Palliative Care Flashcards by Daisy Perez

Philosophy of care for people with life-threatening diseases

Palliative Care

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The goal of palliative care is to improve __________ for the patient and family

Quality of life

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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

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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

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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)

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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

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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

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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)

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Power of Attorney may also be called

Healthcare proxy, healthcare agent, surrogate decision maker

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_____ must be done if DNR is not in place

CPR

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A patient’s order set that identifies type of end-of-life saving measures they want

Physicians Orders for Life-Sustaining Treatment (POLST)

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When should POLST be update?

Annually or any time there is a change in condition

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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

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Framework used in prioritizing patient care

Maslow’s Hierarchy of Needs

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Components of Maslow’s Hierarchy of Needs

Physiological needs, safety needs, love and belonging, esteem, self-actualization

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Maslow’s physiological needs includes

Air, water, food, shelter, sleep, clothing, reproduction

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Maslow’s safety needs includes

Personal security, employment, resources, health, property

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Maslow’s love and belonging includes

Friendship, intimacy, family, sense of connection

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Maslow’s esteem includes

Respect, self-esteem, status, recognition, strength, freedom

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Maslow’s self-actualization refers to

The desire to become the most that one can be

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Cessation of integrated tissue and organ function

Death/dying

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Defining components of death/dying

Lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction

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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

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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

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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

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