Unit 11 Grief and Dying Chapter 30

Question 1

What is Hospice?

Answer 1

Hospice care begins after treatment of the disease or condition is stopped, when it is clear that survival is not possible.

END OF LIFE CARE
<6 months life expectancy

SHORT TERM SUPPORT

EX- terminally ill patient

Question 2

Is Hospice treatment focused in patients during the end of life <6 months expectancy?

A. No
B. Yes

Answer 2

B. Yes

Question 3

Which of the following patients are the main candidate for Hospice?
A. Patient who has been newly diagnosed with Diabetes
B. Patient who is in the severe stage of Alzheimers
C. 91 year old patient with a current UTI
D. Patient who is recovering from a transient stroke

Answer 3

B. Patient who is in the severe stage of Alzheimers

Question 4

Is the focus curing the patient with the terminal illness who is admitted into hospice?

A. No
B. Yes

Answer 4

A. No

Hx – (1960’s) “Nothing more to do” The Model of care that supports and cares for patients facing death

* Life Expectancy <6 months determined by nurse practitioner, or physician

• Available to everyone, regardless of age, dx or ability to pay
• Multidisciplinary approach ‘’

Focus is on care NOT cure

Care extends to patient family *

Settings – free standing, home, Nursing Home, hospital

Question 5

Is hospice only for the elderly and wealthy?

A. No
B.Yes

Answer 5

A. No

• Available to everyone, regardless of age, dx or ability to pay

Many people cite the 6-month rule to determine eligibility for hospice care. Six months or less is thought to be the amount of time that physicians, nurse practitioners, or physician assistants must certify that a person has to live.

Question 6

Are medications that are used to treat the patients illness discontinued in Hospice?

A. No
B. Yes

Answer 6

B. Yes

At the time of entry to hospice, medications and other treat- ments are evaluated.
Medications used to treat the underlying illness are commonly discontinued.

Question 7

What is the goal for patients In Hospice?

Answer 7

The goal is quality of life.

Question 8

Your diabetic patient in hospice has refused to monitor his blood glucose? What is the nurses priority intervention?

A. insist that the patient must take their blood glucose.
B.recognize that his ask will improve the quality of his life.
C. find an alternative measure to test his blood glucose
D. call the health care provider

Answer 8

B.recognize that his ask will improve the quality of his life.

The goal is quality of life. For example, a person with diabetes may decide to give up a strict schedule of blood sugar testing and begin enjoying sweets again.

Question 9

A hospice patient is nearing the end of life, and the family expresses concern about the patient’s breathing pattern. What should the nurse explain about the respiratory changes commonly observed in the dying process?
A. “The patient is experiencing respiratory distress, and we need to administer oxygen.”
B. “This is a normal part of the dying process, and the body is conserving energy.”
C. “It indicates an improvement in the patient’s overall condition.”
D. “I will request a prescription for a bronchodilator to ease breathing.”

Answer 9

Rationale:
B. Respiratory changes, such as irregular breathing patterns, are common in the dying process and are often a result of the body conserving energy. Providing this information helps alleviate family concerns and promotes understanding of the natural progression of end-of-life changes.

Question 10

A hospice nurse is caring for a patient with terminal cancer who is experiencing dyspnea. What is the nurse’s priority intervention?
A. Administering an opioid analgesic to relieve pain.
B. Placing the patient in a semi-Fowler’s position.
C. Initiating cardiopulmonary resuscitation (CPR).
D. Administering oxygen via nasal cannula

Answer 10

Rationale:
B. Placing the patient in a semi-Fowler’s position helps alleviate dyspnea by facilitating optimal lung expansion and easing respiratory effort.

Question 11

A family member asks the nurse about the purpose of a “Do Not Resuscitate” (DNR) order in hospice care. What is the nurse’s best response?
A. “A DNR order ensures that the patient will receive aggressive resuscitation measures in case of cardiac arrest.”
B. “It means that no life-sustaining measures, such as CPR, will be initiated if the patient’s heart stops.”
C. “The DNR order only applies to certain situations, such as respiratory failure.”
D. “It allows the healthcare team to administer any necessary interventions to prolong the patient’s life.”

