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19 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Types of Palliative Care
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-Structure, processes of care
-Physical aspects of care -Psychological, psychiatric aspects of care -Spiritual, religious, existential aspects of care -Cultural aspects of care -Care of imminently dying patient -Ethical, legal aspects of care -Social aspects of care |
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Legislative Issues in End of Life Care
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-DNR orders
-Advanced directives Living will Proxy directive Durable power of attorney -Assisted suicide legislation (oregon and washington) |
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Awareness Context
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Closed Awareness- Pt does not Know
Suspected Awareness- Pt suspects Mutual pretense awareness- everyone knows but pretends it isn't there. open awareness |
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What is Hospice Care?
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Coordinated program of interdisciplinary care, services provided primarily in home to terminally ill patients, their families
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Principles of Hospice Care
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-Death must be accepted
-Patient’s total care best managed by interdisciplinary team whose members communicate regularly -Pain, other symptoms must be managed -Patient, family should be viewed as single unit of care -Home care of dying necessary -Bereavement care must be provided to family members -Research, education should be ongoing |
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Barriers to Improving End-of-care
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-Cure = focus of health care establishment
-Financial criteria, reimbursement issues -Cultural, social issues -Discomfort with addressing issues of death (both patient, family), health care providers -Psychological, coping responses to death, dying (denial) |
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4 levels of Hospice Care*
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-Routine home care
-Inpatient respite care- in hospital or facility -Continuous care- at home or nursing home. For out of control pain or symptoms to have continuous care 24hrs for a couple days -General inpatient care |
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Communication in Hospice Care (2 sided answer)
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-Reflect on your own experiences, values concerning illness, death
-Deliver, interpret technical information without hiding behind medical terminology -Realize best time for patient to talk may be least convenient for you -Be fully present during all communications -Allow patient, family to set agenda regarding depth of conversation |
-Resist impulse to fill “empty space”
-Allow patient, family sufficient time to reflect, respond -Prompt gently -Avoid distractions -Avoid impulse to give advice -Avoid canned responses -Ask questions -Assess understanding, both your own, the patient‘s |
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Responding to Sensitivity
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Responding to difficult questions
Discussing at time issue is addressed by patient - make time Using open-ended statements or questions Seeking clarification Providing realistic reassurance Dealing with grief processes Assessing patient preferences, and spiritual, cultural practices |
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Spiritual Care
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-Spirituality includes religion
But is not synonymous with religion -Spiritual assessment mnemonic-FICA (?) -Addressing spirituality: important component of care of dying patient -Maintaining hope |
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Care management for dying
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Patient's goal should direct care management
Symptoms Pain Dyspnea Nausea Weakness Anxiety |
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Signs of Approaching Death
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-Refusal of food, fluids---don’t force
-Urinary output decreases -Weakness, sleep -Confusion, restlessness---Ativan, Haldol -Impaired vision, hearing -Secretions in throat increase -Breathing pattern…O2, morphine, HOB, fan -Incontinence….foley, padding -Decreased temperature control----acitimenophen supp. |
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Comfort Care
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-Comfort measures ( reposition, lotion, oral care)
-Secretions increase….anticholinergics -Dyspnea/periods of apnea….HOB elevated, O2, fan, morphine -Pain….narcotics -Terminal Restlessness….hallucinations/delirium – Haldol -Anxiety….Ativan Family….speak to pt, hold hand, comfort measures, music, pt may choose TOD ( wait for a family member or wait until room is empty). -Seeing relatives or friends. Support. |
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ACtively Dying- one to two weeks
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-HR weak and irregular, BP low, RR irregular w apnea
-Mottled extremities…blood pooling in core -Decreased urine output -Disorientation -Congestion -Not eating |
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Actively Dying- days or hours
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-Intensification of 1 -2 week signs
-Surge of energy -BP decreases, pulse weak -Eyes glassy, half-open -Periods of apnea -Restless or no activity -Mottled extremities -Incontinence |
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pt/ Family Centered Goals
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-Safe, comfortable death
-Management of pain and symptoms -Death with dignity -Self-determined life closure . Specify pt’s wishes |
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Grief and Mourning
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Grief process – Denial,Anger,Bargaining,Depression,Acceptance
Nursing diagnosis - anticipatory grief Interventions Support expression of feelings Assess social support Assess coping skills Assess for signs of complicated grief and mourning, offer professional referral |
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Definition of Grief
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A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.
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Definition of Complicated Grieving
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A disorder that occurs after the death of a significant other, in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment.
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