Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 202 Week 14 > Problems r/t Terminal Illness > Flashcards

Problems r/t Terminal Illness Flashcards

1
Q

Death, Dying, & End-of-Life

Nurses can affect the dying process
* Preventing death w/o dignity
* Promoting a peaceful, meaningful death
* Helping pt remain free from distress
* Minimizing suffering for pt & families

Part of the normal life cycle

A

Planning for End-of-Life & Advance Directives

Patient Self-Determination Act (PSDA)
Documentation associated w/PSDA

  • Advance directive
  • Durable power of attorney for healthcare (DPOAHC)
  • Living will
  • Do not resuscitate (DNR) [only gives instruct about CPR)
  • Physician orders for life-sustaining treatment (POLST)/MOLST
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hospice

Model for quality, compassionate care for those facing life-limiting illness or inj

  • Usually <6 mos to live
A

Palliative

Philosophy of care for those w/life-threatening dz

  • Provided by physician, NP, or team
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Physical assessment findings

↣ Weakness
↣ Sleeping more
↣ Anorexia
↣ Changes in organ system function

A

↣ Cold, mottled, cyanotic extremities

↣ Changes in breathing pattern - Cheyne-Stokes respirations

↣ Decr LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Psychosocial assessment findings

  • Fear and/or anxiety
  • Difficulty coping
  • Assess cultural considerations, values, religious beliefs
A

Spiritual assessment: HOPE mnemonic

H: source(s) of hope & strength
O: organized religion
P: personal spirituality, rituals, & practices
E: effects of religion & spirituality on end-of-life decisions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outcomes

✓ Needs & preferences met
✓ Control of sx’s of distress
✓ Meaningful interactions w/family
✓ Peaceful death

A

Pain Management

! Pain is the sx that dying pts fear most

! Opioid & non-opioid analgesics are used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complementary & Alternative Therapies

✐ Massage
✐ Music therapy
✐ Therapeutic touch
✐ Aromatherapy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Managing Weakness

✐ Aspiration precautions - dysphagia
✐ Provide mouth care: apply emollient to lips
✐ Altered routes of medication admin
- Choose least invasive route w/most effective treatment

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Managing Dyspnea

✐ Opioids, bronchodilators, diuretics, abx, anticholinergics, benzodiazepines
✐ Oxygen (for comfort)
✐ Electric fan for air circulation
✐ Reposition

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Managing N/V

Anti-emetic agents
* Prochlorperazine
* Ondansetron
* Dexamethasone
* Metoclopramide

A

✐ Remove any source of odors
✐ Comfortable room temp
✐ Aromatherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Managing Delirium

✐ Assess for pain, urinary retention, constipation, other reversible cause

✐ Pharmacologic agents

A

✐ Music therapy, aromatherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Interventions (for the grieving family & pt who will be losing their life)

✐ Presence
✐ Reminiscence
✐ Therapeutic communication
✐ Spirituality
✐ Life review
✐ Religion

A

Postmortem Care

Legal considerations
* Pronouncement of death
* Death certificate

✐ Allow family & caregivers to spend time w/the pt if they desire
✐ Determination of need for autopsy
✐ Transfer of body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ethics & Dying

Active euthanasia
* NOT supported by most organizations
* Legal in some situations in some states

  • Physician-assisted suicide (PAS)
  • Passive euthanasia
  • Voluntary stopping of eating & drinking (VSED)
A

Kubler-Ross’ Stages of Grief

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

John Bowlby’s Grief Process

Stage I Numbness or protest

Stage II Disequilibrium

Stage III Disorganization & despair

Stage IV Reorganization

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

___ ___’s Grief Process

Stage I Shock & disbelief

Stage II Developing awareness

Stage III Restitution

Stage IV Resolution of the loss

Stage V Recovery

A

George Engel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stages of the grief process according to J. William Worden

Task I: Accepting the reality of the loss

Task II: Processing the pain of grief

A

Task III: Adjusting to a world w/o the lost entity

Task IV: Finding an enduring connection w/the lost entity in the midst of embarking on a new life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The grief response is more difficult when:

☞ The bereaved person was strongly dependent

☞ The relationship was an ambivalent one

☞ The individual has experienced a # of recent losses

☞ The loss is that of a young person

A

☞ The bereaved person’s health is unstable

☞ The bereaved person perceives some responsibility for the loss

☞ The loss is secondary to suicide

☞ The loss is a traumatic death such as murder

17
Q

The grief response may be facilitated when:

☞ The individual has the support of significant others

☞ The individual has the opportunity to prepare for the loss

A
18
Q

?

