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NSG 430 - Critical Care > T1: Palliative & EOL Care > Flashcards

T1: Palliative & EOL Care Flashcards

1
Q

palliative care

A

Care or treatment focusing on reducing the severity of symptoms

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2
Q

hospice care

A

LESS THAN 6 MONTHS TO LIVE, comfort care

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3
Q

Indication for Palliative

A

diagnosis of a life-limiting illness

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4
Q

death occurs when

A

all vital organs/body systems cease to function
irreversible cessation of cardiovascular, respiratory, and BRAIN FUNCTION

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5
Q

what can help determine brain death

A

EEG or Neuro Assessment

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6
Q

goals of end of life

A

-Provide comfort and supportive care during dying process
-Improve quality of remaining life
-Help ensure a dignified death
-Provide emotional support to family

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7
Q

end of life

A

as the period of time during which an individual copes with declining health from a terminal illness or from the frailties associated with advanced age even if death is not clearly imminent.

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8
Q

at end of life, metabolism is

A

decreased

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9
Q

end of life physical manifestations: respiratory system

A

-Irregular breathing that gradually slows
-Cheyne-Stokes respiration
-Inability to cough or clear secretions
(Grunting, gurgling, or noisy congested breathing (“death rattle”)

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10
Q

death rattle

A

Noisy, wet-sounding respirations, or terminal secretions, are caused by mouth breathing and accumulation of mucus in the airways.

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11
Q

Cheyne-Stokes respiration

A

a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing.

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12
Q

end of life physical manifestations: heating and touch

A

-Hearing is usually last sense to disappear
-Decreased sensation
-Decreased perception of pain and touch

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13
Q

end of life physical manifestations: taste, smell, sight

A

-Blurring of vision
-Blink reflex absent
-Patient appears to stare
-Eyelids remain half-open
-Decreased sense of taste and smell

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14
Q

end of life physical manifestations: integumentary system

A

-Mottling on hands, feet, arms, and legs
-Cold, clammy skin
-Cyanosis of nose, nail beds, knees
-“Waxlike” skin when very near death

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15
Q

end of life physical manifestations: urinary system

A

-Gradual decrease in urinary output
-Incontinent of urine
-Unable to urinate

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16
Q

end of life physical manifestations: GI system

A

-Slowing of digestive tract
-Accumulation of gas
-Distention and nausea
-Loss of sphincter control
-Bowel movement may occur before imminent death or at the time of death

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17
Q

end of life physical manifestations: musculoskeletal

A

-Gradual loss of ability to move
-Trouble holding body posture and alignment
-Loss of facial muscle tone
-Sagging of jaw
-Difficulty speaking
-Loss of gag reflex
-Swallowing can become more difficult

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18
Q

end of life physical manifestations: cardiovascular system

A

-Increased heart rate
-Decreased BP
-Later slowing and weakening of pulse
uIrregular rhythm
-Delayed absorption of IM or SQ drugs

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19
Q

Psychosocial Manifestations at End of Life

A

-Anxiety and fear
-Life review
-Peacefulness
-Saying goodbyes
-Withdrawal

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20
Q

spiritual needs

A

The patient’s and family’s preferences related to spiritual guidance or pastoral care services should be assessed, and appropriate referrals made.

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21
Q

Kubler-Ross stages of grief

A

denial, anger, bargaining, depression, acceptance

22
Q

Decisional capacity refers to

A

the ability to consent or refuse care

23
Q

Organ and Tissue Donation

A

Any body part or the entire body may be donated
-Decided by a person before death
-With family permission after death

24
Q

full code

A

refers to use of complete and total heroic measures including CPR, drugs, and mechanical ventilation

25
Q

Chemical code

A

involves use of drugs without CPR

26
Q

DNR

A

indicates comfort measures only without interference of technology.

27
Q

AND - Allow Natural Death

A

Also referred to as “comfort measures only” status.
Comfort measures include pain control and symptom management (usually O2 and meds given)

28
Q

if an advance directive is not indicated for a client, what type of code are they?

A

full code

29
Q

nurses often do not provide time of death in the hospital setting, but when they do, what is required

A

TWO NURSES will pronounce them, listen to heart beat for a full minute and then doc will sign certificate

30
Q

The principle of DOUBLE EFFECT

A

*refers to a principle that regards it morally permissible to give a medication that has the potential for harm if it is given with the intent of relieving pain and suffering and not intended to hasten death.
-give more medication for pain for example, TO RELIEVE PAIN AND SUFFERING even if you know It will slow breathing ect.

