Quality of Life Issues Flashcards
Describe Advanced Care Planning
- overall process in which providers can explore preferences/wishes of their pts
- often culminates into preparing an Advanced Directive
What are the 3 steps involved in creating a Advanced Care Plan
- to learn what types of decisions my need to be made around end of life
- how to consider/decide about these issues prior to end of life
- Letting others know about your preferences
Describe Advanced Directives
-legal document that goes into effect when a pt becomes incapacitated/unable to make own decisions
-can be adjusted/amended
living will, durable power of attorney for health care, DNR, DNI, organ/tissue donation
When can Advanced Directives be adjusted/amended
-at different stages of life/illness, based on changing needs/goals
What are some things one may find in an Advanced Directive
- Living Will
- durable POA for Health Care
- DNR, DNI, DNH
- Organ/tissue donation
Describe Patient Self Determination Act (1990)
- requires hospitals/HMOs to inform pts of their right to make health care decisions
- requires hospitals/HMOs to provide Advanced Directives to their pts
What are some End of Life decisions one may find detailed w/in a Living Will
- whether pt wants:
- CPR
- respirator/ventilator use
- artificial nutrition (feeding tube)
- IV hydration
- IV abx
- comfort care (palliative care, hospice)
What is a DNR
- do not resuscitate
- allows others to know that a pt doesn’t want their heart to be restarted or returned to normal rhythm
Describe Medical Futility
-an intervention that is unlikely to result in a positive outcome
Are hospitals/providers obligated to provide futile care/interventions that have no physiologic rationale or have already failed
-No, just b/c an intervention/tx/med exists doesn’t mean it is in the best interest of the pt
Describe Persistent Vegetative State
- may groan/moan
- has more upper brain stem function (able to open eyes/speak)
- may cry/smile
- may briefly move eyes toward persons/objects
- unable to follow instructions
- no purposeful movements
Describe Comatose State
- when person is in a deep stupor and does not respond to external stimuli
- eyes are closed
- can’t follow commands
- no purposeful movements
- no facial expressions or speaking
Where does damage to the brain tend to be in pt’s in Persistent Vegetative states
-cerebral cortex, thalami, or connections b/w areas of brain
How long does someone have to be in a vegetative state for it to be considered persistent
- longer than 1 month
Describe Withdrawing Care
-discontinuing tx that has already been started
Describe Withholding Care
-make decision to NOT start a tx
Does Withholding or Withdrawing Care tend to be harder
-Withdrawing
When should End of Life Conversation start
- as early as possible
- can be done routinely for all pts
- should be done whenever a pt is dx w/ terminal or chronic illness
Describe goal of Hospice
maximize quality of life and reduce suffering
- not intended for those still undergoing tx
- provides services for both family and pt
Where can Hospice be utilized
- pt’s home
- skilled nursing facility
- hospice facility
- hospitals
What are the conditions/diseases that are Indications for Hospice
- any dz/condition that has a somewhat predictable progression and easily recognizable terminal phase
- Examples: CA, CHF, COPD, chronic liver failure, dementia
What are the Typical Services Provided by Hospice
- manage pain/Sxs
- assist w/ emotional/psychological/spiritual aspects of dying
- coaches family on how to care for pt
- when needed, PT/OT/ST
- when needed, inpatient/respite care
- home visits by RNs and LPNs
- home health aide/homemaker services
- chaplain services
- SW services
- bereavement counseling
- medical equipment/supplies and meds paid for
Describe physician assisted deaths
- when providers provide necessary means/info required to commit suicide/hasten death
- pt performs act themselves
Is physician assisted death legal
- varies by state
- illegal in 42 states
- legalized in Colorado, Oregon, Vermont, Washington, Hawaii, and DC
- in legalized state physicians won’t be prosecuted for prescribing meds that hasten death as long as pt has terminal illness and <6 months to live
