Week 10: Hospice and Palliative Care - Dying as a Transition Flashcards
What is the ultimate cause of death?
Lack of oxygen (cardiac and brain)
When is a person considered dead according to Harvard Criteria?
- Unreceptive and unresponsive
- No movements and/or breathing
- No reflexes; pupils are fixed, dilated, not responsive to light, no blinking, no ocular movement
- Flat EEG, no activity in the cerebrum (brain waves)
- No circulation to, or within the brain
What is the definition of a brain death?
Irreversible cessation; entire brain including brain stem
What is the definition of a coma?
Profound unresponsiveness due to illness or injury. Won’t speak, open eyes, engage in purposeful behaviors
What is the definition of a vegetative state?
Depressed consciousness, brain stem function and breathing independently. Person may respond to pain or loud sounds, involuntary motions, etc.
- persons who are in a vegetative state of >1 year are in a permanent vegetative state
What are signs of brain death?
- Pupils stay in mid-position and do not react to light
- The eye does not blink when touched
- The eyes do not rotate in the socket when the head is moved from side to side or up and down
- The eyes do not move when ice water is placed in the ear canal
- The patient does not cough or gag when a suction tube is placed deep into the breathing tube
- The patient does not breathe when taken off the ventilator
What does Neocortical mean?
Least extreme form - upper part of the brain where thoughts, pleasure, pain and volition reside - no longer functions
What does cerebral death mean?
The next step - comes when only the cerebellum and the brainstem are active
What does Whole Brain Death mean?
Brainstem itself has stopped functioning - only type of brain death that is recognized in the US
What does UDDA mean?
Uniform Determination of Death Act - individual who has sustained either irreversible cessation of respiratory function or cessation of all functions of entire brain
What does agonal movement mean? and what types of movements happen before clinical death?
- The body’s ultimate response to a lack of oxygen - the moment before the moment of death
- Muscle spasms, gasps, and possibly a convulsion may occur
Define these 3 different mortis’
- Algor Mortis
- Livor Mortis
- Rigor Mortis
- Algor Mortis: temperature of the body postmortem; normal circumstances (one degree per hr)
- Livor Mortis: the color of death; RBCs settle to lowest part of body, postmortem stain (reddish-purple discoloration)
- Rigor Mortis: the rigidity of death; face, trunk, limbs and organs; contraction of muscle (2-6 hours after death)
Within 24 hours of death, there are additional changes to the body… what are they?
Decomposition
- Autolysis : cell self-destruction; enzymes
- Putrefaction (rotting): 2-3 days after death; smell due to decaying RBCs and intestinal gas
- Breaking down of the body
What are the 5 stages of grief (of dying)
- Denial: No not me, it can’t be true
- Anger: Why me?
- Bargaining: Maybe if I ask nicely or pray
- Depression: Individual can no longer deny his or her illness (reactive, preparatory)
- Acceptance: Person is neither angry nor depressed - a quiet degree of expectation
What are some evaluation of the five stages?
- Existence of stages has not been demonstrated
- People may not move through stages 1 –> 5
- Limitations of methods
- Line is blurred between prescription and description
- Totality of the person is neglected
How do the dying want to be treated?
- Greatest fear of the dying: to be left alone
- No single way to die
- Appropriate death is based on the individual
- Need to pull away
How should someone communicate with the dying?
- Get the setting right
- Find out if he person wants to talk about it
- Listen and show you’re listening
- Encourage the patient to talk
- Silence and non-verbal communication
- Make sure you have understood what is said
- Dont change subject
What are some signs of an approaching death?
- BP is very low 60/40
- Heartbeat is weak, irregular, difficult to count and fast 120-140 beats/min
- Breathing is congested and can be rapid and then very slow
- Decreased urine output; although people may wet the bed
- Hands, feet, and knees are cold and purplish
- Person may be confused
- May be non responsive
- Sleeping with eyes partially open
- Mouth probably open
What happen when death has occurred?
- Breathing/heartbeat ceases
- Person cannot be aroused
- Eyelids may be partially open
- Mouth may fall open
- May be a release of bowel and bladder contents
What does a good death mean?
- Don’t want to be in pain
- Don’t want to suffer
- Don’t want to be a burden
- Don’t want to die alone
What does Palliative care mean?
- Relieving symptoms of the incurable illness - person is not necessarily dying
- Improving quality of life
- Making the best of the time that is remaining
What does Curative care mean?
Eliminating a controllable disease
Explain more facts about hospice care
- Philosophy of care and a program for a persons with a life limiting illness (prognosis of 6 months or less to live)
- Not necessarily a facility (80% is provided in the home)
- Focus not on the disease but on patents comfort and family
- Not 24 hours care but available on call
- Hospice is covered by medicare
How many hospice programs are in the US and what percentage is covered by Medicare
- 4,840
- 85.5%
Name the 4 levels of hospice care
- Routine Hospice Care (RHC): provided at person’s residence
- Continuous Home Care (CHC): 8 to 24 hours/day of care for pain management and other symptoms of an acute nature (predominantly nursing)
- Inpatient Respite Care (IRC): respite refers to relief. This is provided to caregiver on a temporary basis. Provided at hospital, hospice facility, or LTC facility offering 24 hours personnel support
- General Inpatient Care (GIP): Pain and symptom management that cannot be provided elsewhere. Care provided in medicare certified hospital, hospice, inpatient facility on nursing facility with 24 hours nursing required
Name some hospice stats
- Number of patients: 1.55 mil
- 56.2% female and 43.8% male
- 70.6% of hospice patients are over 65 and 62.7% are 84+
- 29.4% are under 65
- <1% are pediatric (0.4%)
- Typically white folks
In 2018, what is the number of patients, total days, and average days of care?
- 1.55 mil
- 113.5 M
- 89.6
What is the most common days of care?
266 days or less
What percentage of hospice admission were cancer patient?
29.6% are for cancer patients and 70.4% are non-cancer
What was the mean survival for hospice compared to non-hospice?
Mean survival was 29 days longer for hospice than non-hospice patients
What disease typically had the longest days of care?
Alzheimer’s disease average being 105.2
When was hospice established in the US?
In 1974 - 3 demonstration projects were designed to evaluate the effectiveness of hospice (In New Haven, Boonton, NJ, and Tuscan, AZ)
Which hospice care location gets the most people (choose between Private residence, Nursing facility, and assisted living facility)
Assisted living facility
In 2018 where was the most common location of death with hospice patients?
51.5% at home
