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54/64 Final Content > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

Philosophy of care for people with life-threatening diseases

A

Palliative Care

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2
Q

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

A

Quality of life

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3
Q

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

A

Hospice care

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4
Q

What are the top 10 causes of death in the US?

A

Heart disease, cancer, accidents (unintentional injuries), chronic lower respiratory diseases, CVAs, Alzheimer’s, DM, flu and pneumonia, kidney disease, suicide

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5
Q

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

A

Patient Self-Determination Act (PSDA)

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6
Q

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

A

Advanced Directive

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7
Q

Part of the advanced directive that identifies what one would or would not want to if they were near death (DNR, ventilation, hydration)

A

Living will

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8
Q

Part of advanced directive that identifies who can make healthcare decisions once healthcare provider determines patient lacks capacity to make heir own health decisions

A

Durable Power of Attorney for Health Care (DPOAHC)

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9
Q

Power of Attorney may also be called

A

Healthcare proxy, healthcare agent, surrogate decision maker

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10
Q

_____ must be done if DNR is not in place

A

CPR

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11
Q

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

A

Physicians Orders for Life-Sustaining Treatment (POLST)

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12
Q

When should POLST be update?

A

Annually or any time there is a change in condition

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13
Q

T or F: withdrawing or withholding life-sustaining therapy is considered a form of euthanasia or physician-assisted death

A

FALSE; withdrawal of the intervention does NOT directly cause the patient’s death

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14
Q

Framework used in prioritizing patient care

A

Maslow’s Hierarchy of Needs

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15
Q

Components of Maslow’s Hierarchy of Needs

A

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

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16
Q

Maslow’s physiological needs includes

A

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

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17
Q

Maslow’s safety needs includes

A

Personal security, employment, resources, health, property

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18
Q

Maslow’s love and belonging includes

A

Friendship, intimacy, family, sense of connection

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19
Q

Maslow’s esteem includes

A

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

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20
Q

Maslow’s self-actualization refers to

A

The desire to become the most that one can be

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21
Q

Cessation of integrated tissue and organ function

A

Death/dying

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22
Q

Defining components of death/dying

A

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

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23
Q

Pathophysiology of dying: inadequate perfusion to body tissues deprives cells of oxygen, leading to aneorobic metabolism, which causes lactic acid buildup, creating

A

Acidosis, hyperkalemia, and tissue ischemia. Multiple organ failure/damage, progresses to renal and liver failure

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24
Q

When body is hypoxia and acidosis, lethal dysrhythmias such as ____ or _____ leads to lack of CO and perfusion followed by cardiac and respiratory arrest

A

Vfib; asystole

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25
Q

Physical manifestations of dying

A

Dyspnea, hypotension, anorexia, nausea, dehydration, altered LOC/seizure activity, pain

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26
Q

Patients at risk for dyspnea

A

Those with lung cancer, heart failure, chronic respiratory disease

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27
Q

Patients at high risk for seizures

A

Patients with brain tumors

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28
Q

Patients with tumors near arteries are at high risk for

A

Hemorrhage

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29
Q

In the dying patient with pain, the nurse can expect pain to

A

Continue, worse, or sometimes lessen

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30
Q

Wet, loud respirations heard in the dying patient

A

Death rattle

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31
Q

Nursing interventions for “death rattle”

A

Put patient on side, towel under mouth, anticholinergics to dry up secretions (scopolamine)

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32
Q

Cardiac dysfunction in the dying patients leads to poor tissue perfusion evidenced by

A

Cold, mottled, cyanotic extremities

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33
Q

LOC in the dying patient declines to

A

Lethargy, inability to speak, unresponsiveness, or coma

34
Q

In the dying patient, blood pressure _________

A

Decreases (may only be palpable)

35
Q

Dying patients may experience periods of apnea followed by rapid breathing. This is known as

A

Cheyne-Stokes respirations

36
Q

HOPE mnemonic for spiritual assessment

A

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

37
Q

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

A

Buddhism

38
Q

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

A

Christianity/Roman Catholic

39
Q

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

A

Hinduism

40
Q

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

A

Islam

41
Q

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

A

Judaism

42
Q

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

A

Mormonism

43
Q

In terms of postmortem care, if death was unexpected, who should be notified?

