

Severe Pain Treatment
for Opiod Naive Patients

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26
Q

Unrelived pain

A

Pain during Dying Process

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27
Q

-Increase physiological stress
-Decrease mobility
-Increases myocardial oxygen requirements

A

Hastens death

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28
Q

-Suffering
-Spiritual distress

A

Causes psychilogical distress to the pt and family

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29
Q

Hearing, Tste, Smell, and Sight

A

End of Life Care
Physical Manifestations

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30
Q

Usually last send to dissappear during end of life care

A

Hearing

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31
Q

-Decrease with disease progression
-Blurring vision
- Sinking and glazing eyes
-Blink reflex absent
-Eyelids remain half-open

A

Physical Manifestation during End of Life

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32
Q

-Mottling on hands, feet, arms, and legs
-Cold, clammy skin
- Cynosis on nose, nail beds, knees
- “Waxlike” skin when very near death

A

Physical Manifestations
Integumentary System

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33
Q

-Increase Resp. Rate
-Cheyne-Stokes respirations
-Inability to cough or clear secretions
( Grunting, gurgling, or noisy congested breathing)
- Irregular breathing
( Slowing down to terminal gasps)

A

Respiratory Physical System

34
Q

Brathing that usually slows down and becomes irregular. It might stop and then start again or there might be long pauses or stops between breaths .

A

Cheyne-Stokes Respirations

35
Q

-Gradual decrease in urinary output
- Incotinent of urine
-Unable to urinate

A

Urinary Physical Manifestations

36
Q

Use for identifying and tracking potential care needs of palliative care patients, particularly as these needs change with disease progression.

A

Palliative Performance Scale

37
Q

The patient spends the majority of the day sitting in bed or lying down due to fatigue from advanced disease. She requires considerable assistance to walk even short distances. She is fully concious. She has a good nutritional intake.

A

Palliative Performance Scale
Case Study

40-50%

38
Q

The pt. is very weak and remains in a chair a couple of hours a day. The rest of the time, he is in bed. He has advanced disease and is requiring almost complete assistance witb self-care and feeding. He is experiencing decreased food intake, woth few small snacks that remains mostly unfinished. He has adequate fluid intake. The patient is drowsy but not confused.

A

Case Study PPS #2

40%

39
Q

The patient is up and about on her own. She has experienced a recent reoccurence of disease. He can do household chores with adequte rest periods. The patient requires occasional assistance with self-care whereby her caregiver watches her get in and out of the shower. Her intake is reduced from normal but still adequate. The patient is fully concious with no confusion.

A

Case Study #3

40
Q

Provide open and honest information. Be sure ro communicate that deat cannot be exactly predicted.

A

Supporting the Family

41
Q

Death

  • the irreversible cessation of circulatory and respiratory function

OR

-the irreversible cessation of all functions of the entire brain, including the brainstem.

-occurs when all vital organs and systems cease to function.

A

Physical Manifestations at End of Life

42
Q

-Presents as “confusion, restlessness, and/or agitation, with or without day-night reversal.

-Visual, auditory, and olfactory hallucinations may occur during this time.

  • Is often irrersible and may vary frok patient to patient.
A

Terminal delirium

43
Q

-includes identifying underlying cause, reducing stimuli and anxiety, and discontinuing all non-essential medications.

A

Terminal Delirium Management Techniques

44
Q

-From striving for cure to achieving relief from pain and suffering.

-No “right” or “correct” way to die. It’s everybody’s right to live independent and die with dignity.

A

Meaning of Hope Shifts

45
Q

Preserving personhood and dignity

A

One of the most important aspects of palliative care

46
Q

-Cleanliness and odour control (1st)
- Bathing and grooming ( Face, hands and feet)
- Mouth and nail care
-Clothing, bedding
-Promote home-like environment
( Pictures, bedding, personal items)

A

Preserving Personhood and Dignity

47
Q

-Pain and noisy breathing
-Attenf to symptoms and hygiene
-Limit/withhold food and fluid intake
-Maintin personhood ( Talk to resident)

A

Final Hours
Common symptoms and distressing

48
Q

Final critical expression of complete and irreversible neurological failure.

A

Brain Death/ brain arrest

49
Q

Are nurses legally able to pronounce death?

A

Yes. In many jurisdictions and agencies, nurses are legally able to pronounce death.

50
Q

Does pronouncement of death differs from certification of death?

A

Yes. Pronouncement of death is not the same as certifying a death.

51
Q

What is certifying a death?

A

It is a legal process of attesting to the fact, cause, and manner of someone’s death, in writing, on the form prescribed by the local authority.

52
Q

What is pronouncement of death?

A

Determination that life has ceased, based on physical assessment.

53
Q

Who can only do certification of death?

A

Can only be done by physician or a coroner.

54
Q

What to document in the health record after pronouncement of death?

