Test 1- End Of Life Care Flashcards by Rachel P

Refers to the “process that ultimately ends in an event called death.”
Fewer than 10% of Americans die “suddenly”
Leading causes are heart disease, malignant neoplasm, CV disease, lung disease, stroke
Progress through failure of one or more body systems until death occurs
Symptom management is important
Process can be overwhelming

dying

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cessation of integrated tissue and organ function

lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction

Definition of dying

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Patients are declared dead at time of brain dead

Lungs will eventually fail due to trauma and illness

Yes

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S/s that happen to the body before death?

Pulmonary system?

Embolism,heart failure, pneumonia, lung disease, respiratory arrest, r/t increased ICP

Hypoxia , decreases mental state, confusion, orthopnea-sob when lying flat, chest ole/sob on exertion , increased pulse and restlessness , irritability , anxiety

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CNS-what happens with death

Decrease in mental status / sleepy

Moments of wakefulness (surprise rally)

Pupil construction and progresses to dilation as brain hypoxia (low o2) occurs

Person is non responsive to light any longer with dilation

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Renal- what happens with death?

Decrease urine and increase concentration

Increase potassium as well as other electrolyte abnormalties as kidney and renal blood flow decrease

Improper perfusion can lead to oxygen deprive To tissues and cells which lead to an aerobic metabolism, acidosis, hyperkalemia, dead tissue, MODS

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What to treat for dying pt

Symptom management

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What do advanced directives consist of ?

Help patient speak out when unable to do so

Cpr/ dnr status

Breathing tube wishes

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POLST

Physician order for life saving treatment

Lists any end of life care regarding respiratory support, intubation, etc signed by the doctor and patient

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What happens if patient wakes up and is alert and oriented after not being able to make decisions for self previously

They are now in charge of decisions again

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Palliative care? What is it

Not always end of life care

Care for someone who is not responding to treatment such as chemotherapy

Focused care on patients symptoms and experience that the patient is having as they go through this.

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Palliative care goal?

How long is Care provided?

Who is involved?

When is care initiated ?

Highest quality of life as well as comfort

(not always terminal disease) can go on for years and have many team members involved

Can be at any stage of disease

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What is hospice care

When is it initiated

End of life care

Patient has 6 months or less to live

Stop all treatments for curatives, help provide comfort

May provide care in any living environment one is living in such as home, nursing home, home health, etc

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Nursing interventions with hospice

Know patient wishes

Understand cultural background

Communication with family during end of life

Be sure patient is comfortable, compationate, knowledgeable with end of life care, Therapeutic communication, compassionate, advocate

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a written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive.

Living will

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ANAs position on assisted suicide

The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession.

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Euthanasia vs assisted suicide

assisted suicide entails making lethal means available to the patient to be used at a time of the patient’s own choosing. Terminal disease, don’t want to suffer and want dignity.

voluntary active euthanasia entails the physician taking an active role in carrying out the patient’s request, and usually involves intravenous delivery of a lethal substance.

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S/s that it is too late for cpr ?

Rigor Mortis

This is a very late sign of death. If you find a victim completely stiff with limbs that do not freely move, it is unfortunately too late to start CPR

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End of life assessment -

Pain, dyspnea (turn, suction, oral care, meds)

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Breathing changes is a normal part of dying?

True

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What to do for dyspnea was

Turn patient

Suction

Oral care

Meds - morohine

Raise hob

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What to do for n/v

Meds - zofran

Let eat what they want

Keep food at room temp

Decrease movement

Decrease odors

Swab mouth, provide oral care , (skin and mouth break down risk due to decreased intake and thrush)

Small snacks

Manage constipation

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What to do for restlessness

May be sleepy or insomnia

Turn lights down , music , decrease visitors , meds

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What to do for percussion changes

Blue /grey changes

Use blankets and stay warm

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Incontinence interventions

Normal part of dying Incontinence product Peri care and keep dry

Confusion or delirium - interventions

Keep safe Orientate to reality -Let grandma live in their own reality if she forgets constantly Anxiety/depression Decreased metabolism

What is most important with dying

Patient comfort and point of view Always address family’s perception but may need to educate

What does HOPE stand for

Hope and strength sources Organized religion and role that it plays Personal spirituality, rituals and practices Effects of religion on care and end of life decisions

What does morphine do and how it works

Changes the way the body perceives pain And air hunger Decreases anxiety with a lower level Of oxygen stability

Med that decrease secretions (gurgle or death rattle )

Atropine , lycosamine (anticholinergics)

Anxiety interventions with dying

Encourage one to express feelings Breathing exercises Medications such as benzo s And some beta blockers LOLs , spiritual support

Home care- what to do if dying at home

Call hospice

Interventions for parents and siblings with death

Let parent hold child Teach parent and siblings In words they can understand Help cope/ provide resources

Priority for actively dying patients

Comfort is #1 No deep suctioning to lungs Suction to mouth is ok Proper bedside manners

An aspect of self no longer available to person

Loss

Cessation/stopping of life

Death

Emotional feeling r/t perception of loss

Grief

Outward expression of loss

Mourning

Obvious loss vs not so obvious loss

Obvious - Death, divorce , break up Not obvious- Illness, aging, changing job, schools, moving

Stages of grief ? How ons goes through them?

