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NURS 428: Evolution > Week 2: Palliative Care > Flashcards

Week 2: Palliative Care Flashcards

Exam 1

1
Q

Palliative and End-of-Life Care:

What is needed?

A

The need for quality at end of life

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2
Q

Palliative and End-of-Life Care:

What exists now? What are examples?

A

Improved ability to care for the critically ill

Meds, technology

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3
Q

Palliative and End-of-Life Care:

What is often lost in healthcare?

A

Loss of sensitivity for human suffering in an effort to aggressively save lives

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4
Q

Palliative and End-of-Life Care:

What must be understood?

A

Understanding Human Death

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5
Q

Palliative and End-of-Life Care:

Understanding Human Death

A

Increased education for health care providers education

Improve EOL decision making

Reduce frequency of mechanically supported, painful and prolonged death.

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6
Q

Palliative and End-of-Life Care:

Opportunity for improvement

A

Respecting decision to avoid CPR

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7
Q

The need for quality end of life care

40 % of ICU deaths were among patients who

A

who were in ICU 10 days or more

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8
Q

The need for quality end of life care

40 % of ICU deaths were among patients who were in ICU 10 days or more

What is this preceded by?

A

Preceded by aggressive support

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9
Q

The need for quality end of life care

40 % of ICU deaths were among patients who were in ICU 10 days or more

Preceded by aggressive support like:

A

Outcomes of decisions often not understood

Highly stressful environment

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10
Q

The need for quality end of life care

What is the role of the nurse?

A

Nurse’s role to explain the choices to patients and family

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11
Q

The need for quality end of life care

When does palliative care begin and end?

A

Palliative care can begin at admission and continue to end of life.

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12
Q

Elements of Palliative Care

A

Alleviation of distressing symptoms (palliation)

Advanced Care Planning

Family centered care

Emotional and psychological care of the patient and family

Facilitating communication

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13
Q

Effects of End-of-Life Issues on Nurses and Health Care Teams

What should you do to lessen stress?

A

Know when you need a break

Discuss experience with colleagues, friends and leaders

Be in touch with your feelings

Physical exercise, mediation, humor, music, eating properly, getting rest

Recognize burnout-

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14
Q

Effects of End-of-Life Issues on Nurses and Health Care Teams

Recognize burnout- what are signs?

A

Increased sick days,

difficulty solving problems,

isolation,

withdrawal,

change in behavior,

diminished capacity for experiencing pleasure

Flashbacks

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15
Q

Common Symptoms at End of Life

A

Pain

Anxiety

Hunger

Thirst

Dyspnea

Diarrhea

Nausea

Confusion

Agitation

Sleep disturbance

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16
Q

Communication and Conflict Resolution:

What should you provide and allow to family?

A

Provide clear, ongoing, honest communication

Allow time for family members to express themselves

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17
Q

Communication and Conflict Resolution:

What should you agree on? What should you emphasize? What should you facilitate?

A

Agree on a treatment plan

Emphasize that patient will not be abandoned

Facilitate continuity of care

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18
Q

What is the most common withdrawal intervention?

A

Ventilator Withdrawal

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19
Q

What “terminal weaning”?

A

Ventilator Withdrawal

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20
Q

During Ventilator Withdrawal, what should be done?

A

Titrate pain medications and sedation during this process

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21
Q

Ventilator Withdrawal: Titrate pain medications and sedation during this process

What does this do?

A

Relieves tachypnea, dyspnea, and use of accessory muscles

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22
Q

Ethical Principles Related to Withdrawal and Withholding of Treatment:

Death is a product of what?

A

Death is a product of the underlying disease

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23
Q

Ethical Principles Related to Withdrawal and Withholding of Treatment:

What is the goal of withdrawal and withholding of treatment?

A

Goal is to relieve suffering, not hasten death

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24
Q

Ethical Principles Related to Withdrawal and Withholding of Treatment:

Withholding life-sustaining treatment is similar to what?

A

Withholding life-sustaining treatment is moral equivalent of withdrawing treatment

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25
Q

Ethical Principles Related to Withdrawal and Withholding of Treatment

When can treatment be withheld or withdrawn?