Answer 11

Rationale:
B. A DNR order in hospice care signifies that the patient does not wish to undergo cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, aligning with the principles of comfort-focused care at the end of life.

Question 12

The nurse is caring for a patient in hospice whose family is concerned about the patient’s nutrition. What is the most appropriate nursing intervention?
A. Initiate enteral feeding to ensure adequate nutrition.
B. Educate the family about the natural decrease in appetite near the end of life.
C. Consult with a nutritionist to develop a high-calorie diet plan.
D. Administer appetite-stimulating medications as ordered.

Answer 12

Rationale:
B. Educating the family about the natural decrease in appetite near the end of life helps manage expectations and encourages a focus on providing comfort rather than aggressive nutritional interventions.

Question 13

What is Palliative care

Answer 13

Unlike hospice care, palliative care can begin at the time of diagnosis and continue throughout the treatment of the illness. Palliative care is specialized medical and nursing care for people living with serious illness. People may or may not be terminally ill to benefit from this type.

LONG TERM SUPPORT

-COMMONNLY USED FOR CHRONIC ILLNESS LIKE:
* Diabetes
*Heart disease
*Dementia
(progressive conditions that can lead to death)

• Anticipating, preventing and treating suffering
• Addresses physical, intellectual, emotional, social, and spiritual needs
• Patient and family centered care
• Optimizes quality of life

Question 14

Is it true that life medication that can cure illness in palliative care are discontinued?

A. NO
B. Yes

Question 15

Can palliative care start primarily at the beginning of a diagnosis or end?

A. Beginning of diagnosis
B. End of diagnosis

Answer 15

A. Beginning

Question 16

What is the outcome or goal for palliative care?

Answer 16

PROMOTE COMFORT

• Optimizes quality of life

Question 17

What are the 5 stages of Grief according to Kubler Ross?

Answer 17

Denial and Isolation
Anger
Bargaining
Depression
Acceptance

Question 18

What is the Denial Stage of grief also give an example?

Answer 18

DISBELIEF AND SHOCK

Example:

This phase can also result in “doctor shopping,” in which the patient will seek advice from other specialists in hopes that the diagnosis will indeed be a mistake. Examples of expressions in this phase include,

“There has been a mix-up with my test results,” or “No, it can’t be true. That’s impossible.”

Question 19

What is the Anger Stage of grief also give an example?

Answer 19

This phase typically surfaces when patients are ready to acknowledge their illness, when they come to terms with the fact that they are, in fact, seriously ill. The patient becomes pessimistic and unhappy.

Example:

Why me? Why not someone else?”

Question 20

What is the Bargaining Stage of grief also give an example?

Answer 20

As the patient attempts to deal with overwhelm- ing feelings of vulnerability and helplessness, the individual may secretly try to make deals with a higher power to pro- long life.

Example:
“I’ll stop smoking if I can just stay alive long enough to attend my daughter’s wedding.”

Question 21

What is the Depression

Answer 21

This phase arises when patients can no longer avoid a sense of great loss. They can feel guilty because of the strain they feel they’re putting on their family and a deep sadness for experiences they may miss out on.

Question 22

Two phases of the Depression stage

Answer 22

reparatory and reactive. Preparatory refers to patients preparing themselves for their final separation from this world, while reactive encompasses the unrealistic guilt or shame patients feel about their illness. In this phase, it is imperative that patients are allowed to express their justified sadness.

Question 23

Acceptance Stage

Answer 23

It is a final time for resting, free of pain and struggle. The patient may wish for solitude and may not be as talkative. Times of silence during visits may be the most meaningful mode of communication for these patients. This phase can be notably difficult for loved ones of the patient, as they may not have accepted the impending loss and view the patient’s ambivalence with death as “giving up.”

