PowerPoint: End-Of-Life Flashcards
Internal emotional reaction to loss
State of grieving from a loss of a loved one
Grief: Internal emotional reaction to loss
Bereavement: State of grieving from a loss of a loved one
Patient Self-determination act
(PSDA)
Grants Americans the right to determine the medical care they wanted if they became incapacitated
Legal document that specifies how you want medical care in the future
Advance directive
is a document that allows you to name someone to make medical decisions for you if you are unable to do so
Durable Power of Attorney for Healthcare
Advanced Directives is concerned with what to do to prevent your death by healthcare.
if a patient has a DRN do you preform CPR?
No
Body should not be displayed
No autopsies
Body not left unattended until the funeral with in 24 hrs
Dying person must recite The Confessional aka the Shema
Jewish
Death is seen as the new beginning
God has an appointed time for everyone
Body is bathed and wrapped in cloth
Muslim
Optimized comfort
Reduced Stress
Provide Emotional and Spiritual Support
Relieve Symptoms
(Shared in common)
Can be received at any stage of the disease
(Hospice / Palliative Care)
Prognosis of 6 months or less
Cannot be using curative treatments
(Hospice / Palliative)
Can be received at any stage of the disease
Palliative Care
Prognosis of 6 months or less
Cannot be using curative treatments Hospice
Last sense to go when dying
Hearing
To enter hospice 2 physicians must certify what?
A recertification only requires 1 physician
Terminal prognosis with less than 6 months to live
Patient is unable to cough up secretions
First nursing intervention
Turn on side
Administer medication to help dry up secretions
Which breathing patter is associated with dying
Cheyne Strokes
Apnea alternating with rapid breathing
In Hospice
Speak with a (Elevated / Softened) tone
Keep room (brightly/ dimmly) lit
Soft tone
Dimly lit
H
O
P
E
Mnemonic for spiritual assessment
Hope & Stength
Organized religion
Personal spiritualness
Effects of religion and spiritual on care and end of life
Is it common for a dying person to talk or see people who aren’t there
Are these hallucinations
Yes
No hallucinations
3 leading causes of death USA
is suicide in the top 10
Heart disease
Cancer (malignant neoplasma)
Accidents
Suicide is #10
When managing pain in a dying person Pain is accessed frequently and PRN medications are given as needed
True or False
False
Pain meds are given on a schedule
Managing dyspnea
Bronchodilators & Corticosteroids
Are used for…
Wheezing & Bronchospams
Managing dyspnea
Diuretics are used for…
Fluid Overload
Dyspnea, crackles, peripheral edema
Managing dyspnea
Anticholinergic are used..
Name 2 medications used
Dry up secretions
Atropine eye drops
Scopolomine transdermal patch
Standard treatment for managing Dyspnea
If this treatment does work
What is second choice
Opiods ?
Ask professor
Benzodiazepine
Constipation can cause nausea and vomiting
Interventions
Biphospahte enema
Mineral oil and gentle disimpactation
Postmortem
If death was unexpected
Do what?
Notify medical examiner
Are physician-assisted deaths legal in USA?
Yes, Oregon, Washington, Vermont, Montana, Colorado, DC
&
Canada
Terminal Delirium may occur a week or two before death.
Use this medication to help
Haloperidol IV is given
Adjuvant therapy may include…
Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy
Break through pain
A sudden increase in pain that may occur in patients who already have chronic pain from cancer, arthritis, fibromyalgia, or other conditions
Cutaneous pain is pain caused by ….
injury to the skin or superficial tissues.
Cutaneous nociceptors
are located just below the skin and produce a localized pain of short duration
Dynorphin is….
a neuropeptide involved in pain, addiction and mood regulation
Endorphins Vs Seratonin
Serotonin helps stabilize mood and well-being
Endorphins are focused on pain and stress relief
Intractable pain:
A type of pain that can’t be controlled with standard medical care. It’s also known as intractable pain disease, or IP. Intractable pain isn’t curable, so the focus of treatment is to reduce discomfort.
Neuromodulation therapies
New field of treatment Simulating
parts of the nervous system to alter or reset the abnormal circuitry
Using drugs or electricity
Neuropathic pain, also known as nerve pain, is pain that occurs when the nervous system is damaged or malfunctions.
It’s not usually caused by an injury or event, but instead by the body sending pain signals to the brain without warning
True or False
True
Nociceptive pain is a type of physical pain that can feel sharp, aching, or throbbing. It’s caused by acute or ongoing tissue damage, such as:
Trauma
Surgery
Chemical burns
Metastasis to bone
Dental infection
Disease of the viscera
Psychogenic pain is….
Pain that is primarily caused by psychological factors
depression and anxiety
Referred pain is pain….
felt in one area of the body, but caused by an injury or pain in another area
(Transduction / Transmission)
is the process by which tissue-damaging stimuli activate nerve endings.
(Transduction / Transmission) is the relay functions that carry the message from the tissue injury site to the brain regions that underlie perception
Transduction is the process by which tissue-damaging stimuli activate nerve endings.
Transmission is the relay functions that carry the message from the tissue injury site to the brain regions that underlie perception.
The activation of pain receptors is called
Transduction
___ or peripheral receptors respond selectively to mechanical, thermal, and chemical noxious stimuli
Nociceptors
The process by which sensation is inhibited or modified is referred to as…
Modulation
Vitals all decreases except
Temp increases then decreases
Pain meds are given
PNR or Regularly
Regularly
Do hospice patients get IV or Tube Feeding
Nope
What is the priority for end of life
Control Pain
Air hunger and breathless are managed by this drug first
Morphine
Type of oxygen delivery system given at end of life
Nasal Cannula
If unexpected death happens what is the post mortem care
Leave all lines & Tubes in
Saline drops and close eyes of deceased
Why
Preserve eyes for donations
Put water proof pad under decreased
Why
All muscles relax including anus
Expected or unexpected death or Brain Dead call Gift of Life
True or False
True
Active euthanasia
Provider takes action that directly causes the patients death
Supported or Not Supported
Not Supported
Physican Assisted Death
Provider helps a person commit suicide by providing drugs for self administration at patients request
Supported or not supported
Supported
Terminal weaning
Patient who is on a ventilator is taken off ventilation
Does Terminal Weaning cause a patents death
No, the patient’s disease process kills them
Why use a CPAP
A. It uses positive pressure to keep airway open
B. Delivers oxygen with respiratory effort
C. Uses negative pressure to close airway.
D. Alternating waves of air to stimulate breathing
A. Uses positive pressure to keep airway open
_____ describes normal cells growing at the wrong place or wrong time
Benign tumors
One of the goals of hospice care is to relieve symptoms
True or False
True
Relieve symptoms yes
Cure disease No
