TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.40 "Hospice Care" Flashcards by Scott Huggins

Hospice is a philosophy of care about providing support to patients with a terminal illness (a disease in an advanced stage with no known cure and poor prognosis) and their families.
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B)false

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Hospice Care

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The philosophy of hospice is to promote comfort and use compassion, interest, and genuine concern to allow the patient to live a better lifestyle during the dying process.
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With hospice support, the patient and the family recognize that dying is a natural part of life. Care and support are managed by an interdisciplinary team, and the goals are to maximize the quality of life and keep the patient as comfortable as possible in the home setting that he or she chooses.
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HISTORICAL OVERVIEW

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Hospice is from the Latin word hospitium, meaning hospitality and lodging. The concept originated in Europe, where hospices were resting places for travelers. Monks and nuns believed that service to one’s neighbor was a sign of love and dedication to God.
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Typical medieval hospices run by monks and nuns were a combination guest house and infirmary. They were places of refuge for the poor, the sick, and travelers on religious journeys. They provided food, shelter, and care to ill guests until they were strong enough to continue their journey or they died
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The idea of hospice was renewed in the 1960s in London, when Dame Cicely Saunders, a nurse and physician, realized that the terminally ill needed a different kind of care.

She had a patient who was dying of a terminal illness, and she found that quality of life was not the main emphasis of his care. She then devoted her life to improving pain management and symptom control for people who were dying.

She believed it is important that each patient know his or her own contribution to life and that his or her life had meaning
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The philosophy of hospice migrated to the United States in the early 1970s, with the first hospice program opening in Connecticut in 1971.
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Hospices vary in structure and organization. Some hospices are based in a hospital, and some in a home health agency or community-based organization. Hospice care usually occurs in the patient’s home
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Occasionally, the hospice patient goes into the hospital and receives hospice services for control of acute pain or respite care for the family or care provider. The patient will sometimes receive hospice care intermentily and sometimes on a continuous basis
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If the hospice is a freestanding facility, the atmosphere is more like that of a friendly dormitory than that of a hospital. The patients usually wear their own clothes, move about the hospice as they choose, and socialize with each other and with the staff. The kitchen is always open for individually prepared food, as well as for conversation.
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Life Span Considerations
Older Adults
Hospice Care

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Many older adult patients at home or in nursing homes will likely meet the criteria and benefit from hospice care.
The Hospice Medicare Benefit covers all expenses for palliative care related to the terminal illness, including professional staff visits, medication, equipment, and respite and acute care.
Hospice often provides the dying older adult with a higher level of control and dignity than other types of health care.
The primary caregiver is often an older adult spouse.
The Hospice Medicare Benefit provides for bereavement follow-up care for at least 1 year following the death.

True

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PALLIATIVE VERSUS CURATIVE CARE

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Palliative care, as defined by the World Health Organization (WHO), is the active, complete care of a patient whose disease has not responded to curative therapy.
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B)false

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Palliative care emphasizes the control of pain, relief of symptoms, and provision of psychological, social, and spiritual assistance (WHO, n.d.).
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lt is possible to begin palliative care earlier in the dying process, whereas hospice is usually available only in the last 6 months of life. As such, palliative care provides the framework for future hospice assistance.
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Curative treatment is aggressive care in which the goal and intent is curing the disease and prolonging life at all cost.
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B)false

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Palliative care is not curative in nature but aims to relieve pain and distress and to control symptoms of the disease.
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Hospice care emphasizes quality and not quantity of Life
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Hospice care is appropriate when active, curative treatment is no longer efffective and supportive measures are necessary to assist the terminally ill patient through the dying process. It offers the patient a supported and safe passage from life to death in a way that preserves dignity and important relationships.
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Hospice is appropriate mainly for those individuals who believe that how they live is more important than how long they live
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Palliative care is not giving up hope; it is full of hope of a good, fulfilling life.
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CRITERIA FOR ADMISSION

The patient is required to meet certain criteria to be admitted into hospice: * The attending physician has to certify that the patient's illness is terminal and the patient has a prognosis of 6 months or less to live. The attending physician is required to be a doctor of medicine or osteopathy and be the patient's desiggnated physician. * For the patient to qualify for Medicare or Medicaid assistance, two physicians are required to verify that the patient is dying and has less than 6 months to live. The hospice patient who continues to live beyond the estimated time period will still qualify for Medicare providing hospice criteria are still met. * It is mandatory that the patient desires the services. The patient has to be willing to for go any further curative treatment and be willing to seek only palliative care. * The patient and caregiver are required to understand and agree that hospice staff will plan the care according to comfort and that they will not necessarily perform life-support measures. * The patient and caregiver are required to underrstand the prognosis and be willing to participate in the planning of the care.

True

Most hospices in the United States request that the patient have a primary caregiver (one who assumes ongoing responsibility for health maintenance and therapy for the illness). The caregiver is sometimes an immediate family member and sometimes a significant other, a friend, or a hired caregiver. A)true B)false

Caregivers become vital when patients are no longer able to care for themselves safely. If the patient resides in a freey. standing hospice residence, a long-term care facility, or a residential home, the nursing staff is designated as the primary caregiver. A)true B)false

GOALS OF HOSPICE

To provide effective hospice care, you will need an understanding of the philosophy and its relationship with the patient's responses and points of view A)true B)false

The basic goals of hospice address the following: * Controlling or alleviating the patient's symptoms * Allowing the patient and caregiver to be involved in the decisions regarding the plan of care * Encouraging the patient and caregiver to live life to the fullest * Providing continuous support to maintain patient and family confidence * Educating and supporting the primary caregiver in the home setting that the patient chooses

True

INTERDISCIPLINARY TEAM

This approach of hospice, defined as holistic (pertaining to the total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person) care, is to use an interdisciplinary team to manage the problems. A)true B)false

The interdisciplinary team (multiprofessional health team working together in caring for the terminally ill patient) develops and supervises the plan of care in conjunction with all those involved with the care. A)true B)false

The core interdisciplinary team members are the medical director, the nurse coordinator, the social worker and the spiritual coordinator. A)true B)false

To provide support to the dying patient and the caregiver, the interdisciplinary team considers all aspects of the family unit. They include the family in all decisions and care planning, because families also experience the stresses of the terminal illness and death of the patient A)true B)false

The hospice patient is assigned a primary team that consists of the patient's own attending physician, the primary hospice nurse, the social worker, a primary hospice aide, a primary volunteer, and a spiritual leader. This group of professionals, along with the interdisciplinary team, develops and is responsible for carrying out the plan of care. A)true B)false

Regular and frequent team meetings are held to discuss the patient's physical, mental, and spiritual conditions, with revisions being made to the plan of care as needed. Discussions as to the effectiveness of the plan of care also take place. The team meeting is the place to bring together all members' observations and thoughts respectfully, and the team strives to function as a cohesive unit to use all expertise and resources in the interest of providing quality patient care. A)true B)false

Core Interdisciplinary Hospice Team

Medical director Licensed physician Is a mediator between the hospice team and attending physician Provides consultation relative to the medical aspect of care

