Palliative Care Flashcards
Philosophy of care for people with life-threatening diseases
Palliative Care
The goal of palliative care is to improve __________ for the patient and family
Quality of life
Comprehensive end-of-life care by which curative treatments have stopped, client is not expected to live longer than 6 months, and continuous care is provided to support the client toward a peaceful and dignified death
Hospice care
What are the top 10 causes of death in the US?
Heart disease, cancer, accidents (unintentional injuries), chronic lower respiratory diseases, CVAs, Alzheimer’s, DM, flu and pneumonia, kidney disease, suicide
Act that allows Americans the right to determine the medical care they want if they become incapacitated and mandates that all patients are asked about their advanced directed upon admission
Patient Self-Determination Act (PSDA)
A written document prepared by a competent person to specify what, if any, extraordinary actions they want when they are no longer able to make decisions on their own
Advanced Directive
Part of the advanced directive that identifies what one would or would not want to if they were near death (DNR, ventilation, hydration)
Living will
Part of advanced directive that identifies who can make healthcare decisions once healthcare provider determines patient lacks capacity to make heir own health decisions
Durable Power of Attorney for Health Care (DPOAHC)
Power of Attorney may also be called
Healthcare proxy, healthcare agent, surrogate decision maker
_____ must be done if DNR is not in place
CPR
A patient’s order set that identifies type of end-of-life saving measures they want
Physicians Orders for Life-Sustaining Treatment (POLST)
When should POLST be update?
Annually or any time there is a change in condition
T or F: withdrawing or withholding life-sustaining therapy is considered a form of euthanasia or physician-assisted death
FALSE; withdrawal of the intervention does NOT directly cause the patient’s death
Framework used in prioritizing patient care
Maslow’s Hierarchy of Needs
Components of Maslow’s Hierarchy of Needs
Physiological needs, safety needs, love and belonging, esteem, self-actualization
Maslow’s physiological needs includes
Air, water, food, shelter, sleep, clothing, reproduction
Maslow’s safety needs includes
Personal security, employment, resources, health, property
Maslow’s love and belonging includes
Friendship, intimacy, family, sense of connection
Maslow’s esteem includes
Respect, self-esteem, status, recognition, strength, freedom
Maslow’s self-actualization refers to
The desire to become the most that one can be
Cessation of integrated tissue and organ function
Death/dying
Defining components of death/dying
Lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction
Pathophysiology of dying: inadequate perfusion to body tissues deprives cells of oxygen, leading to aneorobic metabolism, which causes lactic acid buildup, creating
Acidosis, hyperkalemia, and tissue ischemia. Multiple organ failure/damage, progresses to renal and liver failure
When body is hypoxia and acidosis, lethal dysrhythmias such as ____ or _____ leads to lack of CO and perfusion followed by cardiac and respiratory arrest
Vfib; asystole
Physical manifestations of dying
Dyspnea, hypotension, anorexia, nausea, dehydration, altered LOC/seizure activity, pain
Patients at risk for dyspnea
Those with lung cancer, heart failure, chronic respiratory disease
Patients at high risk for seizures
Patients with brain tumors
Patients with tumors near arteries are at high risk for
Hemorrhage
In the dying patient with pain, the nurse can expect pain to
Continue, worse, or sometimes lessen
Wet, loud respirations heard in the dying patient
Death rattle
Nursing interventions for “death rattle”
Put patient on side, towel under mouth, anticholinergics to dry up secretions (scopolamine)
Cardiac dysfunction in the dying patients leads to poor tissue perfusion evidenced by
Cold, mottled, cyanotic extremities
LOC in the dying patient declines to
Lethargy, inability to speak, unresponsiveness, or coma
In the dying patient, blood pressure _________
Decreases (may only be palpable)
Dying patients may experience periods of apnea followed by rapid breathing. This is known as
Cheyne-Stokes respirations
HOPE mnemonic for spiritual assessment
H- sources of hope and strength
O- organized religion (if any) and role it plays in one’s life
P- personal spirituality, rituals, and practices
E- effects of religion and spirituality on care and end-of-life decisions
Identify the spirituality based on the following description:
- brain death may not be required for “Death” (more focused on breathing and HR)
- death is seen as a stage of life (may advocate for withdrawal of life-sustaining measures)
- may prefer death to occur at home
- body prepared by male
- mourners quiet and peaceful (avoid touching body except head)**
- may use cremation
Buddhism
Identify the spirituality based on the following description:
- many denominations - variety of end-of-life beliefs
- encourages sacrament of the sick administered by a priest; can be done more than once
- baptism by priest
Christianity/Roman Catholic
Identify the spirituality based on the following description:
- clients may want to lie on floor while dying OR body may be placed on floor after death w/ head facing north
- clients prepare for death w/ prayer and meditation
- care of body should by those of the same gender
- cremation can be used to purify the body after death
Hinduism
Identify the spirituality based on the following description:
- client’s face can be turned towards Mecca
- body washed and wrapped in cloth by person of same gender (may prefer person from mosque)
- prayer is often said
- autopsy not permitted **
- burial is preferred to cremation
- value having loved ones close by
Islam
Identify the spirituality based on the following description:
- someone stays with the body
- orthodox clients may prefer bodies to be prepared by Jewish Burial Society (do not typically allow autopsy)
- burial often occurs within 24 hrs unless during Sabbath (push burial to next day)
- displaying, cremation, and embalming are generally not permitted
Judaism
Identify the spirituality based on the following description:
- dying clients are not usually left alone
- last rites may include wearing temple clothes from burial
- burial is often preferred
Mormonism
In terms of postmortem care, if death was unexpected, who should be notified?
