Test 1 Flashcards
palliative care
services offered to clients and their families living with and/or dying from a progressive, life-threatening illness
goals of palliative care
relieve pain, suffering, improve comfort, promote dignity (NOT to cure illness or prolong life)
5 areas of holistic focus
- physical
- emotional
- spiritual
- social
- intellectual
MAID
medical assistance in dying
medically assisted death
aided by providing client with means/information necessary to end their life
euthanasia
act of putting another person painlessly to death
stage 1 of MAID
determine eligibility
- 18 yrs
- capable of making health decisions
- grievous + irremediable med condition
- voluntarily request
- give informed consent
- eligible to receive health services funded by Can gov.
what type of illness is excluded by MAID
mental illness
stage 2 of MAID
ensure safeguards are met
(when a patients natural death is reasonably foreseeable)
- written request signed by one independent witness
- eligibility provided by two independent practitioners (one must be expert in client illness)
- can withdraw consent at any time
- all necessary measures taken to provide reliable means for patients difficulty communicating to understand and communicate their decision
- immediately before providing MAID , patient is given opportunity to withdraw their request and ensure patient gives express consent to receive MAID
(when a patients natural death is NOT reasonably foreseeable)
Everything above^^^ and…
- 90 day assessment period observed
- patient informed about means available to relieve their suffering
- eligibility provided by two independent practitioners but one must be expert in client illness
Stage 3 of MAID
Obtain consent
type of consent when a patient’s natural death is reasonably foreseeable
- General consent
- advanced consent
- express consent (final)
type of consent when a patient’s natural death is NOT reasonably foreseeable
- General consent
- express consent (final)
Stage 4 of MAID
Provide MAID
- prescribing, providing, or administering medications that cause death
- reporting requirement
PSW responsibilities related to Medically Assisted Death
- perform activties/ADL’s
- provide comfort measures
- educate clients
- provide support to clients and family
- do not encourage client to choose medical assistance in dying (it is a CRIME)
factors required for home palliative care
- desire to die at home
- the caregiver’s desire to have client at home
- good family/physician support w/ available medical support 24 hr/day
- available caregivers
- financial resources
- cost of medications/medical equipment
- compassionate leave
home care challenges
- less structured
- more physical demands
- financially more expensive
home care benefits
- more privacy
- less intrusiveness
- more sleep
hospital care benefits
- more sleep
- more structure
- less expensive
hospital care challenges
- more intrusiveness
- less privacy
- decreased access to client for family
capable
understanding information and consequences of a situation
incapable
no understanding of consequences of choices of activities of daily living
advanced directive
making choice while you are capable about how you wish to be cared for in the future in you become incapable of making those decisions
ex: designating Power of Attorney or Substitute Decision Maker
Power of Attorney
A document that gives a designated family member or another trusted friend the right to make legal decisions in situations where the client cannot decide for themselves
2 types of Power of Attorney
Personal - ADL’s, where to live, what kind of treatment to receive
Financial - Property, money, paying bills…
Living Will
- document that speaks for the person in special situations when they cannot speak for themselves
- puts in writing more specific medical interventions in special circumstances
Last Will and Testament
Is an “after death document” that specifies your estate distribution
Hierarchy of Substitutes
- substitute decision maker (POA)
- spouse, common-law or partner
- child (if 16 or older) or parent
- brothers and sisters, any other relative (may share decision-making responsibility)
if no living relatives:
- office of public guardian and trustee
- consent and capacity board appoints a “Board Appointed Representative”
DNR
Do Not Resuscitate - instructions not to perform any heroic measures to keep someone alive
4 reasons why communication is important
- promotes safe/effective care
- establishes client’s needs
- builds relationships
- provides advocacy
tips for effective communication
- use verbal and non verbal
- use simple, clear language
- ask open-ended questions
- give broad openings
- use silence
- active listening
- paraphrase to clarify meaning
- acceptance
barriers to communication
- ease of communication = job satisfaction
- condition of client
- time
- pressure from colleagues + supervisors
- fear
- over-identification with patients and families
- interrupting
- jumping to conclusions
- becoming impatient
- becoming bored
- answering own questions
- hurrying, focusing not on client
tips for communicating w/ unconscious client
- do not shout “can you hear me?”