True

Nurse coordinator Licensed registered nurse Manages the patient care Explains the service, admits the patients, assigns the primary team

True

Social worker Bachelor's degree in social work Evaluates the psychosocial needs Is a resource for potential community services Assists with counseling in grief issues

True

Spiritual coordinator Seminary degree Liaison between the patient and spiritual community Coordinates spiritual support

True

Primary Hospice Team

Volunteer coordinator Experience in volunteer work Recruits and trains the volunteers Coordinates assignments of volunteers

True

Bereavement coordinator Professional with grief experience Assesses and supports the bereaved survivor Facilitates support groups

True

Hospice pharmacist Licensed registered pharmacist Provides drug consultation

True

Primary physician Licensed physician Responsible for the medical aspect of symptom control for patient

True

Primary nurse Licensed registered nurse Is a liaison between patient and caregiver, physician, and interdisciplinary team Evaluates patient's response to treatment Educates the patient and family in disease process and care Assesses symptom management Provides emotional support to patient and caregiver

True

Primary spiritual leader As required by religious group Supports patient and caregiver to cope with fears and uncertainty of spiritual issues

True

Hospice volunteer Completion of volunteer training Provides companionship for patient and caregiver Available for short periods of respite care

True

Hospice aide Certified as a home health aide Administers personal care and assistance with bathing

True

MEDICAL DIRECTOR

The medical director is a doctor of medicine or osteopathy, and assumes overall responsibility for the medical component of the hospice patient's care program. A)true B)false

The medical director does not take the place of the patient's attending physician but acts as a consultant for the attending physician. A)true B)false

The medical director, with consultation from the interdisciplinary team, medically certifies the patient's eligibility for hospice care. The medical director is a mediator between the interdisciplinary team and the attending physician. He or she oversees the plan of care, ensuring that the care being provided and ordered is palliative in nature. A)true B)false

NURSE COORDINATOR AND HOSPICE NURSES

The nurse coordinator is a registered nurse who coordinates the implementation of the plan of care for each patient. The nurse coordinator will often do the initial assessment, admit the patient to the hospice program, and develop the plan of care along with the interdisciplinary team. A)true B)false

The nurse coordinator also ensures that the plan of care is being followed, coordinates assignments of the hospice nurses and aides, facilitates meettings, and determines methods of payment. A)true B)false

Hospice nurses coordinate services of the hospice team, which includes hospice physicians, pharmacists, dietitians, physical therapists, social workers, clergy, certified nursing assistants, and hospice volunteers. A)true B)false

It is also necessary for a hospice nurse to be especially adept(skilled) in pain and symptom control A)true B)false

SOCIAL WORKER

The social worker is required to have at least a bachelor's degree, and in many agencies a master's degree, in social work. A)true B)false

The social worker evaluates and assesses the psychosocial (a combination of psychological and social factors) needs of the patient. The social worker assists with accessing community resources and filing insurance papers, and also supports the patient and caregiver with emotional and grief issues. A)true B)false

The social worker will also assist with counseling in some cases when communication difficulties are present. The social worker will provide these services under the direction of the physician and in accordance with the plan of care A)true B)false

SPIRITUAL COORDINATOR

The spiritual coordinator is the liaison between the spiritual community and the interdisciplinary team. The spiritual coordinator assists with the spiriitual assessment of the patient and, in keeping with patients' and families' beliefs, develops the plan of care regarding spiritual matters. If the patient desires spiritual assistance and does not have a spiritual home, the spiritual coordinator will assist in finding the spiritual support desired. A)true B)false

The spiritual coordinator is vital in assisting the patient and caregiver to cope with fears and uncertainty. Possible support includes dealing with unfinished business and regrets and providing opportunities for reconciliation, prayer, and spiritual healing A)true B)false

Funeral planning and performing funeral services are also included in this role A)spiritual coordinator B)false

VOLUNTEER COORDINATOR

The volunteer coordinator assesses the needs of the patient and caregiver for volunteer services. When families are responsible for the total care of the patient in the home, caregiver "burnout" becomes a concern. This is when the services of volunteers become vital. A)true B)false

They provide companionship, caregiver relief through respite care (a period of relief from responsibilities of caring for a patient), and emotional support. Appropriate services for the volunteer to provide are what we think of as typical of a good neighbor, perhaps reading to the patient, or sitting with the patient while the caregiver leaves the home for short periods, grocery shopping, or yard work. A) Volunteer coordinator B)false

The volunteer coordinator ensures that the volunteer is adequately trained and prepared for working with the dying patient. Responsibilities also include assigning the proper volunteer to the appropriate patient. A)true B)false

BEREAVEMENT COORDINATOR

``` The bereavement (a common depressed reaction to the death of someone close) coordinator is a professional who has experience in dealing with grief issues. A)true B)false ```

The bereavement coordinator assesses the patient and the caregiver at admission to the hospice program and identifies risk factors that have potential to be of concern following the death of the patient. A)true B)false

The bereaveement coordinator follows the plan of care for the bereaved caregiver for at least a year following the death. A)true B)false

The bereavement coordinator facilitates support groups and assigns bereavement volunteers to visit the caregiver. A)true B)false

The goals of bereavement counseling for loved ones during the patient's illness and following the death are to (1) provide support (2) assist survivors in the transition to a life without the deceased person. It is appropriate to incorporate grief support into the plan of care.

True

Cultural Considerations | Death and Dying~-

* The United States is becoming more and more multicultural, and hospice care is challenged to meet the needs of people from other cultures. * Compassionate and empathic care bridges cultures, but it is necessary to learn as much as possible about the culture so it is possible to provide assistance. People all have different reactions and traditions regarding death and dying, but all experience grief. * Do not make a change regarding the plan of care without first discussing it with the whole family. * Often when working with Hispanic people you are working with a large, extended, extremely interdependent family. They tend to show great respect to elders, and many will defer decisions to the men in the family. Hispanics will sometimes want all the family members to view the body before it is removed from the home setting. Often that may mean a wait of several hours before the mortuary is able to remove the body.

True

HOSPICE PHARMACIST

The pharmacist evaluates for drug-drug or drug-food interactions, appropriate drug doses, and correct administration times and routes. The pharmacist typically gives information and advice about common drugs used, administration time, and doses A)true B)false

DIETITIAN CONSULTANT

The hospice nurse performs the nutritional assessment at admission. lf the nurse notes nutritional problems, a referral to the LMNT is possible for assistance with diet counseling and meal planning. The LMNT also assists with educating the caregiver regarding nutritional issues in end-stage diseases. A)Licensed medical nutritional therapists B)false

HOSPICE AIDE

The hospice aide follows the plan of care that the interdisciplinary team develops and assists the patient with bathing and personal care, including hair, nail, oral, and skin care. A)true B)false

The hospice aide will sometimes also assist the patient or the caregiver with light homemaker services. The patient and the hospice aide often develop a close relationship, and the patient will in some cases share feelings with the aide more easily than with any other member of the team. A)true B)false

OTHER SERVICES

The physical therapist is available to assist with teaching the caregiver transferring skills, exercises that are sometimes useful to relieve muscle cramps, wheelchair fittings, and other skills that serve in caring for the dying patient. The speech-language pathologist is available if difficulties arise with communication or swallowing. The occupational therapist is also available for positioning for comfort, providing adaptive equipment for the patient, or other assistance for comfort and for activities of daily living (ADLs)

True

PALliATIVE CARE

The goal and emphasis of hospice is symptom management and palliative care. The team of caregivers routinely assesses, reassesses, and documents the severity, the treatment, and the control of symptoms of the illness A)true B)false

PAIN

Of all the symptoms a dying patient experiences, pain is the most dreaded and feared; therefore pain is a priority for symptom management. It disrupts the quality, the activities, and the enjoyment of life. A)true B)false

To the healthy person, pain is usually temporary and tolerable, but to the terminally ill patient it can be excruciating, constant, and terrifying. A)true B)false

Pain takes many forms, such as physical, psychosocial, and spiritual, and becomes a major factor that it is right and proper to address and alleviate. A)true B)false

It will possibly be related to tumor invasion, compression of organs or nerves, erosion of tissue, or other pathologic factors. Removing the cause will be impossible in some cases; therefore controlling the symptoms becomes central to the successful management of pain for the terminally ill. A)pain B)sign

Assessments are vital to determining the plan of managing pain, and the patient is the primary source to go to for information A)true B)false

The patient's self-report of intensity, quality, and management of pain provides the most significant data. A)true B)false

Make sure that pain assessment (evaluation of the factors that alleviate or exacerbate a patient's pain) includes the severity and the history of the pain and what brings relief to the patient. Begin pain assessment with the patient's self-report and have the patient rate the pain on a scale of 0 to 10, with 0 being having no pain at all and 10 being the worst imaginable pain. Any pain the patient rates at 5 or higher on the pain scale has a great effect on the quality of life A)true B)false