Is the experiencing of feelings & emotions assoc w/the normal grief process in response to anticipation of the loss

  • Is thought to facilitate the grief process when the actual loss occurs
  • Difficulty arises when family members complete the process of & detachment from the dying person occurs prematurely
A

Anticipatory grieving

19
Q

Maladaptive Responses to Loss

  • Delayed or inhibited grief
  • Exaggerated or distorted grief response
  • Chronic or prolonged grief
A
20
Q

Delayed or inhibited grief

✏ The absence of grief when it ordinarily would be expected

✏ Potentially pathological b/c the person is not dealing w/the reality of the loss

A

✏ Remains fixed in the denial stage of the grief process

✏ Grief may be triggered much later in response to a subsequent loss

21
Q

Distorted (exaggerated) grief

✏ All of the sx’s assoc w/normal grieving are exaggerated

✏ Individual becomes incapable of managing ADLs

A

✏ Individual remains fixed in the anger stage of the grief process

✏ Depressed mood disorder is a type of distorted grief response

22
Q

Chronic or prolonged grieving

✏ A prolonged grief process may be considered maladaptive when certain behaviors are exhibited

✏ Behaviors aimed @ keeping the lost loved one alive

A

✏ Behaviors that prevent the bereaved from adaptively performing ADLs

23
Q

Normal vs Maladaptive Grieving

! Loss of self-esteem

! Marked feelings of worthlessness

A

Understanding death

24
Q

Birth to age 2

Unable to understand death but can experience the feelings of loss & separation

A

Ages 3 to 5

Have some understanding about death but have difficulty distinguishing between fantasy & reality; believe death is reversible

25
Q

Ages 6 to 9

Beginning to understand the finality of death; difficult to perceive their own death; normal grief reactions incl regressive & aggressive behaviors

A

Ages 10 to 12

Understand that death is final & eventually affects everyone; feelings of anger, guilt, & depression are common; peer relations & school performance may be disrupted

26
Q

Adolescents

✏ Usually able to view death on an adult lvl
✏ Have difficulty perceiving their own death
✏ May or may not cry; may withdraw
✏ May exhibit acting-out behaviors

A

Elderly adults

✏ A time in life of the convergence of many losses
✏ May lead to “bereavement overload”
✏ Bereavement overload may result in depression

27
Q

Death and Culture

A

African Americans

✿ Similar to those of the American culture of the same religion & social class, w/a blending of cultural practices from the African heritage

✿ Feelings are expressed openly & publicly

28
Q

Chinese Americans

✿ Death & bereavement in the Chinese tradition are centered on ancestor worship

✿ Chinese people have an intuitive fear of death & avoid references to it

✿ They don’t openly express their emotions

A

Japanese Americans

✿ Predominant religion is Buddhism

✿ Body is prepared by close family members

✿ Cremation is common

29
Q

Vietnamese Americans

✿ Buddhism is predominant religion

✿ Believe that birth & death are predestined

✿ Cremation is common

✿ The 1-year anniversary of an individual’s death is commemorated

A

Filipino Americans

✿ Week-long wake takes place in home of the deceased

✿ Among Catholic families, 9 days of novenas are held in the home or church, finishing on the last day w/a fiesta

✿ Wear dark clothing for 1 yr >a death

30
Q

Jewish Americans

✿ Traditional Judaism believes in an afterlife

✿ Dying person is never left alone

✿ No wake & no viewing are part of a Jewish funeral; cremation prohibited

✿ 7-day period beginning w/the burial is called shiva, during which mourners think only about the deceased

A

Mexican Americans

✿ View death as a natural part of life
✿ Death rituals reflect Catholic beliefs
✿ Burial is preceded by a velorio, a festive watch over the body
✿ Mourning is called luto & is symbolized by wearing dark or black & white clothing & by subdued behavior

31
Q

Native Americans

✿ Navajo of the Southwest conduct a cleansing ceremony before burial to prevent the spirit of the dead person from trying to assume control of someone else’s life

✿ Dead are buried w/their shoes on the wrong feet & rings on their index fingers

A

✿ They do not express grief openly & are reluctant to touch the body of a dead person

32
Q

Spiritual Distress

Short-Term Goal: Client identifies meaning & purpose in life, moving forward w/hope for the future

A

Long-Term Goal: Client expresses achievement of support & personal satisfaction from spiritual practices

33
Q

Spiritual Distress: Interventions

↣ Be accepting & nonjudgmental when client expresses anger & bitterness (toward God, the universe, etc.); stay w/client

↣ Encourage client to ventilate feelings r/t meaning of own existence in the face of current loss

↣ Encourage client as part of grief work to reach out to previously used religious practices for support. Encourage client to discuss these practices & how they provided support in the past

A

↣ Assure client that he or she is not alone when feeling inadequate in the search for life’s answers

↣ Contact spiritual leader of client’s choice, if he or she requests

34
Q

Nursing interventions for the bereaved individual

↠ Provide assistance through the grief process in a healthful manner toward resolution

↠ Encourage the individual to express feelings about the loss & how the loss will affect his or her life

↠ Review the circumstances of the loss & the reality that it could not be prevented

A

↠ Encourage the individual to participate in usual religious practices from which he or she derives support

↠ Assist the client to identify positive aspects about his or her life, past relationships, & prospects for the future

NUR 202 Week 14 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions