Palliative care Flashcards
What is palliative care?
reducing the severity of s/s
prevent and relieve suffering
Improve quality of life
emotional support
Benefits
Earlier Palliative and EOL Care
Dec length of stay in ICU
Dec costs without an increase in mortality
Care received in lower acuity sites
Greater focus on comfort care
Where to Start when Planning Care?
Identify patient’s goals of care
Does the patient have an advance directive?
-Directive to Physician
-Living Will
-Medical/Durable Power of Attorney
Fatigue Assessment
question to ask
No.1 s/s
Not easily relieved by rest
0-10 scale
Are you feeling weak, tired, or wiped out?
How long does the fatigue last? Hours, days, weeks? Is there a pattern?
Does anything make it better or worse?
Factors Influencing Fatigue
vital change(fever,pulse change)
hydration status.
neurological changes
medications, especially sedating medications
-are they taking med causing fatigue symptoms?
lab Hgb,CBC with differential, and thyroid function
-animia?hypothyroid?
Fatigue Management
Creating a reasonable exercise plan
Use energy conservation techniques(w/OT,PT)
education pain control, nutrition, hydration, exercise, and energy conservation.
Pharmacologic management has limited evidence
Dyspnea Assessment
scale of 0-10
Presence of chest pain
Anxiety
Any issues or symptoms that make dyspnea worse such as cough or anxiety
Cyanosis
Inability to speak(severe case, they cannot talk till the end)
Dyspnea Management
pain medication-opioids a
Provide anxiolytics is anxiety
Elevate HOB
Pursed lip breathing
Energy conservation techniques
Provide relaxation techniques
Anorexia and Cachexia Assessment
Cachexia
-It is a complex problem that is more than a loss of appetite. It involves changes in the way your body uses proteins, carbohydrates, and fat. You may also burn calories faster than usual
weight loss of more than 5% within the past 6M
presence of skin breakdown(skin very fragile)
Anorexia and Cachexia Management
Quantity vs quality
consider medically administered nutrition and hydration
Do not force
Eating for pleasure should always be the goal.
High calorie foods, in small frequent meals, may improve intake.
Consider distressing odors
Nausea and Vomiting Assessment
Ongoing process
Know the pattern!
Consistency, intensity,frequency volume
Emesis associated with position changes
presence of constipation or impaction
(have to come out somehwere)
Presence of uncontrolled pain or infection
Presence of anxiety
Abdominal examination(bowel sounds, distention, masses, and presence of ascites)
Constipation
when the person becomes too weak to clear their airways in the last days of life
Cominication
nemonic nurse?
NURSE
N: Name the emotion
U: Provide understanding
R: Demonstrate respect
S: Convey support
E: Tell me more…
Pt must physicaly take med themselves
No one can administer medical aid dying med
Opioid=respiratory distress
releave pain? or stop breath?
a) 80 years old pt is pallitavie care for HF. The primary purpose of the pt reciving pallitave cares are?
b) A patient is receiving care to manage symptoms of a terminal illness when the disease no longer responds to treatment. What is this type of care known as?
c) A young adult patient with metastatic cancer, who is very close to death, appears restless. The patient keeps repeating, “I am not ready to die.” Which action is best for the nurse to take?
a) improve her quality life
focus on reducing the severity of disease sympotoms
b) Palliative care
c) Sit at the bedside and ask if there is anything the patient needs.
a) The dying patient and family have many interrelated psychosocial and physical care needs. Which ones can the nurse begin to manage with the patient and family? SATA
b) A deathly ill patient from a culture different than the nurse’s is admitted. Which question is appropriate to help the nurse provide culturally competent care?
a) Anxiety,Fear of pain,The dying process,Care being provided,Anger toward the nurse,Feeling powerless and hopeless
b) “Tell me about your expectations of care during this hospitalization.”
During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness?
Anorexia and nausea
Feelings of hopelessness
Frustration with level of pain
Inability to carry out activities of daily living
Feelings of hopelessness
How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient’s life?
Assess the individual patient’s wishes.
Call a pastor or priest for the family to help them cope.
Assess the beliefs and preferences of the patient and family.
Do not insult a Hispanic patient by suggesting hospice care.
Assess the beliefs and preferences of the patient and family.
Differences among spiritual and culture beliefs and values related to death and dying are innumerable. The individual patient and family must be assessed to avoid stereotyping individuals with different spiritual and cultural belief systems.
A patient has been receiving palliative care for the past several weeks in light of a worsening condition after a series of strokes. The caregiver reports that the patient “stops breathing for a while, then breathes fast and hard, and then stops breathing again.” What should the nurse document that the patient is experiencing?
Apnea
Bradypnea
Death rattle
Cheyne-Stokes respirations
Cheyne-Stokes respirations
A dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient’s needs?
Encourage more physical activity.
Assess for pain, constipation, and urinary retention.
Assess for spiritual distress and restrain in varying positions.
Assess for quality, intensity, location, and contributing factors of discomfort.
Assess for pain, constipation, and urinary retention.
Assessing for all reversible causes of delirium (i.e., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness. Encouraging more physical activity may prevent further skin breakdown, but it will be difficult because weakness and fatigue occur at the end of life. Keeping the skin clean and dry and preventing shearing forces will better avoid further skin breakdown. Spiritual distress may be a cause of restlessness, but the patient should not be restrained.
A patient with terminal cancer tells the nurse, “I know I am going to die pretty soon, perhaps in the next month.” What is the most appropriate response by the nurse?
“What are your feelings about being sick and thinking you may die soon?”
“None of us know when we are going to die. Is this a particularly difficult day?”
“Would you like for me to call your spiritual advisor so you can talk about your feelings?”
“Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you.”
What are your feelings about being sick and thinking you may die soon?”
Rationale:
The most appropriate response to psychosocial questions is to acknowledge the patient’s feelings and explore his or her concerns. This option does both and is a helpful response that encourages further communication between the patient and nurse.
A patient admitted for pneumonia informs the nurse that no one is to attempt CPR. What is important for the nurse to verify in the medical record related to the patient’s directive?
The physician has written and signed the DNR order.
The living will is signed by the patient and two witnesses.
The patient’s durable power of attorney agrees with the decision.
There is an advance directive related to artificial nutrition and hydration.
The physician has written and signed the DNR order.
Rationale:
CPR will be performed for respiratory or cardiac arrest unless a DNR (do not resuscitate) order is written and signed by the physician in the patient’s medical record. The DNR order documents the patient’s desire to avoid CPR.
