Palliative, Hospice, and EOL care (Final)

Question 1

Palliative vs Hospice

Answer 1

Palliative: Paid by insurance, self. Any stage of disease, Same time as curative treatment, typically happens in hospital

Hospice: Paid by medicare, medicaid, insurance, 6 month prognosis (Main difference)

Question 2

Palliative vs Hospice: What in common?

Answer 2

-Comfort care

-Reduce stress

-Offer complex symptom relief related to serious illness

-Physical and psychosocial relief

Question 3

Palliative care has moved upstream based on multiple RCY that show benefit

Question 4

Traditional Palliative Care

Answer 4

-Services were offered at the end-of-life stages

Question 5

Modern Palliative Care

Answer 5

At the time of the life threatening diagnosis. Once there has been a 6 month prognosis then hospice care is called

Question 6

Curative treatments

Answer 6

Hospice care you cannot (for the end of life) (Only comfort approach) (watch slide)

Palliative care you can

Question 7

What if the patient lives longer then 6 months in hospice?

Answer 7

Is up the physician and life expecting still needs to be less than 6 months

-If that changes they can have a live discharge

Question 8

Palliative and Hospice: Interdiscplinary

Answer 8

-Nurse

-Nurse Practitioner

-Physician

-Chaplain

-Pharmacist

-Social worker

Question 9

Communication

Answer 9

-Is the fulcrum of all the care that is provided.

-Need conversations to figure things out. Like currative treatments

-If the acceptance of the patient is not there than maybe they are not ready for hospice or palliative care

Question 10

Key Ideas

Answer 10

-Strong collaboration and communication between and among professionals is a prerequisite to communication with patients and families

Question 11

3 conversations

Answer 11

Family meeting:
-Ensure key topics
-Ensure family understands information
-Provide emotional support

Nurse and family conversation:
-Elicits family’s goal and needs
-Elicit understanding of prognosis
-Provide emotional support

Nurse and physician conversation:
-Elicit physician perspective on prognosis and goals

Question 12

Unique Communication Skills in the Nurse: Patient Relationship near end of life

Answer 12

-Develop and accurate and shared understadning of the patients situations including disease features, prognosis without treatment, psychosocial concerns and needs

-Respond empathically to patients’ emotions

Question 13

It is importance to note that responding to emotions is not fixing the emotion

Question 14

Hyperboleander

Question 15

Remember that patients can not move forward if their emotions are not addressed. What is the nurse accepting reponse?

Answer 15

• Accepts what the patient says non-judgmentally

-Acknowledges that patients ought o hold their own views and feelings

-Validates the importance of the patients contributions in a therapeutic relationship

Question 16

The “I WISH” statement

Answer 16

-Starting with I WISH demonstrates alignment with patient

-Implicitly acknowledges “it won’t happen”

Question 16

NURSE statments

Answer 16

N: Name the emotions

U: Undestanding

R: Respect the role of the caregiver

S: Support

E: Explore

Question 17

It is important to note that acceptance is not the same as agreement. It is important to note that acceptance is not the same as agreement. A physician could accept that a patient wishes to be cured of cancer, yet not agree that it is is possible.

Question 18

The “I WORRY” Statement

Answer 18

-Shares a possibliyt of bad outcome

-“I worry that even with more machines that we will not be able to help him get better”

Question 19

SILENCE IS

Answer 19

Empathic

-It shows support for the patinet

-Do not just sit there do something or Do not just do something sit there!

Question 20

ACP

Answer 20

The frequency of ACP converstations between patients and HCP remains low in clinical practice

Question 21

ACP

Answer 21

The process of discussing illness and end of life (EOL), clarifying values and goal, and preferences through written documents and medical orders

Early goals of care vs a late goals of care (Know These)

Question 22

Living Will

Answer 22

A written document in which a patient wishes regarding the administration of medical treatment are described if the patient becomes unable to communicate in the setting of a serious or terminal medical conditions

Question 23

MOST

Answer 23

A portable document of physician/provider medical order

Question 24

Legal Advance Care Planning Documents in Kentucky

Answer 24

-Kentucky living will

-Five wishes

Question 25

Kentucky Living Will

Answer 25

Living will form has two sections
1. Health care surrogate designation
2. Teratment wishes

You can also decide whether to donate any of your organs in the event of your death

-Requires 2 witnesses or it must be notarized. Law prohibits relatives, heirs, health care providers from being witnessses

Question 26

Five Wishes

Answer 26

-An advance directive form that is legal in 42 states.

-It provides a means to a legally document choices for medical treatment, comfort, and care wishes

-Five wishes meets the legal requirements for an advance directive in Kentucky

-2 witnesses or notarized

Question 27

Hot button issues

Answer 27

-Informed consent

-Withdrawing life sustaining treatment

-DNR’s

-Artificial Hydration / Nutrition

Question 28

What influences EOL care

Answer 28

-Ethnicity

-Intercultural aspects

-Family and Relationships

-Class

-Generation

Question 29

Death with Dignity - Medical Aid in Dying (MAID)

Answer 29

-Competent, terminally ill patient with a prescription for a lethal dose of medication, upon the patients request, which the patient intends to use to end his or her own life

-Not same as:
-Pain medication to hasten death
-Palliative sedation
-Euthanasia

Question 30

The Dying Experience (Weeks - Months - Years)

Answer 30

-Social Withdrawal (weeks to months)

-Food (Decreases) (Body is prepping for death)

-Sleep (Not sleeping or sleeping a lot more) (Not AOx4)

-Disorientation

-Restlessness

-Decreased sense

-Incontinence

-Physical Changes (Lower blood sugar) (higher heart rate)

Question 31

Syndrome of Imminent Dying (Hours - Days - Weeks)

Answer 31

Early:
-Bed Bound
-Lost of intrest of drink
-Cognitive changes - Increase time sleeping delirium

Middle:
-Further decline in mental status to obtundation (slow to arouse, brief periods of wakefulness)

Late:
-Death rattle
-Coma
-Fever
-Altered respiratory pattern. (Long apnea between each breath) (Wait for infants)
-Mottled extremities

Question 32

Family Concerns

Answer 32

-Is my loved on in pain?

-Aren’t we just starving my loved one?

-What should we expect; how will we know that time is short

-Should I/we stay by the bedside?

-Can my loved on hear what we are saying?

-What do we do after death?

Question 33

Morphine and Hastened Death

Answer 33

-No difference in survival with absolute opiod dose or change in dose

-Morphine-related will be evidence in drowsiness, confusion, loss of LOC before signficant compromised respiratory drive

Question 34

-If the intent for using morphine in the scenario is to relieve pain and not to cause death and accepted dosing guidelinse are follow :

Answer 34

-The treatment is considered ethical

-The risk of a potentially dangerous adverse secondary effects particularly hastening death is minimal

-The risk of resp depression is WAY over estimated

Question 35

Greif And Bereavement

Answer 35

-Anticipatory grief (Prior to death)

-Bereavement (Post mortem)

Question 36

KNOW THE MODELS OF GREIF IN THE PP