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19 Cards in this Set
- Front
- Back
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Hospice
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-philosophy of care for the incurably ill
-medicare-certified health care agency that administers hospice palliative care via a multidisciplinary team under the direction of the pts attending physician and the hospice's medical director |
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Curative/disease focus
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-diagnosis of disease and related symptoms
-curing the disease -treatment of disease -alleviation of sx |
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palliative focus
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-pt/family identify unique end-of-life goals
-assess how sx, issues are helping/hindering reaching goals -interventions to assist in reaching end-of-life goals -quality of life closure |
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The six month rule
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-probable life expectancy if illness runs its expected normal course
-pts MD and hospice medical director can dialogue -clinical evidence needed to back up prognosis -not meant to be precisely 6mo -the MD will not be legally accountable -pt may stay on program longer than 6 months |
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types of diagnoses treated in hospice
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-cancer
-non-cancer: end-stage cardiac. acute and chronic stroke, end-stage liver, HIV, advanced COPD etc. |
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process
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1. Dr gets certified
2. assessment nurse collects clinical data 3. reviewed at daily HCN admissions discussion 4. admission accepted or alternate plan presented 5. consents and advance directives 6. initial orders by PMD 7. equipment and medication delivered 8. hospice team formulates pt driven plan of care |
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medicare hospice benefit
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-pt elects hospice benefit- acknowledges terminality and foregoes curative txs
-dr confirms dx and prognosis of less than 6 months if the disease runs its normal course - |
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who pays what
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-hospice care pt: all hospice services - inpt, outpt - Part A; all PMD services -part B; all consultant services - hospice
-most 3rd party payers follow medicare |
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goals of care: physical well being
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1. pain
2. multiple other sx 3. assist with managing physical care in the chosen setting 4. impact on family caregivers |
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goals of care: psychological well being
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1. wide range of emotions and concerns
2. meaning of illness 3. depression 4. coping 5. cognitive assessment |
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goals of care: social well being
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1. relationship/role description
2. caregiver burden 3. impact on children 4. financial concerns 5. sexuality concerns |
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goals of care: spiritual well being
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1. religion and spirituality
2. seeking meaning 3. hope vs. despair 4. importance of ritual |
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Symptom management
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psychosocial and spiritual intervention is key to complement pharmacologic strategies
-common sx: pain, dyspnea, cough, anorexia, constipation, D/N/V, fatigue, weakness, depression, anxiety |
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pain
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Assessment:
-location -intensity -quality -pain at its best, worst -acceptable level -patterns -med hx -origin of pain -pain can be stopped adequately in 90% of all pts (IM hardly ever used) |
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Morphine
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-Gold standard in pain mgmt
-if opiod naive: give 0.1 mg/kg as a safe starting dose in a good risk pt |
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Nutritional goals in hospice
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-pt will safely tolerate diet prescribed without adverse effects
-pt will have adequate pain control so that desired eating will not be impacted -pt will derive QOL from food -pt will experience a peaceful death (dec interest in food is nml at end of life) |
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Artificial nutrition
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-does the pt want it?
-would the pt have wanted it? -does the pt have a health care proxy or advanced directives? (AMA states that there is not ethical difference between withholding or withdrawing artificial nutrition) |
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end of life- fluids
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-IV fluids need to be low volume drip toavoid anasarca
-EOL gurgling can be dec with decreased fluids and anticholinergics |
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Bereavement
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-counselor assigned to each team and attend weekly meetings
-when a pt dies the social worker completes a risk assessment -each fam is contacted and followed for 13mo -children's program -services offered to community |