Medical examiner
The inner emotional response to loss exhibited through thoughts, feelings, and behaviors
Grief
Grief and mourning (outward social expression of loss) often culturally influenced or learned behaviors
Bereavement
Kubler-Ross model of grief
Denial, Anger, Bargaining, Depression, Acceptance
Kubler-Ross model consideration
Clients may not experience stages in order and length varies from person to person
Grief should change to acceptance over time, typically by ___ months after loss
6
Examples of somatic complaints that may occur during grief
Chest pain, palpitations, headaches, nausea, changes in sleep patterns, fatigue
Letting go of an object or person before the loss by which individuals start grieving process before the actual loss
Anticipatory grief
Anticipatory grief is common in patients with
Terminal illness
Types of complicated grief
Chronic, exaggerated, delayed, masked
Complicated grief that extends longer than average, for years or decades
Chronic
Complicated grief that may be self-destructive, maladaptive, and at risk for suicide/ideation
Exaggerated
Complicated grief that is avoided due to overwhelm
Delayed
Complicated grief that interferes with normal life and may present as a headache, heartburn, body rash, or tachycardia
Masked
Expression of loss that cannot be publicly shared or is not socially acceptable
Disenfranchised grief
Example of disenfranchised grief
Miscarriage
Any loss of valued person, item, or status (loss of job) that others can recognize
Actual loss
Anything clients define as loss but is not obvious or verifiable to others (patient may have had hope that you didn’t know of)
Perceived loss
Loss related to a change that is part of the cycle of life (anticipated); can be replaced by something different or better
Necessary loss
Example of necessary loss
Child no longer needs parent to read to them to go to sleep at night
Loss normally expected due to developmental processes of life
Maturation/developmental loss
Example of maturational/developmental loss
Child leaving home for college
Any unanticipated loss caused by an external event
Situational loss
Example of situational loss
Loss of home due to tornado
Loss experience before the loss occurs
Anticipatory loss
What is the symptom that dying patients fear most?
Pain
Medicine recommended only for refractory cancer pain as adjunct to other prescribed analgesics to address fatigue, anorexia, sleep problems, anxiety, nausea, and vomiting
Medical Marijuana
Managing weakness
Bed rest (avoid falls, injuries), foley cath, aspiration precautions, mouth care (emollient to lips)
Standard treatment for managing breathlessness/dyspnea
Opioids (morphine sulfate)
Nonpharmacologic interventions for managing breathlessness/dyspnea
Limit exertion, foley, elevate HOB or recline chair (increase chest expansion), wet cloths to face, imagery and deep breathing
Intervention for N/V if caused by constipation
Biphosphate enema
Seizures are not common, but may occur in patients with
Brain tumors, advanced AIDS, and pre-existing seizure disorders
Managing seizures
Around-the-clock drug therapy: benzodiazipine, barbiturates
Managing refractory symptoms of distress
Palliative sedation
The nurse can help meet the client/family’s psychosocial needs through _________, which is the concept of “being with” not just “being there”
Presence
Structured process of reflecting on what one has done through life
Life review
Randomly reflecting on memories of events in one’s life
Reminiscence
What gives someone meaning and purpose
Spirituality
Formal belief systems that provide a framework for making sense of life, death, suffering, and universal spiritual questions
Religion
