S4_EOL_Bereavement Flashcards
Pharmacological Management for
–> Terminal Restlessness
Anti-muscarinic / anti-cholinergic drugs are used to reduce terminal secretions,
–> given S/C or S/L,
e.g.:
SC Buscopan
SC Scopolamine
SC Glycopyrrolate
Atropine 1% eye drops
Non-pharmacological management for
–> Terminal restlessness
(1) Position patient on the side or a semi-prone position to facilitate postural drainage
(2) Good mouth hygiene
(3) Stop or reduce artificial nutrition and hydration
(4) Proactively explain and reassure family:
–> No evidence it is distressing to patient
–> Patient is not ‘drowning’
- Most secretions are usually below the pharynx and inaccessible to suctioning.
It is also causing discomfort to patient.
Routine deep suctioning is discouraged.
Name some of the EOL symptoms
1) Integumentary
- Mottled feet
- Peripheral oedema
- Cool extremities
2) Respiratory changes
–> Cheyne Stokes breathing aka Death rattles
–> reduced lung function, pleural effusion,
reduced RR
3) Fluctuating consciousness,
Hyperactive to hypoactive delirium
4) GI
–> LOA, cachexia, constipation
5) Cardiovascular
–> reduced CO
–> Lower HR, slower cap refill
–> oedematous third spacing
6) Urinary
–> Decreased urine output
(kidney failure, reduced intake)
What are the causes of terminal restlessness?
Patient is uncomfortable.
Full bladder.
Urinary retention.
Impacted bowel .
Inadequate pain or symptoms control.
Drug toxicity.
Emotional upset.
Fear, anxiety, unresolved issues.
Altered biochemistry-hypercalcemia, uremia.
Cerebral anoxia.
Stimulation of busy care environment- activity and lighting.
What is Compassionate discharge (CD) commonly known as?
Terminal discharge
Compassionate discharge is defined as a discharge home when patients are critically ill and likely to pass away within short hours or days.
For seriously ill patients with little chance of recovery, it is a good practice to proactively discuss about **patients’ preference of place of death (PPOD) ** to facilitate early planning and coordination.
What are the considerations and discussion topics to bring up for CD/ TD?
Patient
Has patient expressed a desire to die at home?
Will symptoms be manageable at home?
Could patient die enroute?
Family/Caregiver
Are there caregivers available?
Is the family able to cope physically and emotionally with patient’s care and demise?
Is the family aware of what to expect (e.g. about the signs of dying), how to respond, and who to contact when patient dies?
Resources/Equipment
What equipment is needed (e.g. hospital bed, oxygen concentration)?
Should referral to a home hospice team or home care services be made?
Kubler Ross 5 Stages of Grief:
(DAB-DA)
Denial
Anger
Bargaining
Depression
Acceptance
Difference between Normal Grief and Complicated Grief
Grief
A “normal” response to an “abnormal” situation.
process of reacting to the loss, with emotional, physiological, & cognitive symptoms resulting in a unique behavioral response.
Types of grief:
“Normal” grief reactions/ uncomplicated grief (Normal Grief)
Expression varies from person to person as it depends on cultural norms and expectations.
Usually causes mild functional impairment and** lasts about 6 months.**
“Abnormal” grief reactions/ (Complicated Grief)
Failure to return to normalcy.
Prolonged, overly intense, delayed or absence.
Risk factors for complicated grief
Cause
Sudden or unexpected death.
Relationship
Intimate relationship with the deceased.
Mental
History of mood or anxiety disorders.
Health
Poor health.
Stressors
Multiple stressors.
Support
Poor social support.
Consequences of Complicated Grief
Depression
Anxiety
Alcohol abuse
Increased use of prescribed drugs
Suicidal tendencies
Health deterioration
Mourning
Task 1 - 4
Task one
-Accept the reality of loss.
Task two
- Feeling & expressing the grief.
Task three
-Adjust to a world without this
deceased.
At functional level- taking on roles of the deceased.
At internal level - adjusting own sense of self.
At spiritual level - how does the death impact upon the bereaved sense of beliefs, values and meaning.
Task four
-Find an enduring connection with the deceased in the midst of embarking on a new life.
7 Factors influencing the impact &
outcome of bereavement
(1) Who the person was (impact of r/s)
i.e. spousal/ friend/ lover/ family etc.
(2) Nature of the attachment relationship.
(Strength, security, ambivalence, conflict)
(3) Nature of the death. (untimely, violence, multiple)
(4) Previous experiences
(5) Personality (attachment style)
(6) Social Variables (level of support)
(7) Concurrent stresses
