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Med Surg > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is palliative Care?

A

approach to care that improves the quality of life of pts and their families facing problems with life threatening illness

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2
Q

What is end of life care?

A

care provided in the last days or weeks of life

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3
Q

What is MAID?

A

administration of a substance that directly causes death administered by a physician or NP (clinician administered) or by the individual themselves (self-administered) following an eligability process with strict criteria

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4
Q

what are the 2 types of MAID?

A

1)clinician administered
2) self administered

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5
Q

what is death

A

permanent and irreversible cessation of all systems and vital organ functions including the capactiy for counciousness and all brain stem functions.

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6
Q

what are the minimal acceptable clinical standards of death?

A

absence of palpable pulse, breath sounds, heart sounds, respiratory effect or chest wall mostion. also loss of palpitile arterial blood pressure from non invasive measurements

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7
Q

What is the process of dying?

A

metabolism slows and body gradually slows down until all functions end. respirations generally stop first then the heart shortly after.

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8
Q

What is the physology of palliative care?

A

provide relief of symptoms including pain, provide dignity and respect of patiect and support their families

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9
Q

What is an interprofessional care team?

A

physicians, nurses, support works, social workers, care givers, substitue decision makers and pt/family. pt needs to be involved in care as much as possible.

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10
Q

When does palliative care start?

A

at the begining of diagnosis of terminal illness can start 2 years before pts of end of life or 2 weeks before end of life, depends on illness, pts willingness to participate and the availability of EOL care team

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11
Q

What sense is usually the last to disapear during dying?

A

hearing.

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12
Q

What are chyene stokes breath?

A

hyperventilate really fast then stop breathing

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13
Q

what are guppy breaths?

A

agonal breathing, looks like fish out of water, lips puff and gasp for air, is a reflex of not enough air, O2 can be provided does not treat but provide comfort

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14
Q

What is death rattle?

A

an audible breath sound. known as terminal resp secretions pool in oral pharynx due to impaired swallowing related to overall loss of muscle tone. may not need to be treated but can be stressful to pt and those visiting them, treatments include glycopyrrolate and scopolamine. they do NOT work immediately, help stop the build up of secretions and are given SC

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15
Q

What medications can be given for help with eyes when dying?

A

to protect eyes in case of weak eyelid seal with infrequent blinking apply tears naturale 1-2 drops in each eye Q4h and prn. Lacrilube can be applied 1/4 inch in each eye at bedtime.

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16
Q

What happens to the MSK system when dying?

A

reduction in muscle tone and overall strength and abilities such as body posture and alignment.

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17
Q

What reflex disapears resulting in deifficulty speaking, swallowing and sagging jaw?

A

gag reflex

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18
Q

What are common MSK effects of backlophen?

A

muscle spasms

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19
Q

What are myoclonus movements?

A

jerky muscle movements with opioid use and may indicate need of narcan

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20
Q

What happens to the urinary system during death?

A

reduction in urinary output, reduced control and inability to void. higher risk of UTI.

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21
Q

Describe urine when dying

A

usually not clear or yellow, dark or tea colour and fowel smelling

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22
Q

What happens with the GI system during the process of dying

A

reduction in apetite and thirst resulting in dry mouth. accumulation of gas, distentiona nd nausea, constipation and hiccups.

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23
Q

If pts are on O2 what can you not use to treat dry lips?

A

vasoline. contraindications of O2

24
Q

When does loss of spincter control occur?

A

before imminent death or at the time of death. meaning bowel movement may coccur at this time. due to loss of overall muscle tone

25
Q

What happens to heart rate during dying?

A

initially climbs and becomes tachy and then slows right down, pulse becomes weak and hard to find on extremedies.

26
Q

where do we check for pulse during death?

A

chrodid or femoral due to slowing and weakening of heart

27
Q

What happens to blood pressure during death?

A

hypotension

28
Q

WHy is edema common during process of dying?

A

shut down of kidneys and less movement. typically occurs in legs, feet and hips.

29
Q

What is mottling skin?

A

stretched, purplish at nail beds, fingers and joints

30
Q

What vitals do we focus on during death/dying?

A

palpate pulse and count resps

31
Q

What are the concerns with anxiety, confusion and depression nearing EOL?

A

pt at risk of altered decision making, important to rule out delerium. anxiety about unfinished business (lonliness, meaninglessness, pain and helplessness)

32
Q

What is used to assess pts confusion, anxiety and depression nearing death?

A

CAM (confusion assessment method)

33
Q

What medications are used for confusion, anxiety and depression for those nearing death?

A

haloperidol, olanzapine, quetiapine, citalopram and venalfaxine

34
Q

What is palliative sedation?