Shock/ denial Anger/depression Bargaining Acceptance - can loop around , back and forth

Perceived loss vs actual loss | How they process grief?

Perceived - decreased confidence, births a boy instead of wanted girl Actual- mastectomy, limb Both process grief the same- stages

Loss that results from normal life transitions such as loss of childhood dreams, increases age , metapause , decrease hair/teeth/hearing/sight and deceased youth. Different stages in life

Maturational loss

A sudden and unexpected loss

Situational loss

Any loss that requires adaption through grieving process | Can’t feel, hear, see someone or something

Personal loss

Depressed reaction to death

Bereavement

Expected it awaited loss

Anticipatory grief

Sudden loss/death with powerful emotions

Unexpected grief

Nurses grief ?

?After patients die, nurses manage bereavement tasks such as making sense of the death, managing mild to intense emotions, and realigning relationships. These tasks become more difficult when multiple deaths are encountered or when a conflict about the death occurs.

Type of grief with disturbances of the normal progress to resolution

Unresolved grief

Delayed or exaggerated response to a perceived , actual, or potential loss May have no one to listen, unable to express self, may sir up other losses, may cut people off, develop “same s/s” as loves one who passed away. Make poor choices (brings drinking, gambling) Unable to move or get rid of loved ones possessions long after death Extreme crying/emotions 1 year or longer after loss, feels as if it happened yesterday. People may be stuck in this grieving for very long time and become depressed

Dysfunctional grieving

Give _______ to family and patient through dying and grieving Consider the 5 aspects of human functioning?

Supportive care 1. Physical 2. Emotional 3. intellectual 4. sociocultural 5. spiritual

Always offer what before and after loss?

Supportive care

Assess patients and family what before educating

Intellect

Always communicate with dying patients Don’t give false hope What are other ways a nurse can communicate with a dying patient? Why is it important?

Assist the patient with what before death

Saying goodbye or unresolved feelings to family / friends May be verbal, nonverbal, concrete, symbolic. How?

What occurs when a dying patients arms and legs are discolored ?

Mottling is caused by the heart no longer being able to pump blood effectively. Because of this, blood pressure drops, causing extremities to feel cool to the touch. The skin then starts to become discolored.

Cool and clammy with dying. What is occurring ?

As the heart gets weaker, it won't pump as strongly as before. The blood pressure may drop. Body temperature may go back and forth between hot and cold. The skin then may be clammy. Also, lack of fluid in the skin can cause dryness and make skin feel cool and clammy to the touch.

Examples of unresponsive

No movement No breathing No reflexes No apical HR Flat ecg

What is a flat ecg?

where the heart shows no electrical activity (asystole), or to a flat electroencephalogram, in which the brain shows no electrical activity (brain death). Both of these specific cases are involved in various definitions of death.

Post Mortem care? Why is it so important ?

Try to clean patient first , before family sees patient But it’s ok if family needs time with patient first Try to clean up ASAP

How to communicate to children about death?

Communicate on their level Be blunt and to the point

Documentations with death

Time of death Any interventions prior to S/s of impending death Where and to who the body was transferred Personal belongings brought with to funeral home

Suicide - Family will often go through what ?

All stages of grief, guilt , shame in community, survivors are at risk for suicide , show s/s Give support

S/s of suicidal?

Getting rid of belongings

How to assist one with sudden death?

Let the family start experiencing their loss. You are in a supportive role more than anything. ... Give the family their space.” As in most nursing situations, nonjudgmental compassion for the patient's family is key to helping the newly grieving

What to say to the bereaved ?

I’m sorry for your loss. Etc

How to provide grief support?

Being there physically and psychologically Empathize, listening, acknowledging loss Storytelling or reminisce on memories Do not minimize family reaction

What happens to the heart in dying

Heart fails to pump Improper blood flow Decrease circulation Decreasing BP, tachycardia, irregular pulse, decreases mentation, reduced urinary output, chest pain, dyspnea