``` Clinicians use many different pain assessments, such as the familiar OLD CARTS, which stands for 0 = onset, L = location, 0 = duration, C = character of pain, A = aggravating factors, R = relieving factors, T = treatments, S = severity. ``` Use this type of assessment with the patient on every visit and every new complaint or increase in pain.

True

Make sure that assessment of pain, considered the fifth vital sign, is ongoing; note any change in the intensity or type of pain that will necessiitate changes to the plan of care A)true B)false

Somatic pain arises from the musculoskeletal system and is described as aching, stabbing, or throbbing. There are appropriate roles for nonsteroidal antiinflammatory drugs (NSAIDs), nonopioid drugs, and opioid drugs in treating somatic pain A)true B)false

Pain that originates from the internal organs is called visceral pain. The words people commonly use to describe this are cramping, pressure, dull, or squeezing pain. Physicians typically prescribe anticholinergic medications alone or as an adjuvant (additional drug or treatment that is added to assist in the action of the primary pain treatment) to nonopioids or opioids. A)true B)false

Neuropathic pain arises from the nerves and the nervous system. Tingling, burning, or shooting pains are often due to neuropathic causes. The physician will sometimes order anticonvulsants to give as an adjuvant to assist with pain control. A)true B)false

After determmmg the severity of pain and the type of medication to be used, it is important to titrate (slowly increase the amount of drug to find the therapeutic dose) the dosage of the medication. A)true B)false

Mild to moderate pain is sometimes possible to manage with NSAIDs; as the pain increases in severity with progression of the patient's condition, the physician will often switch the analgesic over to an opioid drug with or without adjuvant drugs A)true B)false

Nonsteroidal drugs are possible to give along with the opioid to enhance the medication's effectiveness. Oral administration of analgesics is not allways feasible because of nausea and vomiting, obstruction, or inability to swallow, and other routes enter into consideration, such as sublillgual, subcutaneous, parenteral, rectal, or topical. A)true B)false

Morphine derivatives are often the drugs of choice in caring for the hospice patient because it is possible to deliver them by all routes and the dose can be titrated to control the pain. Administer analgesic routinely, with a prn drug available for breakthrough pain so good control is possible to maintain A)true B)false

Using long-acting medications such as MS Cantin, Oxycontin, or Duragesic patches often provides better pain control and is more convenient for the patient and the caregiver. A)true B)false

As the pain increases, it is important to monitor the amount and frequency of prn medications so the appropriate increase in the routine medications is possible A)true B)false

Ineffective pain management is usually associated with undermedication resulting from common myths and fears. The myths and fears are addiction, tolerance, and respiratory depression. With careful and expert monitoring by the hospice team, along with reassurance and support, these fears are possible to relieve A)true B)false

Never rule out other effective methods in managing pain. Radiation therapy, nerve blocks, and psychological or physical methods are all options to try in appropriate circumstances. Hot or cold packs at the site of discomfort, repositioning the patient, music therapy, relaxation techniques, acupuncture, or even transcutaneous electric nerve stimulation (TENS) are sometimes good alternatives. If it works for the patient, do not overlook it A)true B)false

Pain Assessment Questionnaire

1 . Throughout our lives, most of us have had pain from time to time such as minor headaches, sprains, and toothhaches. Have you had pain other than everyday kinds of pain today? 2. Where is the pain? (The use of a body chart often helps the patient to identify the location.) 3. Using the scale of 0 to 10, with 0 being no pain and 1 0 being the worst pain imaginable, rate the pain at its worst in the past 24 hours. 4. Using the same scale of 0 to 10, rate the pain at its lowest point in the past 24 hours. 5. Using the same scale of 0 to 1 0, rate the pain on the average. 6. Describe your pain. (The words the patient uses to describe the pain help you to understand the type of pain for treatment purposes.) 7. What treatments or medications are you using to control the pain? 8. Using the scale of 0 to 10, with 0 being no relief and 10 being complete relief, rate the amount of relief received from the treatment. 9. What causes or increases the pain? ``` 10. Does the pain interfere with any of the following: • General activity • Mood • Walking ability • Normal work • Relations with other people • Sleep • Appetite • Enjoyment of life ```

True

Pain Control

* It is never right for a patient to suffer pain, often intolerable pain, because of the lack of adequate pain control. Try asking the question, "What is pain?" The answer is simple; pain is anything the patient says it is, whether real or perceived. * Pain is treated with drugs (morphine) or a combination of drugs to provide maximum relief while at the same time avoiding maximum side effects. * Proper pain relief is provided on a regular round-the-clock basis. * The need for palliative care worldwide is enormous and will continue to increase. Symptom management and adequate pain control have to be the prime objective for you as a hospice nurse, at the same time you always strive to maintain the patient's dignity and capacity to contribute as a full human being.

