test 4 Flashcards
hospice home
a place you go in last few months when you dont want to pass away at home or at hospital
most common place of death in us
hopsital
factors that influence peoples ability to cope with death
personal and cultural views
age- older is less anxious
religious beliefs- less depression in those who have a strong faith
s/s of death approaching
weakness, immobility
weight loss, decreased appetite
loss of bowel and bladder control
decreased awareness of surroundings
diaphoresis and lung congestion “death rattle”
altered breathing patterms, slowed pulse
cold and mottled extremites
relazed and open jaw
2 step process of death
psychological- when told they are dying
physiological- when body declines in function
Kubler Ross grief cycle
denial, anger, bargaining, depression, acceptance
not everyone has all of these steps- not universal
options for end of life care
acute care
hospice care
palliative services
paid by-self, insurance
any stage of disease!
same time as curative treatment!!
typically happens in hospital
hospice services
paid by medicare, medicaid, insurance
for when prognosis is 6 months or less!!
excludes curative treatment
occurs at wherever patient calls home
what is one of the biggest thing we want to do for dying patient
taking care of pain
acute care of the dying patient options
continuation of full life support?
full cardiopulmonary resuscitation- CPR ?
removing all life support or life sustaining equipment?
stopping all drugs except for sedation and pain?
the 5 wishes document
- The person they want to make care decisions for them when patient cant
- The kind of medical treatment they want vs dont want
- How comfortable they want to be in final days
- How they want people to treat them
- what they want there loved ones to know
advanced directives
Health care power of attorney
living will
do not resuscitate (DNR)
very important!
a living will is needed to have a DNR
Commonalities of palliative vs hospice
comfort varer
reduce stress
symptom relief
physical and psychosocial relief
informed consent
have a right to know you are dying and make decisions about your life
this is a grey area for peds
assisted suicide and euthansia
some people believe in right to die- they can die when they want.
lots of legal, moral and ethical issues
Active euthanasia- illegal in US. done for you by dr
assisted suicide- with active euthanasia- legal in some states, dr gives you prescription med and you do it yourself
passive euthanasia- withholding life sustaining measures so death occurs naturally. legal in all states.
role of healthcare worker in end of life
educate patient and family concerning the diagnosis
ensure informed consent
ensure wishes are respected
communicate with healthcare team when death is imminent or has occurred
how to tell children theyre dying
toddlers- very simple language
preschooler- tell them in language they understand
school age- can be more incorporated in planning. they know what death is but afraid it will hurt
adolescent- ^
normal losses: maturational
newborns loss of security of womb
toddlers loss of being exclusive focus when sibling arrives
teens loss of security when leaving college
normal losses: situational
loss of income
loss of health
abnormal losses
loss of national security- such as world trade center
loss of health and control- covid pandemic
grief
process of when going through loss
can start before death
delayed grief- doesn’t come to terms right away, grieves later from a different triggering event
complicated grief- deliberating prolonged grief
anticipatory grief- grief as people emotionally prepare themselves for a loss of loved one
death of a child
ensure other children (siblings) are token care of
bereavement
the process during which people cope with a loved ones death. the entire coping process. similar to grief
bereavement overload
occurs when loosing several people in a short time
when are infants capable of responding to loss
10 months (if they see them often).
could effect trust vs mistrust