A

Medical examiner

44
Q

The inner emotional response to loss exhibited through thoughts, feelings, and behaviors

A

Grief

45
Q

Grief and mourning (outward social expression of loss) often culturally influenced or learned behaviors

A

Bereavement

46
Q

Kubler-Ross model of grief

A

Denial, Anger, Bargaining, Depression, Acceptance

47
Q

Kubler-Ross model consideration

A

Clients may not experience stages in order and length varies from person to person

48
Q

Grief should change to acceptance over time, typically by ___ months after loss

A

6

49
Q

Examples of somatic complaints that may occur during grief

A

Chest pain, palpitations, headaches, nausea, changes in sleep patterns, fatigue

50
Q

Letting go of an object or person before the loss by which individuals start grieving process before the actual loss

A

Anticipatory grief

51
Q

Anticipatory grief is common in patients with

A

Terminal illness

52
Q

Types of complicated grief

A

Chronic, exaggerated, delayed, masked

53
Q

Complicated grief that extends longer than average, for years or decades

A

Chronic

54
Q

Complicated grief that may be self-destructive, maladaptive, and at risk for suicide/ideation

A

Exaggerated

55
Q

Complicated grief that is avoided due to overwhelm

A

Delayed

56
Q

Complicated grief that interferes with normal life and may present as a headache, heartburn, body rash, or tachycardia

A

Masked

57
Q

Expression of loss that cannot be publicly shared or is not socially acceptable

A

Disenfranchised grief

58
Q

Example of disenfranchised grief

A

Miscarriage

59
Q

Any loss of valued person, item, or status (loss of job) that others can recognize

A

Actual loss

60
Q

Anything clients define as loss but is not obvious or verifiable to others (patient may have had hope that you didn’t know of)

A

Perceived loss

61
Q

Loss related to a change that is part of the cycle of life (anticipated); can be replaced by something different or better

A

Necessary loss

62
Q

Example of necessary loss

A

Child no longer needs parent to read to them to go to sleep at night

63
Q

Loss normally expected due to developmental processes of life

A

Maturation/developmental loss

64
Q

Example of maturational/developmental loss

A

Child leaving home for college

65
Q

Any unanticipated loss caused by an external event

A

Situational loss

66
Q

Example of situational loss

A

Loss of home due to tornado

67
Q

Loss experience before the loss occurs

A

Anticipatory loss

68
Q

What is the symptom that dying patients fear most?

A

Pain

69
Q

Medicine recommended only for refractory cancer pain as adjunct to other prescribed analgesics to address fatigue, anorexia, sleep problems, anxiety, nausea, and vomiting

A

Medical Marijuana

70
Q

Managing weakness

A

Bed rest (avoid falls, injuries), foley cath, aspiration precautions, mouth care (emollient to lips)

71
Q

Standard treatment for managing breathlessness/dyspnea

A

Opioids (morphine sulfate)

72
Q

Nonpharmacologic interventions for managing breathlessness/dyspnea

A

Limit exertion, foley, elevate HOB or recline chair (increase chest expansion), wet cloths to face, imagery and deep breathing

73
Q

Intervention for N/V if caused by constipation

A

Biphosphate enema

74
Q

Seizures are not common, but may occur in patients with

A

Brain tumors, advanced AIDS, and pre-existing seizure disorders

75
Q

Managing seizures

A

Around-the-clock drug therapy: benzodiazipine, barbiturates

76
Q

Managing refractory symptoms of distress

A

Palliative sedation

77
Q

The nurse can help meet the client/family’s psychosocial needs through _________, which is the concept of “being with” not just “being there”

A

Presence

78
Q

Structured process of reflecting on what one has done through life

A

Life review

79
Q

Randomly reflecting on memories of events in one’s life

A

Reminiscence

80
Q

What gives someone meaning and purpose

A

Spirituality

81
Q

Formal belief systems that provide a framework for making sense of life, death, suffering, and universal spiritual questions

A

Religion

54/64 Final Content (4 decks)

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