True

Nursing Interventions and Patient Teaching for pain

Educate the patient and the caregiver in the appropriate administration, scheduling, and effects of the medication to help them become aware of increasing signs and symptoms of pain. A)true B)false

Make sure the patient and the caregiver understand that it is possible to control pain and that using large doses of opioids is common and necessary to achieve that control. A)true B)false

It is good to educate the patient and the caregiver that " the dose that works is the dose that works." Assist the caregiver in setting a schedule for admiJlistering the medications and then monitor the patient's response to and compliance with the established plan. A)true B)false

Patient education regarding other techniques of pain and symptom management are also a nursing responsibility. Possibilities include music therapy, relaxation methods, and other alternative methods. It is imporrtant to give encouragement and positive reinforcement to the patient and the family ill their effort at following the plan. A)true B)false

NAUSEA AND VOMITING

Many patients consider nausea to be worse than vomiting because at times it is only noticeable to the patient and therefore flies under the radar of caregivers and health professionals. It is important to assess for the cause of nausea and vornitmg, and remove it if at all possible A)true B)false

Nausea is a possible result of chemotherapy side efffects, obstruction, tumor, uncontrolled pain, constipation, and even food smells. At times the treatment of the nausea is as simple as bringing in food already prepared so that the cookmg smells do not bother the patient A)true B)false

Sometimes the drugs used for pain control cause nausea; giving antiemetics with the opioid analgesic is useful. A)true B)false .

Nausea is a common side effect with the initiation of opioid treatment. This side effect usually subsides after a time, and the best response is to use an antiemetic rather than discontinue the opioid. A)true B)false

Anxiety has also been known to cause nausea, which then leads to vomiting. Patients who vomit are typically anxious about why they are vomiting, which often worsens the symptoms A)true B)false

Nursing Interventions and Patient Teaching for nausea and vomiting

Encourage the patient to take the ordered antiemetics routinely, 30 mins before meals and at bedtime. Try using antiemetic drugs such as produorperazine (Compazine) and promethazine (Phenergan) suppositories if possible until the nausea is controlled , and then use oral drugs prophylactically to prevent the nausea from returning A)true B)false

Metocloprarnide (Reglan) is effective in controlling mild to moderate nausea and vomiting. Because it increases gastric motility, its use is contraindicated in patients with suspected bowel obstruction. A)true B)false

Benzodiazepines are not for use as singleagent antiemetics, but they are often extremely effective when used in conjunction with other antiemetics or for treating nausea and vomiting associated with anxiety. Drugs in this class, such as lorazepam (Ativan) or alprazolam (Xanax), reduce anxiety, although they tend to be sedating. A)true B)false

Eating slowly and in a pleasant atmosphere, with relaxation and rest periods after eating, is a good way to control the nausea. If vomiting occurs, discourage eating for a short time until peristalsis stabilizes. A)true B)false

When the nausea and vomiting have subsided, have the patient begin drinking liquids to avoid dehydration or start eating soft, bland foods. Serve small, Light, bland meals, avoiding sweet, greasy, spicy, or strong-smelling foods A)true B)false

If anxiety and fear are causing nausea and vomiting, verbalizing the fears is often helpful. Under no circumstances is it ever acceptable to force the patient to eat food or drink fluids if he or she has no desire to eat, because this also has potential to compromise dignity and be detrimental to the patient's well-being A)true B)false

CONSTIPATION

One of the most common problems of the terminally ill patient is constipation.

Sometimes this problem causes more anxiety and discomfort than pain itself. Because constipation has the capacity to cause other symptoms, such as abdominal pain, nausea, or vomiting, prevention of the problem is important. A)true B)false

Factors that contribute to constipation are poor dietary intake, poor fluid intake, hypercalcemia, hyponatremia, tumor compression of the bowel, use of opioids for pain control, and decrease in physical activity. A)true B)false

Some opioids are more likely to cause constipation than others; in such cases, a different opioid will perhaps be helpful. A)true B)false

Changing the rate of administration sometimes also provides some relief. Transdermal fentanyl has proven to be associated with significantly less constipation than sustained-release oral morphine (the drugs were equally effective in treating pain) A)true B)false

A rectal examination will sometimes be necessary to check for an impaction along with manual removal of stool. The Fleet enema helps soften and dissolve a hard impaction whose removaL is otherwise a painful procedure. A)true B)false

Nursing Interventions and Patient Teaching for constipation

Make sure to cover the following points with the patient and the caregiver: * A decrease in oral intake will also decrease the amount of stool expelled. * Even though a patient does not have oral intake, bowel movements will still be possible in some cases. * Opioids pose a risk of constipation, so it is necessary to give laxatives. * Comfort is the all-important factor. If the patient has not had a bowel movement, assessment of discomfort, bowel sounds, and firmness of·abdomen are necessary to do before any active treattment.

True

ANOREXIA AND MALNUTRITION

Anorexia and malnutrition are major anxiety-producing symptoms of terminal illness. Poor appetite potentially arises from nausea, vomiting, constipation, dysphagia, stomatitis, tumor invasion, general deterioration of the body, depression, or infections. These complications lead to difficulty in eating, which in turn causes loss of appetite. Odors of food cooking, inability to tolerate sweet foods, or a bitter taste in the mouth also contribute to the problem. This makes food less enjoyable, so the patient does not eat. A)true B)false

A for patients with malnutrition

Disease processes change the body's metabolism and appetite, which sometimes lead to cachexia (mallnutrition marked by weakness and emaciation), usually associated with a serious disease such as cancer and resulting in muscle weakness and weight loss. If poor oral intake of either food or fluids is affecting the quality of life, it is necessary to make adjustments to the plan of care A)true B)false

Nursing Interventions and Patient Teaching for ANOREXIA AND MALNUTRITION

If anorexia is related to stomatitis or infections, good oral hygiene is imporrtant. A technique to alleviate discomfort of the mouth is to use swabs or Toothettes soaked in flavored mouthwash. A)true B)false

Small frequent drinks, crushed ice, or arrtificial saliva are often useful to relieve a dry mouth. A)true B)false

If the odor of food causes anorexia, make sure the patient is not in the kitchen during meal preparation, or have family, friends, or volunteers bring in meals. Make the meals as attractive as possible, using foods the patient chooses. High-protein supplements are helpful when eating is difficult. A)true B)false

Avoid weighing the patient because sometimes the patient wiLl be depressed and discouraged by attention to weight Loss. Often the caregiver needs additional support when a patient is not eating, because caregivers often think a reduced diet will hasten death and in contrast, if they manage to get the patient to eat, the food will prolong life. A)true B)false

You will often have to reassure the patient and the caregiver that anorexia is part of the end-of-dying process and that forcing the patient to eat has some potential to be harmful. A)true B)false

If the anorexia's cause is untreatable, such as tumor invasion, the patient and the caregiver are likely to need additional emotional support. Rarely do artificial hydration, total parental nutrition, and tube feedings come into consideration. These will perhaps slow the overall cachexic effect, but the long-term result and quality of life will not change A)true B)false

DYSPNEA OR AIR HUNGER

Dyspnea is a symptom that arises from a variety of possible conditions, such as heart failure, dysrhythmias, infection, ascites, or tumor growth. Breathing effectively will be difficult for many patients, especially during the very end stages of the illness A)true B)false

Air hunger is sometimes caused by tumor pressure, fluid and electrolyte imbalance, or anemia. Anxiety resulting from fear or panic will potentially accompany this problem A)true B)false

Some respiratory distress will be relieved by oxygen, morphine, or bronchodilators. Oxygen will perhaps not actually relieve the dyspnea, but it often eases the anxiety of both the patient and the caregiver A)true B)false