- speak as if they can hear you
- describe what you are going to do
- make physical contact if culturally appropriate
what is grief
- internal part of loss
- how we feel
- it is real
- leaves its imprint
- reflection of the connection we had with the person who has died
- healing process that brings us comfort
factors that influence grief
- time
- attachments/connection
- religion
- culture
- past experience
- dying person’s role in family
- length of illness
- presence of social supports
- cultural differences
public grief
- gathering of people to share a loss in villages, town, cities
- funeral, memorial, vigil, wake are NA examples
- normal and healthy
time after learning of a fatal illness, when one experiences all of the emotions of grief in ‘anticipation of the loss of a loved one’
anticipatory grieving, normal grief reaction
mourning
external part of loss: actions, rituals, customs
who noticed that when people were dying they were “shunned and abused and no one wanted to be honest with them?
dr. elisabeth kubler-ross
what year was “Death and Dying Published”
1969
Kubler-Ross Stages of Grief
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Denial Stage of Grief
- 1st stage of grieving process
- helps us survive loss
- world becomes meaningless
- numb and shock
- disbelief, ‘nothing is wrong’, unimaginable
Anger Stage of Grief
- envy other
- feel others dont care
- ‘why me’
- projected anger
- anger at higher power
Bargaining Stage of Grief
- brief stage
- not always obvious
- ‘try to be good’
- attempts to postpone “if only”
Depression Stage of Grief
- mourning for losses
- reactive depression, loss of job, hobbies, mobility, independence
- different from chronic depression
- preparatory depression or losses yet to come
- increased dependence on the family
Acceptance Stage of Grief
- not necessarily a happy stage
- can be void of feeling
- consists of giving up
- realizing that death is inevitable but hope for a calm/painless death
true/false - when someone grieves they must go through each stage of grief
false: some never reach acceptance, some get stuck, there is no ‘must’ in grieving, can move back and forth, may not move through stages in order
3 major areas of difference in culture + palliative
- communication of bad news
- locus of decision making
- attitudes toward end of life care
role of psw in cultural aspects of death and dying
- explore own feelings, values, beliefs about death
- learn about client’s culture + beliefs through them and family
- use other forms of communication if applicable//appropriate
- DO NOT impose views on client/family
whose teachings are Buddhism based on
Siddhartha Gautama // The Enlightened One // Buddha
some general aspects of buddhism + death
- each person is responsible to learn perfect wisdom+compassion in their lifetime to reach enlightenment
- importance on preparing mind for death (some may believe its favourable for rebirth)
- provide words of hope+encouragement to dying person
- be mindful of not disturbing dying person’s concentration
- monk can be called to perform last rites/chants
some general aspects of christianity + death
- appreciate offering readings from bible or prayer
- belief in one god as source of life
- based on teachings of Jesus Christ and the bible
- hymns or songs may be appreciated
some general aspects of hinduism + death
- belief time is cyclical + eternal
- bathing and cleanliness important
- can believe and worship many deities
- can believe in monotheism where all gods are manifestation of one
- family obligation to care for sick + dying
- cremation ASAP
- may wish to wash deceased body // psw should wear gloves
- priest may tie a thread around wrist or neck that is not to be removed
some general aspects of islam + death
- monotheist belief in one god - Allah
- 2 main branches: Sunni and Shi’a
- haram = forbidden
- halal = permissible
- typically no pork or pork byproduct
- buried not cremated
some general aspects of judaism + death
- monotheistic belief in one god
- minyan may be requested which is a group of at least 10 ppl for prayer
- someone may remain with body at all times
- emphasis on living a moreal and ethical life rather than eternal rewards
some general aspects of sikhism + death
- belief in one god
- disciplined path of meditating about god, selfless service to humanity
- belief in reincarnation
- initiated Sikh’s have five K’s of Khalsa (Kesh/uncut hair, Kara/wrist bangle, Kirpan/dagger, Kaccha/white underpants or shorts, Khanga/wooden comb)
- importance on modesty, cleanliness and privacy
- crying at end of life not permitted
- cremation performed
- funeral = Celebration of the Completion of Life
causes of N+V
- analgesics (pain relievers)
- chemotherapy
- constipation
- odors
- pain
comfort measures for Nausea
- frequent mouth care
- small frequent meals
- deep breathing
- repositioning
- cold foods
- avoidance of unpleasant odors
- clear fluids only
- antiemetic (anti-nausea medications) b4 meals
causes of loss of appetite
- illness progression
- treatments
- medications
- taste changes in the mouth
care measures for anorexia
- offer small amounts of food/high calorie drinks
- anti-nausea meds
- ensure meals are attractively served
- eliminate odors
- frequent mouth care
- offer cold foods (less odors than hot)
comfort measures for dyspnea
- oxygen therapy
- no smoking signs
- frequent rest
- encourage energy conservation
- use a humidifier
- remove tight or constructed clothing
- semi-fowlers positioning
constipation comfort measures
- fluids
- fibres
- laxatives (if ordered)
- observing/reporting if no BM for 2+ days
frequent loose stools comfort measures
- promote dignity
- wash perineal area gently with soap and water
- barrier cream if necessary
- medication to stop the diarrhea
- room spray to reduce odor
comfort measures for insomnia
- back rubs, massages
- quiet/calm environment
- warm, non-caffeine drinks
- clean incontinent products
- sheets wrinkle-free/clean
care measures for edema
- diuretics if ordered
- elevate limbs
- frequent skin care
- frequent repositioning
care measures for mouth ulcers
- lip balm
- ice chips
- decrease spicy/acidic food
- popsicles
- avoid commercial mouthwashes
- use of a soft toothbrush
three types of pain
acute, chronic, radiating
factors affecting pain
- past experience
- anxiety
- rest and sleep
- gender
- meaning of pain
- support from others
- culture
S+S of pain
- general body tension // clenched teeth, hands, shoulders ex.