A

medication used to intentionally produce sedation in order to relieve intractable symptoms in the last days of a pt’s life

35
Q

What os priciple of double effect?

A

justifies the use of medications that cause sedation as an adverse effect, an unintended harm as primary role is to relieve suffering and not intended to hasten death. ethical obligation to keep pt comfortable. usually use a three pronged approach.

36
Q

What is a three pronged approach?

A

uses 3 medications. 1 for anxiety/depression eg. benzodiazapine, 2. for confusion an antipsychotic eg. haloperidol and 3. an opioid for pain eg. hydromorphone.

37
Q

How often do angalgesic components need to be reviewed/adjusted to meet pts needs

A

every 24 hours. beware of opioid toxicity

38
Q

What is the PPS?

A

palliative performance scale. measured in %. 0% is dead and 100% is full capacity of life.

39
Q

What does WLSM stand for?

A

withdraw of life saving measures

40
Q

What does announcing of death include?

A

confirm identity by checking armband, note general apperance of body. certain that client does not rouse to verbal or tactile stimuli, check for absence of heart sound and carotid pulse, look and listen for absence of spontaneous resps and pupillary light reflex

41
Q

What is involved in post mortem care?

A

close eyes, replace dentures, wash body as needed, remove tubes and dressings, straighten the body, pillows to support head, rolled towel under chin to close the mouth, brief/pad in case of incontinence.

42
Q

Who is eligable to be an organ donner?

A

all ppl aged 16 to 79. compotent. may choose organ and tissue donation. only pts who have sustained a nonrecoverable injury and are on life support may donate organs.

43
Q

What is anxiety?

A

an uneasy feeling caused by a source that is not easily identified.

44
Q

What are nursing responses of loneliness and abandonment?

A

holding hands, touching and listening. simply provide companionship allowing the dying person a sense of security

45
Q

What is included with spiritual needs?

A

beliefs, values and practices that relate to the search for existential meaning and purpose. Respect pt’s wishes with regard to spiritual guidence or patoral care services and make refferals as appropriate

46
Q

Cultural compotenet care in EOL care

A

ways in which ppl understand and expirience death varies across cultures. Understanding care of dying pts and practices or rituals concerning the care of the body upon and immediately after death. practice cultural safety and humility. Assess your own knowledge and cultural competency

47
Q

What are advance directives?

A

written documents prepared by compotent persons outlining treatment wishes. 3 types;
1) instructional directives: living wills or treatment directives
2) proxy directives: power of attorney for personal care (POA)
3) substitute decision maker (SDM). substitue decision act 1992

48
Q

What stuggles do families struggle with during terminal illness?

A

cardiopulmonary resuscitation: full code, DNR, Intubation/mechanical ventilation
Medical management: ICU admission, allow natural death (AND) and withdraw of life saving measures (WLSM)

49
Q

Determining substitute decision making (SDM)

A

1) gaurdian 2) attorney for personal care 3) consent & capacity board representative 4) spouse or partner 5) child (>16 years) or parent or CAS if applicable 6) parent who has only a right of access 7) brother or sister 8) any other relative

50
Q

What is a power of attorney?

A

the person(s) to make health care decisions should a client become unable to make informed decisions for self. can be reffered to as SDM

51
Q

What is breavement?

A

period after the death of a loved one during which grief is expirienced and mourning occurs. time spent in breavement is individual. breavement and grief counselling are components of hospital palliative care

52
Q

What is grief?

A

normal reaction to loss. includes anger, guilt, anxiety, sadness, depression, despair or a combination of these. disruption in sleep, changes in appetite, physical symptoms and illness

53
Q

What is anticipitory grief?

A

grief that takes place before actual death

54
Q

What is complicated grief?

A

prolonged and intense mourning

55
Q

List and describe the 5 stages of Kubler-Ross’ model of grief.

A

1) Denial: “not me, cannot be true”, denying the loss has taken place and possibly withdrawing. may last mins to months
2) Anger: “why me”, anger at the person, world or even self for an event occuring even if nothing could have stopped it
3) Bargining: “Yes me but”, making bargins with God. If I do this will you take loss away
4) Depression: “yes me and I’m sad”, feeling numb, although anger & sadness may remain subcontiously
5) Acceptance: “Yess me but it’s oaky”, accepting reality of loss. tapering off of anger, sadness and mourning

stages are NOT linear. not all stages are expirienced by griver

56
Q

What are Warden’s tasks of monitouring used for and what are they?

A

a counselling model for grief work.

1) to accept the reality of the loss
2) to work through the pain of grief
3) to adjust to an enviroment in which the deceased is missing
4) to find an enduring connection with the deceased while embarking on a new life

57
Q

True or false. Nurses are immune to feelings of loss

A

False.

Med Surg (4 decks)

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