Oral or nebulized morphine helps relax the patient's respiratory effort, thus allowing a greater respiratory efficiency. Bronchodilators sometimes ease respiratory obstructions and ease the respiratory distress. A)true B)false

Often, 24 to 48 hours before death, the patient will exhibit the "death rattle," which is the result of an accumulation of mucus and fluids in the posterior area of the pharynx. The sound that air makes as it passes through the mucus is coarse and loud and very upsetting to the caregiver. Medications that are sometimes helpful in the prevention of excess secretions are the anticholinergic drugs such as transdermal scopolamine A)true B)false

Nursing Interventions and Patient Teaching for DYSPNEA OR AIR HUNGER

Your main focus is in relieving the anxiety and supporting the patient and caregiver. A)true B)false

Education on positioning, use of a fan to circulate air, use of morphine to decrease the work of respiration, use of tranquiUzers to ease anxiety, and maintaining good oral hygiene will aid the patient. Keep suctioning at a minimum because it actually increases mucus production and is very uncomfortable to the patient. Only use suctioning if the patient is choking and unable to recover. A)true B)false

PSYCHOSOCIAL AND SPIRITUAL ISSUES

Spiritual unrest and issues are often interrelated with psychosocial problems and have the potential to surface especially when symptoms are uncontrolled. It is always necessary to respect any religious or spiritual concerns and meet the patient's wishes if at all possible. A)true B)false

Spiritual assessments are meant to gather information regarding the patient's feelings and needs. Some patients will question their faiths and beliefs, and some will look to find support that they have never had, when confronted with a terminal illness. Many symptoms such as depression, the need to suffer, bittterness, anger, hallucinations, or dreams of fire are in some cases indicative of unmet spiritual needs. A)true B)false

Nursing Interventions and Patient Teaching for PSYCHOSOCIAL AND SPIRITUAL ISSUES

Refer spiritual issues to the spiritual coordinator, and do not use them as an opening for you to share your own feelings and beliefs unless specifically asked. It depends on the hospice organization whether the nurse or the spiritual coordinator does the spiritual assessment. It is essential for the assessor to be nonjudgmental and accepting of the patient's and the caregiver's spiritual beliefs. A)true B)false

The social worker will possibly also assist with the relationship between the patient and the caregiver and provide counseling to resolve conflict. The social worker does not "fix" the conflicts but assists in finding solutions and problem solving. The development of trust is critical between the patient and the interdisciplinary team and is invaluable when dealing with these issues. A)true B)false

OTHER COMMON SIGNS AND SYMPTOMS

Weight loss and dehydration will sometimes lead to a decrease of soft tissue, especially on the bony areas of knees, hips, elbows, and buttocks, leading to skin impairment A)true B)false

Increased weakness is also notable in the last stages of a terminal illness. With increased weakness, activity intolerance increases, and the patient spends most of the time reclining. This leads to risk for skin impairment and the formation of pressure ulcers. Along with weakness come safety issues of being unstable and falling. A)true B)false

Patients often exhibit signs of depression and will perhaps make comments regarding suicide. Comments regarding suicide do not always come from the actual desire to kill oneself but are, in some cases, rather a statement of a desire for independence A)true B)false

Sleeplessness and insomnia sometimes occur as a result of an accumulation of signs and symptoms, and exhaustion has the potential to cause an exacerbation of all other signs and symptoms A)true B)false

Nursing Interventions and Patient Teaching

It is important at this time to teach the patient and the caregiver the basics of good skin care. Cleanliness promoted by bathing is often refreshing, as well as therapeutic in promoting comfort and the feeling of self worth. Inspect the skin frequently, and keep it as dry and clean as possible. Stress the need to avoid harsh soaps, strong detergents, and irritations from buttons, snaps, or food crumbs. A)true B)false

An eggcrate mattress, sheepskin, or air-flotation mattress, as well as heel and elbow protectors, help cushion the bony areas. The hospice aide will often be very helpful to the patient in assisting with personal care, hygiene, and bathing. If pressure ulcers occur, cleaning with normal saline, drying well, and applying a skin protector are helpful measures. A)true B)false

An awareness of safety is essential in preventing falls and injuries, and providing information regarding home safety is important. A)true B)false

Listening and providing emotional support is an important nursing intervention for depression and suicidal thoughts. The social worker is influential in these situations. A)true B)false

Safety Alert! | Prevention of Skin Impairment

Safety risks for hospice patients are many, owing to the debilitating nature of the terminal illness and other comorbidities many patients have. There is potential for skin impairment due to poor nutrition, decreased circulation, and decreased mobility. Frequent education to the family and the patient are required to promote integrity of the skin. Have the caregiver observe the patient's skin and report any erythema or impairment. Instruct the caregiver to reposition for comfort, use alternating air or eggcrate mattresses, and to perform good hygiene to prevent skin impairment. A)true B)false

PATIENT AND CAREGIVER TEACHING

It is thought that the fear of the unknown is always greater than the fear of the known. Because of this, education is an important part of the care the team provides to the patient. Educating the caregiver in symptom management, hands-on care of the patient, caring for body functions, and teaching regarding the signs and symptoms of approaching death are important to help relieve fears. A)true B)false

BEREAVEMENT PERIOD

Hospice care does not conclude once the patient dies but usually continues for at least 1 year with bereavement support. The family, especially the primary caregiver, continues to need support during the bereavement period after the patient dies. Even though the family feels they have prepared for the death, facing the future without the person who died is difficult. A)true B)false

Some teams facilitate a bereavement support group that meets on a regular basis, providing these families the opportunities to communicate and share their feelings. Volunteers and pastors keep in touch by visits, phone calls, cards, and remembering the bereaved person on holidays and anniversaries A)true B)false

The hospice staff also goes through a grieving period for each patient who dies. It is a good idea to encourage the team members to attend funeral services, attend memorials, or visit the caregivers as appropriate following the death to help ease their grief. Each hospice provides support to its staff with support meetings and time to vent their feelings and to heal. A)true B)false

Signs and Symptoms of Approaching Death

The arms and legs of the body sometimes become cool to the touch and the underside of the body sometimes becomes darker. The patient sometimes spends more and more time sleeping during the day and at times will be difficult to arouse. The patient sometimes becomes increasingly confused about time, place, and identity of close and familiar people. Incontinence of urine and bowel movements often happens when death is imminent. Sometimes there is a significant decrease in urine output. Oral secretions sometimes become more profuse and collect in the back of the throat. This produces the sound often referred to as the "death rattle." Clarity of hearing and vision decrease slightly. Restlessness, pulling at the bed linen, and having visions of people or things that do not exist sometimes occur. The patient will have a decreased need for food and drink. Breathing patterns will change to an irregular pace; there are sometimes 10- to 30-second periods of no breathing, or apnea. Changes in vital signs occur, with decreased blood pressure and elevated pulse.

