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49 Cards in this Set
- Front
- Back
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What is palliative care?
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care that provides comfort, rather than cure
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What do nurses need to do in order to improve communication and maximize end of life care?
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explore their own values, attitudes and beliefs about issues surrounding death
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When is hospice usually chosen?
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if you have about 6 months or less left to live
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What does hospice cover?
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meds, home medical equipment, comfort kit, spiritual, education
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WHO definition of palliative care
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an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems
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What is the focus of geri palliative care?
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quality of life, support for functional independence, and centrality of the patient's values and experiences in determining the goals of medical care
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What is the goal of geriatric palliative care?
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relieve pain and suffering and improve quality of life for elderly patients and their families
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Theory of beneficence
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"doing good theory"
health care providers do good for the patients under their care Good care requires understanding the patient from a holistic perspective, including their beliefs, feelings and wishes as well as those of the patients family and significant others |
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What is a goal of end of life care
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making the time spend at the end of life precious, not merely tolerable
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What is the 4th leading cause of death in OA's?
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dementia
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What do 80% of Medicare patients in hospice have?
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cancer
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How many people with Alzheimers are in hospice?
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less than 3%
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Who are oofter under treated or untreated for pain and symptoms?
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over age 65
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Who have fewer interventions for pain, nausea, anxiety and other symptoms?
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over age 80
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What are some core end stage indicators that indicate a person is in the terminal phase?
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physical decline
weight loss multiple co morbidities Serum albumin less than 2.5 dependence on assistance for most ADLs Karnofsky performance score less than 50% |
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Karnofsky scores 60-100%
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normal health 100%
minor symptoms 90% normal activity with some effort 80% unable to carry on normal activity but able to care for oneself 70% requires occassional help with personal needs 60% |
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Karnofsky scores 0-50%
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disabled 50%
requires considerable assistance adn medical care 40% Severely disabled, in hospital 30% Very sick, active support needed 20% Moribund 10% Death 0 |
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Symptoms of the final stage of the dying process
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pain, weakness, fatigue, immobility, lack of interest in eating or drinking, drowsiness, dyspnea, and delirium
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Who is in need of care during the dying process?
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the patient that is dyring, as well as the family
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The number of EOL symptoms increase with?
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age
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What are symptoms most commonly seen in older adults at the end of their lives?
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mental confusion, incontinence, difficulty hearing and seeing, and dizziness
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What may diminish in the terminally ill adult due to weakness, falls, delirium, dementia, urinary incontinence, sleep disturbance, or serious depression?
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independence and quality of life
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What is a barrier to providing excellent end of life care?
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the inability to determine prognosis (or the course the disease will take and when death will occur)
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What helps the patient, family and health care providers prepare for the final stage of life?
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identifying transition point in the patient's condition
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What enables nurses to plan strategies with the patient and family to help them consider their needs for care and services?
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prognostication
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Why is prognostication important?
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to help the healthcare provider acknowledge that the patient is entering the perideath period
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We cannot provide excellent EOL care if we don't...?
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recognize and acknowledge that the patient is dying
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What are categories on the Flacker and Kiely end of life assessment tool?
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weight loss, shortness of breath, swallowing problems, sex, body mass index, congestive heart failure, and age
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What are categories of scores on the mortaility risk index?
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ADLs, eating less than 25% of food at most meals, bowel incontinence, being bedfast, being over age 83, and not being awake most of the day
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What are some factors associated with poor survival in older adults with advanced dementia?
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older age, male sex, greater functional impairment, diabetes mellitus, poor nutritional status, and cardiovascular disease
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What was the Karnofsky Performance status designed to do
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rate a patient's function status according to descriptors with associated percentage scores
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How many descriptors are there on the Karnofsky Performance Status instrument
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11
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What does a clinician do with the Karnofsky Performance Status instrument
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choose the descriptor that best describes the patient's functional status
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Where can the Karnofsky Performance Status instrument be used?
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any care setting in order to follow the course of the illness in terms of progressive deficits and also as a prognostication tool
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On the Karnofsky Performance Status instrument, the lower the score....?
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the shorter the period that the patient would be expected to survive and the lower the quality of life available to the patient for the rest of the illness
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What are core end-stage indicators on teh Karnofsky Performance Status instrument?
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physical decline, weight loss, multiple comorbidities, serum albumin level less than 2.5, dependence on assistance to complete most activities of daily living, and a Karnofsky score of less than 50%
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What is the cornerstone for planning care in the chronically ill patients?
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ongoing nursing assessment
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According to the dehydration article, what are benefits of allowing dehydration near the end of life?
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drowsiness and reduced LOC reduce anxiety of dying and avoid psychological suffering, allows a peacful death, decreased urinary incontinence, decreased N/V, decreased edema to improve respiration, and decreased pulmonary secretions therefore reducing suctioning
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What are some symptoms of dehydration
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thirst, change mental status, increased lethargy, decreased skin turgor, dry mucous membranes, decreased urine output
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What can you do for the discomfort of dry mouth?
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good mouth care, artificial saliva, ice chips
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What can drowiness from dehydration do?
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reduce LOC and therefore reduce anxiety and lead to less fear of dying
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What are the downsides to artifical hydration?
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discomfort of tubing or IV, site of infection with IV, risk for removal if confused
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What is a futile treatment?
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treatment or intervention of any kind that does not benefit the patient as a whole
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What should you do if the patient feels strongly about being kept hydrated until the end?
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his or her wishes should be respected, but less uncomfortable and dangerous methods should be considered and the patients wishes should carry the most weight
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Artificial hydration should not be done for this reason alone...
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To prevent pressure ulcers: it does not affect them significantly
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What are the 4 C's in considering treatment during dehydration near the end of life?
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common sense, communication, collaboration, and caring
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What comes in a comfort pac?
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ABHR suppositories for N/V (Ativan, Benedryl, haldol, Reglan), acetaminophen suppository for pain and fever, Haloperidol liquid for resless/agitation, Lorazepam for anxiety, Morphine concentrate liquid for pain and/or air hunger, Prochlorperazine capsule and suppository for N/V
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Some symptoms that trigger hospice evaluation
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change in continence, increased anxiety from illness, lack of appetite, weight loss, cessation of dialysis, ortho hypo, increased hospital visits, decline major function, change mental status, recurrent infection, multiple ulcers, increased edema, chest congestion, new onset ascites, decline ADLs, orthopnea, coma, decreased LOC, frequent falls/injuries
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Covered by hospice
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medications for diagnosis or symptoms, treatments for diagnosis, wound care, supplies for personal care, medical equipment like bed, commode, walker, nebulizer
*anything to provide comfort based on clinical diagnosis |
