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30 Cards in this Set
- Front
- Back
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Focus of End-of-Life Care
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physical and psychosocial needs at the end of life for the patient and his/her family
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Palliative Care
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healthcare aimed at symptom management rather than curative treatment; often begun early in the disease process
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Focus of palliative care
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allowing for a natural death in a pain-controlled and symptom-controlled environment with psychosocial support
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Hospice Care
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concept of care that provides compassion, concern and support for the dying; generally prescribed during the last six months of life
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What are some terminal conditions that may warrant a prescription for Hospice Care?
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cancer, AIDS, COPD, ESRD, Alzheimer's Disease, Parkinson's, Liver disease, ESCVD
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What is the role of the nurse in end-of-life care?
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management of physical and psychosocial changes and problems, client/family teaching, and acknowledgment and documentation of client/family's practices, beliefs, preferences, etc.
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Kubler-Ross Theory on Death & Dying
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Denial
Anger Bargaining Depression Acceptance |
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Variables affecting end-of-life care
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culture, age, religious beliefs, illness, privacy, gender, ethnicity, spirituality
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What is happening to a patient when he is "actively dying?"
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physical changes due to decreased oxygenation and altered circulation; metabolic changes contribute to muscle weakening, and difficulty speaking and swallowing
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What are some symptoms of the actively dying patient?
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blurred vision, decreased pain and touch perception, along with decreased levels of consciousness, pale, mottled and cyanotic skin, diminished urinary output, slower HR, lower BP, elevated temp, lost blink reflex, hearing loss, death rattle, and Cheyne-Stokes breathing
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What are some important elements of post-mortem care?
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notification of death, organ/tissue donation, autopsy, preparation of the body, spirituality, providing privacy, viewing the body, care of personal belongings, documentation and transportation of the body
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What are the five types of loss?
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Loss of: possessions or objects, known environment, significant other, aspect of self, and loss of life
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Necessary losses
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naturally occurring as we move forward in life; most of these are replaced by something different or better
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Maturational losses
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a type of necessary loss and includes all normally expected life changes across the life span
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Situational loss
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brought about by sudden, unpredictable external events
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Actual losses
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are when a person can no longer feel, hear or know a person or object
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Perceived losses
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uniquely defined by the person experiencing the loss and are less obvious to other people.
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Grief
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The emotional response to a loss, manifested in ways unique to an individual, based on personal experiences, cultural expectations and spiritual beliefs
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Mourning
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the outward, social expressions of grief and the behaviors associated with loss
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Bereavement
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encompasses grief and mourning and outward behaviors of a person experiencing loss
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Normal grief
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is the most common reaction to death; a complex response with emotional, cognitive, social, physical, behavioral and spiritual concepts
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Complicated (dysfunctional) grief
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the grieving person has a prolonged or significantly difficult time moving forward after a loss -- last at least 6mos after a loss and interrupt every dimension of the person's life
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Anticipatory grief
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the unconscious process of disengaging or "letting go" before the actual loss or death occurs, especially in prolonged or predicted loss
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Disenfranchised grief
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(aka marginal or unsupported grief) when the relationship to the deceased person is not socially sanctioned, cannot be openly acknowledged or publicly shared, or seems of lesser significance
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Bowlby's Attachment Theory
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Numbing
Yearning and Searching Disorganization and Despair Reorganization |
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Worden's Grief Tasks Model
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Accepting the reality of loss
Working through the pain of grief Adjusting to environment w/o the deceased Emotionally relocating the deceased and moving on with life |
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The R Process Model (Rando)
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Recognize and accept the reality of the loss
React to, experience and express the pain of separation Reminisce Relinquish old attachments Readjust and Reinvent |
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What are the eight factors that influence loss and grief?
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Human Development, Personal Relationships, Nature of the loss, Coping Strategies, Socioeconomic Status, Culture and Ethnicity, Spiritual/Religious Beliefs, Hope
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What are the primary obligations of the collaborative team offering palliative care?
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Affirm life and regard dying as normal
Neither hasten nor postpone death Provide relief from pain Integrate psychological/spiritual aspects of care Offer a support system to client/family Enhance the quality of life |
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Assessment activities for a diagnosis of hopelessness in relation to terminal illness
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Ask pt. to discuss future goals and plans
Observe nonverbal behavior and responses to care options Assess activity level Observe pt. interaction w/family and friends |
