Test 1- End Of Life Care Flashcards
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
cessation of integrated tissue and organ function
lack of heartbeat, absence of spontaneous respirations, or irreversible brain dysfunction
Definition of dying
Patients are declared dead at time of brain dead
Lungs will eventually fail due to trauma and illness
Yes
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
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
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
What to treat for dying pt
Symptom management
What do advanced directives consist of ?
Help patient speak out when unable to do so
Cpr/ dnr status
Breathing tube wishes
POLST
Physician order for life saving treatment
Lists any end of life care regarding respiratory support, intubation, etc signed by the doctor and patient
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
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.
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
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
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
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
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.
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.
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
End of life assessment -
Pain, dyspnea (turn, suction, oral care, meds)
Breathing changes is a normal part of dying?
True
What to do for dyspnea was
Turn patient
Suction
Oral care
Meds - morohine
Raise hob
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
What to do for restlessness
May be sleepy or insomnia
Turn lights down , music , decrease visitors , meds
What to do for percussion changes
Blue /grey changes
Use blankets and stay warm
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