True

Signs and Symptoms of Approaching Death | NURSING INTERVENTIONS

Keep warm blankets on the patient to prevent feeling of coldness. Assist caregiver in planning time to be with the patient when the patient is most alert. Reorient the patient as appropriate to the time of day and who is present. Do not upset the patient. Educate the caregiver in keeping the patient clean and dry. Provide pads or adult diapers as needed. Provide a cool-mist humidifier to increase the humidity in the room when oral secretions build up. Elevating the head of the bed with pillows or obtaining a hospital bed will make breathing easier. Keep lights on in the room when vision decreases and never assume that the patient is not able to hear you. Talk calmly and assuredly with the confused person so as not to startle or frighten the person further. Educate the caregiver that the patient will not starve to death or die of dehydration. Much reassurance is needed in this area. Elevating the head of the bed often relieves the person who has irregular breathing patterns. Oxygen sometimes is and sometimes is not beneficial. Educate the family that these changes are normal and expected and are not uncomfortable for the patient.

True

EthICAL ISSUES IN HOSPICE CARE

Ethical issues that sometimes arise when dealing with hospice patients include withholding or withdrawing nutritional support, the right to refuse treatment, and do not resuscitate (DNR) orders. Families find it difficult to discontinue nourishment, even when death is clearly approaching. If the patient is unconscious, decisions regarding these issues sometimes fall on one family member, which has potential to create guilt feelings if other family members disagree. There are no simple answers to any of these concerns. It is helpful when the patient makes his or her wishes known in advance, such as in a living will or an advance directive, or assigns a durable power of attorney. A)true B)false

An advance directive is a document prepared while an individual is alive and competent. It provides guidance to the family and the health care team in the event the person is no longer capable of making decisions. The directive states the individual's preferences concerning life-support measures and organ donations and sometimes gives authority to another person to make decisions for the patient who is now perhaps in a coma A)true B)false

A hospice patient has lost so much throughout the illness: health, job, independence, self-esteem, family, and financial security. Hospice attempts to assist the patient in maintaining dignity and control. A)true B)false

Hospice places the emphasis on living and not dying. lt is important for the hospice team to be sensitive to the patient's and the caregiver's needs and maintain honesty at all times. Make sure to include the patient and the caregiver in all aspects of care and decision making. Provide opportunities for expressing concerns and fears, because this will make the process less fearful and threatening. Allowing the patient and the caregiver to live fully, comfortably, and in dignity until death occurs naturally is the main goal of hospice care. A)true B)false

THE FUTURE OF HOSPICE

Physicians, patients, and family members are often unwilling to begin hospice care for several reasons. The patient or family sometimes believe that availing themselves of the services of hospice denotes giving up hope, and some physicians are hesitant to prescribe hospice care if they perceive the patient's worsening condition a personal failure on their part A)true B)false

It is necessary for physicians and nurses caring for patients with terminal illnesses in clinical facilities to open the dialogue with families about the option of hospice and its possible benefits to patients and their caregivers. Until clinicians, patients, and families become more comfortable talking about the process of death and dying, hospice will remain too marginalized to fulfill its promise as an excellent option for accessing supportive services during an extremely difficult time A)true B)false

Key Points

* Hospice is a philosophy of care about providing support to patients with a terminal illness and their families. * Hospice is from the Latin word hospitium, meaning hospitality and lodging. * Hospice care is appropriate when active treatment is no longer effective and supportive measures are necessary to assist the terminally ill patient through the dying process. * The Hospice Medicare Benefit covers all expenses for palliative care related to the terminal illness, including professional staff visits, medication, equipment, and respite and acute care. * Hospice care emphasizes quality, not quantity, of life. * Palliative care is appropriate when a cure is not possible but care is still necessary.

True

* The goal of palliative care is to control pain and other symptoms for the prevention of distress. * Palliative care is the active, complete care of a patient whose disease has not responded to curative therapy. * Admission to a hospice program is the decision of a patient and family, because not all people need or desire hospice care. * An important criterion(principle/standard) for the patient to be admitted into hospice is certification that the patient has a prognosis of 6 months or less to live from the attending physician and a second physician. * Hospice care consists of a blending of professionals and nonprofessionals to meet the total needs of the patient and family. * An interdisciplinary team delivers hospice care, because no individual or individual profession is able to meet all the needs of terminally ill patients and families all the time.

True

* Hospice care takes all aspects of the lives of patients and their families into consideration. Stresses and concerns have the potential to arise in many ways when families are faced with a terminal illness. * A hospice care program considers the patient and family together as the unit of care, because families experience much stress and pain during the terminal illness of one of their members. * Family participation in caregiving is an important part of palliative care. * Hospice care is available 24 hours a day, 7 days a week, because it is possible that needs will arise at any time. * Hospice care is respectful of all patient and family belief systems, seeking resources to meet the physical, psychosocial, and spiritual needs of the family unit. * Hospice care for the family continues into the bereavement period. Needs of the family continue after the patient dies.

True

NCLEX PREP

1. The doctor is explaining to a 74-year-old patient that his prostate cancer is progressing and that curative treatment is no longer an option. The doctor has recommended hospice to the patient and his wife with this explanation: 1. "We can provide support and control your symptoms and discomfort so you have good quality days." 2. "With hospice we would continue with aggressive curative care." 3. "There is no hope left for you and you should just go home and wait to die." 4. "We can no longer guarantee controlled symptoms or a dignified life, but we can still provide sympathy."

2. The patient's wife calls the hospice nurse and reports that her husband is complaining of pain in his leg and is not able to get comfortable. The hospice nurse will: 1. tell the wife that pain will increase because of the progression of the disease and there is nothing to be done. 2. ask the wife what the patient is rating his pain and if he had taken any prn medication for breakthrough pain. 3. tell the wife that her husband must be a complainer. 4. tell the wife to wait until morning and call the doctor.

3. When the nurse makes a home visit the patient is experiencing shortness of breath and has increased anxiety. The hospice nurse will: 1. assess the respiratory status, check the oximetry, call the doctor for possible orders for oxygen, and increase morphine to assist in decreasing the respiratory distress 2. tell the patient that he is out of shape and needs to exercise. 3. have the wife tell him that she is disappointed in him for complaining. 4. sit and hold his hand

The patient is experiencing a decreased appetite and is worried about his weight loss. The hospice nurse will: 1. tell the wife to cook all of his favorite foods and maybe he will eat. 2. tell the patient that he should really force himself to eat. 3. tell the patient that decreased appetite is normal and it is okay for him to eat only what he feels like eating. 4. bring the patient a pizza to stimulate his appetite.

5. The patient's wife is exhausted and expresses a need to get away for a short time. The volunteer coordinator has assessed the need for a volunteer and will: 1. tell the wife a volunteer will not help the situation at all. 2. tell the wife that it is best for her to just stay with her husband because he might die while she is away. 3. assign a volunteer to sit with the patient for a couple of hours two or three times a week so that the wife is able to either take a nap or to leave for a short time to do errands. 4. assign a volunteer to do errands so that the patient's wife does not have to leave.

6. As a part of the hospice program, the patient has a core interdisciplinary team that manages his care. This team is made up of a(an): 1. accountant, pharmacist, priest, and nurse. 2. physical therapist, occupational therapist, speechlanguage pathologist, and home health aide. 3. nurse coordinator, medical director, social worker, and spiritual coordinator. 4. volunteer, pastor, home health aide, and social worker.