A

-Date
-Time
-Finding of assessment and whether family has been notifiedbor autopsy required.

-Check agency policy to determine whether to notify provincial/territorial coroner.

55
Q

What are some considerations when preparing body for end-of life care?

A

-Close pt’s eyes
-Replace dentures
- Wash body as needed
- Remove tubes and dressings
-Staighten the body (leave pillow to support head)

-Cultural customs
-Accordance with provincial/territorial law
-Accordance with agency policies and procedures

56
Q

Wht is prerequisite for Neurological Determination Death (NDD)?

A

-Severe brain injury

57
Q

Is Neurological Determination of Death (NDD) abl prerequisite for cadaveric organ donation?

A

Yes.

58
Q

How many phycisians is required to determine NDD?

A

Leak and medical standards require 2 physicians to determine NDD.

59
Q

Legal and ethical issues affects end-of-life care of a patient

Patients and families struggle with many decisions during terminal illness, such as:

A

-Cardiopulmonary resuscitation (CPR)
-Admission to intensive care units (ICU)

60
Q

What is advance care planning? (ACP)

A

-It is a legal document used in end-of-life care.

(Advance directives)
-is a written documents prepared by competent persons outlining treatment wishes should they become incapacitated.

61
Q

What is Instructional directives?

A

-Ex. Living wills or treatment directives

62
Q

What is proxy directives?

A

-Ex. Power of attorney for personal care (POA)

63
Q

What is DNR?

A

-It is an order instructing health care providers not to attempt CPR.

(often requested by family)

(Does not preclude the use of oyher forms of treatment or care)

-also called Full code
-Allowing natural death (AND)
-Witholding or withdrawing treatments

64
Q

DNR Special considerations

A

It does not mean “do not treat”

-Symptom management is key component of end-of-life care.

65
Q

What is advance directives?

A

-general term used to describe documents that give instructions about future medical care and treatments.

66
Q

What is DNR?

A
  • a written physician’s order instructing healthcare provuders not to attempt cardioplumonary resuscitation.
67
Q

Wyat is Living will?

A

-a lay term used frequently to describe any number of documents that give instructions about future medical dare care and treatments or the wish to be allowed to die without heroic or extraordinary measures shoild the patient be aunable to communicate for self.

68
Q

Special considerations of Living will.

A

-May be prepared by the individual or bu the individual in consultation with a lawyer.

69
Q

What is power of attorney for personal care (POA)?

A
  • term used to describe a document that names the person or person’s authorized to make decisions regarding personal care.

Ex. housing, food, hygiene, healthcare ) when ill person us unable to do so for self.

70
Q

Special considerations of Power of attorney for personal care (POA).

A

The person appointed may be called a substitute decision maker, agent, or proxy.

71
Q

Level 1 ( Levels of Care)

A

-Stay in the facility and be kept comfortable, but not given antibiotics or other medications to cure.

72
Q

Level 2 (Levels of Care)

A
  • Stay in the facility and receive all medications and treatments possible within the facility.1
73
Q

Level 3 ( Levels of Care)

A

-Be transfered to a hospital from a nursing facility but not given CPR ot taken to intensive care

74
Q

Level 4

A

-Be taken to a hospital anf given all possible medical interventions.
-Do everything possible.

75
Q

Level 1 and 2

A

-Allow someone to fie naturally in familiar surroundings.

76
Q

What is MAID?

A

-Medical Assistance in Dying

77
Q

What are 2 tupes of MAIDS available to Canadians?

A

Ghey include a physician or nurse practitioner

-who directly administers a substance that causes death, such as injection of a drug. ( this is becoming known as clinician-administered medical assistance in dying.

-or

-provides or prescribes a drug that eligible person takes themselves, in order to gring about their own death.

(known as self-administered medical assistance in dying)

78
Q

MAID’s Criteria in accordance to federal legislation

A

-Must be:

-eligible for publicly funded health service in Canada.

  • atleast 18 y/o and capable of making decisions with respect to their health.
  • have a grievous and irremediable medical condition ( including an illness, disease or disability)

-make a voluntary request for MAID that is not a result of external pressure

-provide informed consent to receive MAID after having informed if the means that are available to relieve their suffering, including palliative care.

79
Q

Is having only 1 medical condition as a mental illness iligible to seek MAID at this time can be considered?

A

No. If mental illness is the only medical condition leading you to consider MAID, you are NOT iligible to seek MAID ay this time.

80
Q

Is having mental illness along with ither medical conditions, will you be eligible to seek MAID?

A

Yes. You may be eligible to seek MAID.

81
Q

Eligibility for MAID

A

-is always assessed on an individual basis, taking into account all of the relevant circumstances.

However, you must meet all the criteria to be eligible for MAID.

Nursing Theory (Level 4) (2 decks)

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