Question 24

Anticipatory Grief

Answer 24

Once a life-threatening diagnosis has been received or curative efforts are stopped, people begin a period of grieving called antic- ipatory grief (International Council of Nurses, 2019), sometimes referred to as anticipatory mourning. This type of grief is antic- ipatory in the sense that a future loss is being mourned in the present. It happens as people acknowledge the importance of the dying person, adjust their lives to accommodate the intervening time, and foresee how their futures will be altered by the loss.

Question 25

Is artificial nutrition and hydration a comfort measure

Answer 25

Artificial nutrition and hydration through feeding tubes or intravenous fluids is legally considered a medical interventionand not a comfort measure.

Question 26

What are the negative effects Artificial nutrition and hydration

Answer 26

Supplementation of food and water is therefore not a component of basic care for people who are actively dying. It does not generally benefit people who are dying. In fact, providing artificial hydration by such means as intrave- nous fluids can increase edema, pulmonary congestion, ascites, nausea, and vomiting.

Question 27

Should artificial nutrition and hydration be used for patients experiencing impending death?

A. Yes
B. No

Answer 27

B. No

It does not generally benefit people who are dying.

In fact, providing artificial hydration by such means as intrave- nous fluids can increase edema, pulmonary congestion, ascites, nausea, and vomiting. Generally, the unwillingness or inability to eat and drink is caused by the impending death of the patient.

Question 28

Nursing Intervention for dying patients

Answer 28

Nurses caring for the dying can encourage families to offer water orally as often as their actively dying loved one desires and is able to swallow.

Question 29

Patient and family teaching for the dying patient

Answer 29

inform family that…

-One distinction to keep in mind is that the patient is not dying of dehydration or lack of food, but rather from their illness.

Nurses caring for the dying can encourage families to offer water orally as often as their actively dying loved one desires and is able to swallow.

Listening to patients and their family mem- bers and including the interdisciplinary team in this decision is vitally important

Question 30

What is Euthanasia

Answer 30

Often called mercy killing, euthanasia is the act of putting someone to death.

-Euthanasia means that someone other than the patient commits an action with the intent of ending the patient’s life.

Question 31

What are the 3 types of euthanasia?

Answer 31

-Voluntary euthanasia
-Passive euthanasia
-Involuntary euthanasia

Question 32

Voluntary Euthanasia

Answer 32

Voluntary euthanasia is requested by the patient and is typically performed when a person is suffering from a terminal illness and is in great pain.

Example:

Your patient in the ICU who has lost all limbs do to a car accident ask the primary care provider to stop all life preserving measures.

patient participates in this decision

Question 33

Passive Euthanasia

Answer 33

Passive euthanasia is the omission of acts (i.e., withdrawing or withholding) that would keep a patient alive who is unable to participate in decision making. Examples of passive eutha- nasia include discontinuing a medication that is keeping a patient alive or not performing a life-saving procedure on a person.

Example: Your patient with an ischemic stroke is admitted and the Health Care provide withholds the Alteplase.

patient not able to participate in this decision

Question 34

Involuntary euthanasia

Answer 34

Involuntary euthanasia is actively ending the life of a person who is able to perform consent, typically by the injection of a lethal drug. This active form of euthanasia may result in charges of homicide.

Example:

Your alert and oriented patient is ambulatory. You as the nurse decides to administer IV Push potassium

patient able to particapte in this decision but health care provider has not asked for consent- HOMICIDE

Question 35

Arguments as to why Physian Assisted Suicide is relevant

Answer 35

Individual Liberty
* Individual has the right to refuse or withdrawal tx
* Government has a constitutional power to override certain rights to protect citizens * Autonomy
* Individualism, self-determination
* Every competent person has the right to make decision * Quality of care
Pg 555 Box 30.2 * Removal of bans would force quality end-of-life care HPNA Statement on Physician-Assisted Suicide
* Nomaleficence
* Do no Harm
* Is assisted suicide harmful? Are we promoting and protecting life? * Beneficence
* Do good
* Can patient’s benefit from the relief?
* Preserving and supporting life