7. The patient's wife tells the hospice aide that she is having problems meeting their financial obligations. The hospice aide will: 1. tell no one because this is confidential information. 2. ask her for permission to report this to the interdisciplinary team and have the social worker make a visit to see if it is possible to provide assistance. 3. report this to the patient's church to see if there is some financial assistance available. 4. tell the next-door neighbor.

8. The patient has an advance directive, but the nurse is not sure that she is able to follow his wishes. The nurse should: 1. ignore the advance directive. 2. call the patient's lawyer. 3. discuss it with the interdisciplinary team and the organization's ethics committee. 4. follow the directive even though the nurse is uncomfortable with the directions.

9. The patient is complaining of constipation. He has had very little food intake the past 4 days. The nurse should: 1. tell his wife to stop all food and water. · 2. assess for bowel sounds, abdominal distention, and possible impaction. 3. tell him that due to his decreased intake, he will have very little stool. 4. tell him to bear down to assist in elimination of his stool.

10. The patient is complaining of pain at a 5 on a pain scale of 0 to 1 0. The nurse should: 1. assume that since the pain is a 5, no further treatment is necessary or no changes are appropriate. 2. ask the patient what he wants his pain goat to be; if it is below 5, then you will have to notify the physician. 3. explain that the patient needs to try to tolerate a pain rating 5 or less. 4. automatically give the patient an additional analgesic

The _______________is the mediator between the hospice team and the attending physician A) Medical director B) speech therapist

_______is considered the fifth vital sign and is | important to assess with every hospice visit.

Pain

13. The patient is in the terminal stage of life. His wife, the caregiver, asks the nurse if it is still appropriate to turn the patient every 2 hours even though it causes the patient discomfort and stimulates restlessness. The nurse should: 1. reply, "You should always reposition the patient every 2 hours no matter what." 2. reply, "Yes, you do not want the patient to develop pressure ulcers." 3. educate the wife that her husband is actively dying and she does not have to position the patient unless he appears uncomfortable and a change of position would make him feel better. 4. None of the above.

14. The patient has never attended church and on admission requested no spiritual support. Now he is within days of death and voiced some spiritual concerns to the nurse. The nurse should: 1. share personal spiritual beliefs with him. 2. tell him that it is too late and no church would accept him. 3. report to the interdisciplinary team and have the spiritual coordinator make a home visit. 4. report information to the social worker.

. The patient died peacefully and with dignity, but his wife is still having problems dealing with the death. The hospice program has: 1. continued bereavement support for her for the next year. 2. dismissed the wife from all hospice services. 3. told her to be grateful he died a peaceful death and get on with her life. 4. had the hospice aide continue with her visits to the home.

16. For the patient to qualify for assistance from Medicare or Medicaid for hospice care, which criteria are necessary? (Select all that apply.) 1. Physicians state the patient has less than 6 months to live. 2. The patient is receiving chemotherapy or radiation. 3. Two physicians verify the patient is dying. 4. The patient has less than 1 year to live.

1 3

17. The bereavement coordinator on the hospice team follows a plan of care for the bereaved caregiver for what length of time following the death of the patient? 1. 3 to 4 months 2. 9 to 1 0 months 3. At least 1 year 4. 3 years

18. What is included in the definition of palliative care according to the World Health Organization? (Select all that apply.) 1. Focusing on controlling pain and other symptoms as well as reducing psychological, social, and spiritual distress for the patient and the family 2. The active total care of patients whose disease is not responsive to curative treatment 3. The framework for hospice care 4. The active total care of patients by providing treatments to assist in improving patient prognosis

1 2 3

STUDY GUIDE

Hospice care originated in Europe where hospices were resting places for travelers. Medieval hospices run by monks and nuns were combination guesthouses and infirmaries. Food, shelter, and care were provided to ill guests until they died or were strong enough to continue their journey. A)true B)false

Hospice care is the provision of support to patients with terminal diseases and their families. Quality of life and comfort are key elements. Palliative care is provided for relief of pain and control of symptoms. The goals are: • Control or alleviation of symptoms • Involvement of patient and caregivers in decision making • Encouragement to live life to the fullest • Support of patient and family to achieve goals • Education of patient and primary care- giver

True

The core inter- disciplinary team includes: * Medical director–mediator between team and attending physician; provides con- sultation relative to the medical aspect of care * Nurse coordinator–manages the patient care, explains the service, admits the pa- tients, and assigns the primary team * Social worker–evaluates the psychosocial needs and acts as resource for potential community services * Spiritual coordinator–liaison between the patient and the spiritual community; coordinates spiritual support .

True

The bereavement team provides support and follow-up for at least 1 year after the patient’s death. The team allows for ongoing communication and sharing of feelings and needs with the family A)true B)false

The usual criteria for patient admission to hospice are: * Certification by attending physician of terminal illness and prognosis of 6 months or less to live. * Patient’s willingness to forego further curative treatment * Patient’s understanding that comfort will be the focus and life-support measures may not necessarily be implemented. * Patient’s understanding of the prognosis and willingness to participate in the plan of care.

True

Pain assessment includes presence of pain, location, intensity (use of scale), variation of intensity, subjective description, treatments being used, rating of relief with current treatment, factors that precipitate or aggravate the pain, and its effect on ADLs. Nursing responsibilities in addition to pain assessment are monitoring the use and effectiveness of pain relief medications and treatments, having dosages of medications adjusting according to the patient’s needs, and educating family members/caregivers about pain relief measures.

True

Mild to moderate pain is usually controlled by NSAIDs (nonsteroidal antiin- flammatory drugs). A)true B)false

Severe pain is usually treated with opioids. A)true B)false

Long-lasting results are achieved with MS Contin, OxyContin, and Duragesic patches. A)true B)false

Additional measures for pain relief include application of hot or cold packs, repositioning, music therapy, relaxation techniques, TENS devices, imagery, hypnosis, and biofeedback. A)true B)false

Education of the patient and the family/ support persons is crucial in all aspects of symptom management. Additional nursing interventions for common signs and symptoms:

a. Nausea and vomiting–administration or encouragement of the use of antiemetics, having the patient eat slowly and in a pleasant atmosphere, recommending small, light, bland meals, and promoting verbalization of fears and concerns b. Constipation–encouragement of oral intake of fluids (as able) and use of laxatives, and assessment of status (discomfort, bowel sounds) c. Anorexia and malnutrition–nutritional assessment, oral hygiene, attractive meals, and not weighing the patient or forcing eating d. Dyspnea or air hunger–relief of anxiety, positioning, use of morphine or tranquilizers, and administration of oxygen and/ or bronchodilators to improve comfort e. Weight loss, dehydration, and weakness– skin care, cushioning of bony areas, safety measures, and active listening

True

An appropriate response of the nurse in regard to the patient’s spiritual needs is to refer the patient to and consult with the spiritual coordinator A)true B)false

Examples of signs and symptoms of impending death and nursing interventions are: * Signs/symptoms–extremities become cool, more time spent sleeping, increasing confusion, incontinence, increasing oral secretions, restlessness, irregular breath- ing patterns, changes in vital signs, de- creasing clarity of senses * Nursing interventions–keep patient warm, spend time with patient when awake, keep patient comfortable, keep lights on, talk calmly and assuredly, elevate the head of the bed, educate the family/caregiver about the process.