- tense facial expression (wincing)
- constant fidgeting
- nervous habits, lip, nail biting
- withdrawal - unsual
- strained voice
questions to describe pain
- where did the pain begin?
- when did it start?
- on a scale of 1-10/1-5 where is your pain level?
- any other symptoms?
- what were you doing at the time that the pain started?
- does it affect what you are doing?
- what makes it better or worse?
- does the pain stay in one place or does it spread to other areas?
words to describe pain
- aching
- burning
- cramping
- spasmodic
- pounding
- knotting
- pinching
- shooting/stabbing
analgesic staircase
Mild
Moderate
Strong
PCA
patient controlled analgesia
analgesic myths
- addiction to drug
- increased tolerance to the drug making it ineffective
- hallucinations
comfort measures for pain
- repositioning the client
- keep bed linens clean, dry + wrinkle-free
- make sure the client is not lying on drainage/catheter tubes
- use correct body alignment
- proper temperature
- wait 1/2 after pain meds given before giving care or turning
- back massage
- soft music
- appropriate touch
- avoid sudden or jarring movements
- passive ROM’s
- practice safety if client is receive pain meds - check for dizziness
- check client every 10-15 min
- humour
signs of death
- loss of movement, muscle tone and sensation
- slowing of peristalsis and GI function
- circulation failure
- respiratory failure
- excessive fatigue + sleep
- changes in eating
- social withdrawal
- coolness in tips of fingers + toes
physiological signs of death
absence of: pulse, respirations, blood pressure
fixed, dilated pupils
PSW roles in postmortem care
- know employers policies + procedures
- standard precautions
- respect right to privacy + dignity, cultural practices
- positioning body in normal alignment before rigor mortis sets in
What year did the Substitute Decisions Act come into effect?
1992
What does the substitute decisions act cover?
establishes the legal criteria determining when a person has the ability to make decisions that are fundamental to their well-being. The ability to make these types of decisions is termed capacity and the decisions are termed consent.
Which religion has a Southeast Asian tradition that involves placing a coin in the mouth of the deceased?
Buddhism
which religion prefers their deceased to be cremated as soon as possible?
Hinduism + Sikhism
Which religion prefers their dead to be buried within 24 hours?
Judaism
Which religion may request to wait 3 days after someone has died before cremation?
Buddhism
Which religion forbids alcohol, even in cooking?
Islam
True or false: all followers of a religion follow it the same
False - of course not
What is a portfolio
a collection of examples and evidence to showcase one’s experience, capability and potential for employment opportunities and professional development.
Which religion involves removing jewellery from the body, then washing the body and dressing the body in a white kimono and straw shoes
Shinto
Which religion requires someone to remain with the body all the time before burial
Orthodox and Conservative Judaism
Bowlby’s Four Phases of Mourning
Numbing
Yearning and searching
Disorganization and despair
Reorganization
Worden’s Four Tasks of Mourning
Task 1 - Accepting Reality of Loss
Task 2 - work through pain of grief
Task 3 - Adjusting to environment w/o deceased
Task 4 - emotionally relocating and moving with life
children aged 5-7 believe death….
is final but wont happen to them
3-5 year old believe death…
is temporary
two types of resumes
chronological + functional
