Palliative care

Question 1

What is palliative care?

Answer 1

reducing the severity of s/s
prevent and relieve suffering
Improve quality of life
emotional support

Question 2

Benefits
Earlier Palliative and EOL Care

Answer 2

Dec length of stay in ICU
Dec costs without an increase in mortality
Care received in lower acuity sites
Greater focus on comfort care

Question 3

Where to Start when Planning Care?

Answer 3

Identify patient’s goals of care
Does the patient have an advance directive?
-Directive to Physician
-Living Will
-Medical/Durable Power of Attorney

Question 4

Fatigue Assessment
question to ask

Answer 4

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?

Question 5

Factors Influencing Fatigue

Answer 5

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?

Question 6

Fatigue Management

Answer 6

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

Question 7

Dyspnea Assessment

Answer 7

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)

Question 8

Dyspnea Management

Answer 8

pain medication-opioids a
Provide anxiolytics is anxiety
Elevate HOB
Pursed lip breathing
Energy conservation techniques
Provide relaxation techniques

Question 9

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

Answer 9

weight loss of more than 5% within the past 6M
presence of skin breakdown(skin very fragile)

Question 10

Anorexia and Cachexia Management

Answer 10

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

Question 11

Nausea and Vomiting Assessment

Answer 11

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)

Question 12

Constipation

Answer 12

Question 13

when the person becomes too weak to clear their airways in the last days of life

Answer 13

Question 14

Answer 14

Question 15

Cominication
nemonic nurse?

Answer 15

NURSE
N: Name the emotion
U: Provide understanding
R: Demonstrate respect
S: Convey support
E: Tell me more…

Question 16

Pt must physicaly take med themselves
No one can administer medical aid dying med

Answer 16

Opioid=respiratory distress
releave pain? or stop breath?

Question 17

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?

Answer 17

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.

Question 18

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?

Answer 18

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.”

Question 19

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

Answer 19

Feelings of hopelessness

Question 20

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.

Answer 20

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.

Question 21

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

Answer 21

Cheyne-Stokes respirations

Question 22

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.

Answer 22

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.

Question 23

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.”

Answer 23

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.

Question 24

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.

Answer 24

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.

Question 25

When the nurse assesses the patient, what findings indicate to the nurse that the patient is very near death?
The patient responds to noises.
The patient’s skin is mottled and waxlike.
The heart rate and blood pressure increase.
The patient is reviewing his life with his family.

Answer 25

The patient’s skin is mottled and waxlike.
When a patient is very near death, the skin will be waxlike, cold, clammy, and mottled or cyanotic. Although hearing is the last sense patients lose before death, it is unlikely that they will be responding to noises when very near death. Initially, the heart rate increases but later slows, and the blood pressure decreases. Near death, speaking may be slow and unusual and indicate confusion.

Question 26

The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family?
The patient will be incontinent of urine after frequent seizures.
The skin will feel cold and clammy, with mottling on the extremities.
The patient will have increased pain, and the sense of touch will be enhanced.
The gag reflex is exaggerated, and the patient will have deep, rapid respirations.

Answer 26

The skin will feel cold and clammy, with mottling on the extremities.
Rationale:
As death approaches, the following physical manifestations occur: cold, clammy skin; mottling on hands, feet, arms, and legs; jerking (not seizures), which occurs in patients on large amounts of opioids; bowel and bladder incontinence; decreased perception of pain and touch; loss of gag reflex; and Cheyne-Stokes respirations.

Question 27

After a patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient?
Maintain daily contact with the adolescent’s family for the next 2 to 3 months.
Request a prescription for an anxiolytic to aid in dealing with the death of this patient.
Attend a debriefing session with interprofessional team to allow expression of feelings.
Avoid caring for any other patients who are terminally ill until the feelings of grief subside.

Answer 27

Attend a debriefing session with interprofessional team to allow expression of feelings.
The nurse needs to express feelings of loss and grief. Interventions such as a peer support, professionally assisted groups, and informal discussion sessions are appropriate ways for the nurse to express feelings related to death and dying.