True

Ethical and legal issues related to hospice care include: * Withholding or withdrawing treatments * Right to refuse treatment * Do not resuscitate (DNR) orders * Advance directives * Durable power of attorney * Access to services * Patient’s right to control and dignity

True

Key terms

Adjuvant-Additional, as in additional drug or treatment A)true B)false

Bereavement-Common depressed reaction to the death of a love one A)true B)false

Holistic-Pertaining to the total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person A)true B)false

Interdisciplinary team-a diverse team of professionals from several disciplines that relate to optimize care and decrease fragmentation(breaking) services A)true B)false

Primary caregiver-One who assumes ongoing responsibility for health maintenance and therapy for the ill A)true B)false

Respite care-period of relief from responsibilities for the care of a patient A)true B)false

Terminal illness-An advanced stage of disease with no known cure and poor prognosis A)true B)false

Titrate-Slowly increasing the amount of drugs to find a therapeutic dose A)true B)false

To provide effective hospice care, the nurse needs to have an understanding of the goals of hospice. Which of the following statements appropriately addresses the goals of hospice? Select all that apply. A)Allow the patient and caregiver to be involved in the decisions regarding the plan of care B)Provide support only when the patient and family request it to help achieve the goals of the plan of care. C)Encourage the patient and caregiver to live life to the fullest.

A C

Of the core interdisciplinary team, which member assists with community resources and filing insurance papers, and also supports the patient and caregiver with emotional and grief issues A)Medical director B)Social worker

The medical director assumes overall responsibility for the medical component of the hospice patient's care program. A)true B)false

The nurse coordinator is a registered nurse who coordinates the implementation of the plan of care for each patient. A)true B)false

The social worker evaluates and assesses the psychosocial needs of the patient, including filing of insurance papers and providing emotional and grief support. A)true B)false

The spiritual coordinator is the liaison between the spiritual community and the interdisciplinary team. Assists with the spiritual assessment of the patient and develops a plan of care regarding spiritual matters. A)true B)false

The hospice nurse is visiting a terminally ill patient. During the assessment, the patient complains of pain in her stomach. She rates the pain as a "7" on a 0 to 10 scale. What is the nurse's best intervention? A)Assess the patient's vital signs and note any changes. B)Call the physician and see if there is another pain medication that can be given to control the pain.

Any pain rated as a 5 or greater on the pain scale impacts the quality of life for the patient. When a cure is not possible, palliative care becomes the goal of hospice care: to alleviate the patient's pain and at the same time allow participation in ADLs. A)true B)false

A patient has been admitted to hospice with end-stage colon cancer. During the initial assessment, the patient tells the nurse that he is having squeezing pain on the left side of his abdomen. The nurse performing the assessment knows this as what type of pain? A)Somatic pain B)Visceral pain

Somatic pain arises from the musculoskeletal system and is described as aching, stabbing, or throbbing. A)true B)false

Visceral pain originates from the internal organs. The words commonly used to describe the pain are cramping, pressure, dull, or squeezing A)true B)false

Neuropathic pain is initiated from the nerves or nervous system and is usually described as tingling, burning, or shooting. A)true B)false

Generalized pain is nonspecific pain and is usually described as achy all over. A)true B)false

Pain control for a hospice patient is best attained using long-acting medications. Which of the following are long-acting medications? A)Duragesic patch B)OxyContin C)MS Contin

A B C

A patient is having trouble with nausea and vomiting following chemotherapy. The nurse's most appropriate intervention is to: A)Encourage the patient to eat slowly and in a pleasant atmosphere, with relaxation and rest periods after eating. B)Encourage the patient to eat and drink even if nauseated to prevent dehydration

When the nurse is admitting a patient to hospice care, the nurse is explaining all the benefits that hospice covers. The spouse asks about bereavement support. What is the most appropriate response by the nurse? A)Bereavement follow-up care lasts for at least 1 year following death." B)There are certain criteria that have to be met to receive bereavement support."

The United States is becoming more multiculturally diverse, presenting challenges for hospice nurses. When working with a Hispanic family, it is important for the nurse to remember that: A)You are working with a large, extended, extremely interdependent family. B)Elders in the family are treated the same as the rest of the family.

The hospice nurse knows that constipation is a problem in terminally ill patients. The initiation of opioids to treat this condition should also be followed with: A)The initiation of a stool softener and stimulant B)The reminder to increase fluids

Respiratory distress is seen often during the end stages of an illness. The nurse knows that 24 to 48 hours before death, the patient may exhibit: A)The "death rattle" B)Decreased depth of breathing

Patients may exhibit the "death rattle," which is an accumulation of mucus and fluids in the posterior area of the pharynx. A)true B)false

Hospice care is appropriate when the treatment is no longer effective and supportive measures are needed to assist the terminally ill patient through the dying process A)true B)false

Criteria for admission-The attending physician must certify that the patient illness is terminal and that the patient has a prognosis of six months or less to live A)true B)false

Goals of hospice; - Controlling or alleviating the patient's symptoms - Allowing the patient and caregiver to be involved in the decision regarding the plan of care - Encourage the patient and caregiver to live life to the fullest - Providing continuous support to maintain patient and family confidences and reassurances to achieve these goals - Educating and supporting the primary caregiver in the home health setting that the patient chooses

True

Spiritual coordinator-Assist with funeral planning and performing funeral services A)true B)false

Hospice aide; - Certified nurse assistant who is supervised by the hospice nurse - Assist the patient with bathing and personal care - May also assisted patient and caregiver with light housekeeping services

True

Somatic pain-Arises from the musculoskeletal system, described as aching, stabbing, or throbbing A)true B)false

Visceral pain-Described as cramping, pressure, goal, or squeezing. A)true B)false

Neuropathic pain- Tinglings, Brian, or shooting pain. Usually treated with anticonvulsants May be given as an adjuvant to assist in pain control A)true B)false

Nausea can result from chemotherapy side effects, obstruction, tumor, uncontrolled pain, constipation, and even food smell A)true B)false

Eating slowly and in a pleasant atmosphere is a good way to control nausea A)true B)false

Patient should not be forced to eat or drink if they have no desire A)true B)false

Nursing interventions for constipation-a decrease in oral intake will also decrease the amount of stool expelled A)true B)false

Anorexia and malnutrition Nursing intervention and patient teaching; - If related to infection or stomatitis, good oral hygiene is important - If the order of food causes anorexia, the patient should not be the kitchen doing meal preparation - High protein supplements are helpful

True

Dyspena or air hunger Nursing interventions and patient teaching-Suctioning should occur only if the patient is choking and unable to recover A)true B)false

Psychosocial and spiritual issues other, common signs and symptoms - Weight-loss - Dehydration - Weakness - Risk for skin impairment - Depression - Sleeplessness and insomnia

True