31
Q

principle of beneficence

A

means that care is provided to benefit

32
Q

assessment: if patient is alert

A

-Brief review of body systems to detect signs and symptoms
-Assess for discomfort, pain, nausea, or dyspnea
-Assess coping abilities of patient and family

33
Q

In the last hours of life

A

-Limit to comfort measures
-More peaceful for patient and family
-Pain level, respiratory status concerns should be addressed
-Transition your efforts to emotional and comfort support for patient and family as death approaches

34
Q

Psychosocial Care: Anxiety and Depression management

A

-Pharm and Non-pharm interventions
-Encouragement, support, and education

35
Q

Psychosocial Care Hopelessness, Powerlessness, and Fear management

A

-Encourage realistic hope within the limits of the situation
-Decision making about care can foster a sense of control and autonomy

36
Q

Four specific fears

A

1.Pain
2.Shortness of breath
3.Loneliness and abandonment
4.Meaninglessness

37
Q

Respiratory distress and dyspnea are common near the EOL, so…

A

Anxiety-reducing agents (e.g., anxiolytics) may help produce relaxation.

38
Q

nursing interventions for Fear of Loneliness and Abandonment

A

Holding hands, touching, and listening

39
Q

Anorexia, Nausea, and Vomiting

A

Assess the patient for nausea or vomiting and possible contributing causes
* Provide antiemetics before meals if ordered
* frequent meals with small portions of favorite foods
* Offer culturally appropriate foods
* frequent mouth care, especially after vomiting
* Ensure uninterrupted mealtimes
* If ordered, give drugs to increase appetite
* Teach family that appetite naturally decreases at end of life and hunger is rare
* Do not force the patient to eat

40
Q

EOL constipation causes

A

Immobility, opioid medication use, depression, lack of fiber in the diet, and dehydration

41
Q

EOL constipation nursing management

A
  • Assess for and remove fecal impactions
  • Encourage movement and physical activities as tolerated
  • Encourage fiber in the diet if appropriate
  • Encourage fluids if appropriate
  • Assess for confusion, agitation, restlessness, and pain, which may be signs of constipation
  • Use suppositories, stool softeners, laxatives, or enemas if ordered
42
Q

Candidiasis

A

White, cottage cheese-like oral plaques
* Fungal overgrowth in the mouth due to chemotherapy and/or immunosuppression

43
Q

Candidiasis nursing management

A
  • If ordered, give oral antifungal nystatin
  • Clean dentures and other dental appliances to prevent reinfection
  • Provide oral hygiene and use soft toothbrush
44
Q

Dehydration nursing management

A
  • oral care to provide for comfort and hydration of mucous membranes
  • Encourage consumption of ice chips and sips of fluids
  • Use moist cloths and swabs for unconscious patients to avoid aspiration
  • Apply lubricant to the lips and oral mucous membranes as needed
  • Do not force the patient to drink
  • Teach family that thirst is rare in the last days of life
  • Reassure family that cessation of food and fluid intake is a natural part of the process of dying
45
Q

Delirium nursing mamagement

A
  • room that is quiet, well lit, and familiar to reduce the effects of delirium
  • Reorient the dying person to person, place, and time with each encounter
  • Stay physically close to frightened patient Reassure in a calm, soft voice with touch and slow strokes of the skin
  • Provide family with emotional support and encouragement in their efforts to cope with the behaviors associated with delirium
46
Q

Dysphagia nursing management

A
  • Identify the least invasive alternative routes of administering drugs needed for symptom management
  • Suction orally as needed
  • Modify diet as tolerated/desired
  • Hand feed small meals
  • Elevate the head for meals and at least 30 minutes after
  • Discuss risk for aspiration
47
Q

Dyspnea nursing management

A
  • Elevate the head and/or position patient on side to improve chest expansion
  • Use a fan or air conditioner to help movement of cool air
  • Teach and encourage the use of pursed-lip breathing
  • Give supplemental oxygen as ordered
  • Suction PRN to remove accumulation of mucus from the airways. Suction cautiously in the terminal phase
  • Give an expectorant as ordered
48
Q

Myoclonus

A
  • Mild to severe jerking or twitching sometimes associated with use of high dose of opioids
  • Patient may have involuntary twitching of extremities
49
Q

myoclonus nursing intervention

A
  • Changes in opioid medication may decrease myoclonus, discuss with HCP
50
Q

pain nursing intervention

A

intervention
* Assess pain thoroughly and regularly to determine the quality, intensity, location, and contributing and alleviating factors
* Minimize irritants, such as skin irritations from wetness, heat or cold, pressure
* Give medications around the clock, in a timely manner, and on a regular basis to provide constant relief rather than waiting until the pain is unbearable and then trying to relieve it
* Provide complementary and alternative therapies, such as guided imagery, massage, and relaxation techniques as needed

51
Q

Skin Breakdown nursing management

A
  • Implement protocols to prevent skin breakdown by controlling drainage and odor and keeping the skin and any wound areas clean
  • nursing management to prevent skin irritations and breakdown from urinary and bowel incontinence
  • Use blankets to cover for warmth. Never apply heat
52
Q

Postmortem Care

A

-Close patient’s eyes
-Replace dentures
-Wash and position body
*Remove tubes and dressings if appropriate.
*Straighten the body, leaving the pillow to support the head and prevent pooling of blood and discoloration of the face.

NSG 430 - Critical Care (42 decks)

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