Question 36

Nursing Care and role at the End of Life

Answer 36

Communication
* Can be difficult
* Develop therapeutic relationship

• Presence
  There are often ways nurses can take action to make a patient feel better, such as pain medication, bathing, and turning. Sometimes, however, the best action is simply being present with people who are dying and their families.
• Listening and observing
  Pg 555 Box 30.3 * Reflect, restate, summarize
  HPNA Statement on Pain Management
• Open ended questions
• Silence * Symptom Management
• Hallmark of palliative care
• Common Sx: Constipation, dyspnea, fatigue, depression and delirium
• Pain Management

Question 37

Signs and Symptoms of Impending Death

Answer 37

Growing weakness
* Loss of appetite
* Increasing Drowsiness
* Mentality changes – *Shortening attention
span, difficulty processing information
*Circulatory Change *Increased HR,
*Decreased BP
* Mottling of Skin – Grayish-blue splotches *Decrease in Urine Output
* Breathing Changes “Death Rattle”

Question 38

Post Mortem Care

Answer 38

• Listen for Heartbeat while feeling for Pulse
  for 2 minutes * Pronounce the time of death (Date & Time) * Families will remember the actions of the
  nurse * Communicate deep respect for the dead
  and for the bereaved * Invite family to participate in care
• Care may vary according to culture

Question 39

What is grief

Answer 39

While grief is a reaction to a loss,

Question 40

What is Bereavement

Answer 40

bereavement, derived from the Old English word berafian, meaning “to rob,” is the period of grieving after a death.

TIME AFTER THE PRONOUNCED DEATH

Question 41

What is Mourning

Answer 41

Mourning refers to things people do to COPE with grief, including shared social expressions of grief such as viewing hours, funerals, Life of celebration, looking at pictures of something and bereavement groups.

Everyone grieves but not everyone engages in the work of mourning. The length of time, degree, and ritual for mourning are often typically determined by cultural, reli- gious, and familial factors.
ex-funeral

Question 42

What is Persistent Complex Bereavement Disorder

Answer 42

• Persistent Complex Bereavement Disorder
  acute grief persist more than 1 year in adults and more than 6 months in children
  -Bereavement persists beyond 12 months in adults, 6 months in children

Question 43

Complicated Grieving

Answer 43

Complicated Grieving
- The experience of distress accompanying bereavement **fails to follow normative
expectations **

• Functional impairment
• Sx – Preoccupation with thought of the deceased, feeling sof emptiness, anger,
  depression, disbelief, detachment and rumination * Self blame *

Tx – Protect from self harm

• Encourage patient to talk about the good and bad of the deceased
• Encourage adequate nutrition, hydration, sleep, and physical activity

Question 44

What nurses should not say during the grieving process

Answer 44

“I know how you feel” * “When my mother died, I cried for
months…(proceed with long story)…” * “At least he didn’t suffer” * “He is in a better place” * “Have you thought about getting a new
wife/dog/husband?” * “Be grateful for the time you did have…

Question 45

What should nurses say during the grieving process

Answer 45

• “Your loss must be devastating. I can’t
  imagine how you feel.”
• “This must be difficult for you right now..”
• “It must have been a shock to lose your
  husband so suddenly.”
• “I can only imagine how much you are
  missing her”
• “You’re loved one was irreplaceably
  special

Question 46

Self Care for Nurses

Answer 46

• Lack of self-care can lead to compassion fatigue, vulnerable to emotional
  attachments
• Remind self – What is happening is happening to the patient and their family…..not
  you.
• Countertransference – explore your deeper issues or needs – Talk to friend or counselor *

Boundaries – State what you can and can not do upfront *

** Create a healthy balanced private life**

Question 47

Which statement made by a patient demonstrates accep-
tance of criteria required of hospice care?
a. “I want my family to be with me.”
b. “There is no cure for my illness. I’ve accepted that.”
c. “It’s important to me that I die in my own home.”
d. “I don’t want my family to bear the burden of caring for
me.”

Answer 47

b. “There is no cure for my illness. I’ve accepted that.”