A

Any treatment may be withheld or withdrawn with patient and family consent

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26
Q

Nursing Interventions During Withdrawal or Withholding of Treatment

include?

A

Provide

Anticipate

Titrate

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27
Q

Nursing Interventions During Withdrawal or Withholding of Treatment

What should you provide?

A

Provide anticipatory guidance to patient and family

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28
Q

Nursing Interventions During Withdrawal or Withholding of Treatment

What should you anticipate?

A

Anticipate distressing symptoms and medicate to relieve symptoms

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29
Q

Nursing Interventions During Withdrawal or Withholding of Treatment

What should you Titrate?

A

Titrate therapy to relieve emotional and physical distress

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30
Q

Hospice Care

What does it comfort?

A

Emphasizes comfort rather than cure

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31
Q

Hospice Care

How does it view dying?

A

Views dying as a normal process

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32
Q

Hospice Care

Philosophy?

A

Philosophy of care, not a location

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33
Q

Hospice Care

Where is it common?

A

Common in oncology

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34
Q

Hospice Care

When is it appropriate?

A

Appropriate when aggressive interventions are withdrawn

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35
Q

Hospice Care

What is it considered?

A

Quality end-of-life care

36
Q

Hospice Referral:

Hospice is what kind of care?

A

Hospice is a model of care based on comfort measures

37
Q

Hospice Referral:

When is a referral made?

A

After decision to withdraw or withhold therapy

38
Q

Hospice Referral:

How does care occur?

A

Smooth transition of care

39
Q

Hospice Referral:

What occurs?

A

Family and patient involvement
Communication

40
Q

Cultural Competence in End of Life

How do most clinicians feel?

A

Most clinicians feel ill-prepared

41
Q

Cultural Competence in End of Life

Cultural differences?

A

Cultures differ in death practices

Cultures differ in end-of-life options selection

42
Q

Cultural Competence in End of Life

What should providers do?

A

Become familiar with religious groups and beliefs about end of life rituals and practices

Attend Ethics committee meetings

Attend ethics rounds

43
Q

Legal issues in Critical Care

Medical futility:

A

Situation in which therapy or interventions will not provide a foreseeable possibility of improvement in the patient’s health condition, or a lack of attainable goals of care

44
Q

Legal issues in Critical Care

HIPAA: What must nurses do to decide who has patient information accessible to them?

A

Nurses need to verify who can have access to patient information

45
Q

Legal issues in Critical Care

HIPAA: Who decides who has access to patient information?

A

Patient has right to make this decision

46
Q

Legal issues in Critical Care

HIPAA: What must be communicated to the patient?

A

Must communicate HIPAA to the patient

47
Q

Legal issues in Critical Care

HIPAA:

A

Keep patient information confidential

48
Q

Criminal Law:

What kind of law?

A

Public Law

49
Q

Criminal Law:

Conviction of public law means what?

A

= penalty can include loss of liberty

50
Q

Criminal Law

Conviction = penalty can include loss of liberty
For nurses these cases include:

A

Intentional assault and battery

Fraud

Theft

Negligent homicide

51
Q

Civil Law:

What kind if law is it?

A

Private law

52
Q

Civil Law:

What does it involve?

A

Individual conflicts

53
Q

Civil Law:

What does it include?

A

Includes tort law: trespass, assault, battery and negligence

Nursing malpractice

54
Q

Malpractice law:

What does it require?

A

Requires a causal relationship between the nurse’s breach of standard of care and injury to the patient.

55
Q

Malpractice law:

What must is show?

A

Must show that injury is result of nurses’ action or inaction

55
Q

Malpractice law:

What is the award most often?

A

Most often award is monetary

56
Q

Malpractice law:

What are noneconomic damages? What do many states have limits on?

A

Noneconomic damages: pain suffering..

Many states have limits on monetary awards

57
Q

Nursing Malpractice Case:

How does it start?

