(W7/8) EOL Care and Bereavement

Question 1

How to anticipate and prepare for death?

Answer 1

• Stop unnecessary medications and monitoring
• Switch essential meds to non-oral route
• Standby Haloperidol for delirium (anticipatory medication)
• Evaluate symptoms (eg pain, breathlessness, dry mouth, agitation and secretions)
• Provide nursing care (for skin, oral, bladder and bowels)
• Assess family/caregiver coping ability

Question 2

What are the signs of death onset?

Answer 2

• Profound weakness
• Gaunt appearance
• Drowsiness
• Disorientation
• Diminished oral intake
• Difficulty taking oral meds
• Poor concentration
• Skin color changes
• Temperature change at extremities
• Terminal restlessness

Question 3

Causes of death rattling sounds

Answer 3

• Salivary/bronchial secretions accumulate in the pharynx and upper airways
• As air moves overs the pooled secretions in the oropharynx and bronchi, turbulence occurs -> rattling sound

Question 4

What is the pharmacological management for secretions?

Answer 4

• Anti-muscarinic drugs
• Anti-cholinergic drugs
• Eg Buscopan, Scopolamine, Glycopyrrolate, Atropine

Question 5

What are the non-pharmacological measures to reduce secretions?

Answer 5

• Position px to the side or semi-prone
  ~ Facilitates postural drainage
• Good mouth hygiene
• Stop or reduce artificial nutrition and hydration
• Note: Suctioning not really done as most secretions are below the pharynx and are inaccessible

Question 6

How to involve family

Answer 6

• Inform them that px can no longer tolerate oral intake
• Encourage them to continue talking to patient
• Ask family to assist in basic hygiene eg oral care, applying lotion
• Prepare a calm environment

Question 7

What is compassionate discharge?

Answer 7

• Discharge home when px are critically ill and likely to pass away within a few hours or days

Question 8

Factors influencing behaviours in responding to death

Answer 8

1) Exposure to death
2) Life expectancy
3) Perceived control over the force of nature
4) Belief system

Question 9

What are the 2 types of grief?

Answer 9

• Normal/uncomplicated grief (mild functional impairment and lasts about 6 months)
• Abnormal/complicated grief (failure to return to normalcy, prolonged, overly intense, delayed or absent)

Question 10

What are risk factors for complicated grief

Answer 10

• Sudden or unexpected death
• Intimate rs
• Hx of mood or anxiety disorders
• Poor health
• Multiple stressors
• Poor social support

Question 11

IMPT:
What is the Kubler Ross 5 Stages of Grief?

Answer 11

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

Question 12

What are tasks of mourning?

Answer 12

Task 1 (Accept the reality of loss)

Task 2 (Feeling and expressing the grief)

Task 3 (Adjust to a world without this deceased)
- At functional level (taking on roles of deceased)
- At internal level (adjusting own sense of self)
- At spiritual level (sense of beliefs, values and meaning)

Task 4 (Find an enduring connection with the deceased)

Question 13

What is the difference between of grief, mourning and bereavement?

Answer 13

Grief:
- Process of REACTING to a loss
- Emotional, physiological and cognitive symptoms resulting in a unique behavioural response

Mourning:
- Process of someone ADAPTING to a loss
- Influenced culture, spiritual and society norm

Bereavement:
- Period of grief and mourning after the loss of someone

Question 14

Types of bereavement support

Answer 14

• Written information
• Counselling, psychotherapy
• Family/peer support
• Self-help group
• Voluntary services
• Spiritual