A

Distressed patient and or family file lawsuit against nurse in civil court

57
Q

Nursing Malpractice Case:

What is the nurse in these situations?

A

Nurse becomes a defendant w legal representation

58
Q

Nursing Malpractice Case:

Discovery phase: What is it? What else occurs?

A

Discovery phase- written answers to written questions

Depositions /oral testimony

59
Q

Elements of malpractice

Duty: What is there a legal relationship between?

A

legal relationship between two or more parties

60
Q

Elements of malpractice

Duty: What is there a contractual relationship between?

A

Contractual relationship between patient and HC facility

61
Q

Elements of malpractice

Duty: Nurses name is where?

A

Duty of Nurse’s name in patient records

62
Q

Elements of malpractice

Duty: What is the duty of the nurse?

A

Duty to provide reasonable care within established standard of care

63
Q

Elements of malpractice

Include:

A

Breach of duty

Causation

Damages/Harm

64
Q

Breach of Duty:

What must be shown for malpractice?

A

Must show breach

65
Q

Breach of Duty:

How is negligence detemined?

A

Negligence is determined by comparing the nurse’s conduct with the established standard of care (SOC)

66
Q

Breach of Duty:

Negligence is determined by comparing the nurse’s conduct with the established standard of care (SOC)

If nurse fails to meet SOC…

A

If nurse fails to meet SOC, violation has occurred in duty to patient

67
Q

Breach of Duty:

Negligence can be ____or ____.

A

Negligence can be ordinary or gross

68
Q

Breach of Duty

Negligence can be ordinary or gross

What is gross negligence?

A

Gross negligence indicates the nurse willfully and consciously ignored a known risk of harm for the patient

69
Q

Vicarious liability

A

Holding someone responsible for the actions of another

70
Q

Vicarious liability

Includes:

A

respondent superior (employer responsible for actions of employee)

Corporate liability

Negligent supervision

Rule of personal liability

71
Q

Vicarious liability

Includes: respondent superior

A

(employer responsible for actions of employee)

72
Q

Vicarious liability

Under respondent superior, who is held liable for negligent behavior?

A

Under this legal theory, hospitals are held liable for the negligence of their employees.

It is a legal doctrine based on public policy that notes that because a hospital profits from the patients seeking care, the hospital should pauy for some of the damages caused by the hospital personeel if ngligence occurs.

73
Q

Vicarious liability

Includes: Corporate liability

A

Is a vicarious liability that occurs when a hospital is found liable for its own unreasonable conduct.

74
Q

Vicarious liability

What is an example of corporate liability?

A

if it is found that a unit is chronically understaffed and a patient suffers an injury as a result of short staffing, the hospital can be held accountable.

75
Q

Vicarious liability

Negligent supervision: What is it?

A

When a supervisor fails to reasonably supervise people under their direction.

76
Q

Vicarious liability

Negligent supervision: What is an example?

A

If a nurse rotates to an unfamiliar unit and informs the charge nurse that they have never worked in critical care, it would be unreasonable. for the charge to ask the floating nurse to perform invasive monitoring.

If the charge did assign such responsibilities, to the floater and patient injury occurs, the charge nurse could be held accountable to the patient for negligent supervision.

77
Q

Vicarious liability

Rule of personal liability

A

Nurses are responsible for making sound decisions by virtue of their own specialized education, training and experience.

78
Q

Corporate liability: Who is liable?

A

When hospital is liable for unreasonable conduct

79
Q

Nurse responsibility

A

Nurses are responsible for making sound decisions by virtue of their own specialized education training and experience.

80
Q

Nurse responsibility: What kind of orders should nurses not follow?

A

Do not follow orders that the nurse deems unsafe.

81
Q

Nurse responsibility:

Orders that are deemed unsafe- what should nurses do?

A

Seek clarification or follow the chain of command

82
Q

Nurse responsibility:

There is a problem with devices, what is it called?

A

Safe medical devices act: report malfunctions of medical devices

83
Q

Nurse responsibility:

What should not be done with defective equipment?

A

Do not use defective equipment

NURS 428: Evolution (17 decks)

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