Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
Is slow code a standard of care?
|
no, it's illegal and unethical
|
|
|
When should you have a discussion on end of life care?
|
BEFORE end of life
|
|
|
Ethical and Moral issues in practice
|
witholding treatment
intensity of care life support allocation of sources patient rights right to choose alternative and complementary medicine and therapies dying at home limiting treatment for dementia withholding nutrition/fluids or forcing them euthanasia gene therapy |
|
|
What states have Right to Die
|
Washington and Oregon
|
|
|
Impediments to care
|
misconceptions, unfamiliarity with practical aspects, no evidence, reimbursement of ineffective tx, insufficient use of healthcare regimen
|
|
|
Nurses role in ethics and end of life
|
take the lead in initiating an open discussion about life sustaining or ending treatments
education: self, patients, families, other HCPs |
|
|
Who can write orders?
|
physicians or advanced practice clinicians
|
|
|
Whose responsibility is it to make sure patients wishes are followed?
|
health care team
|
|
|
Life sustaining treatment?
|
resuscitation
artificial nutrition and hydration surgery dialysis blood transfusions, blood products diagnostic tests elective intubation antibiotics other treatments future hospital or ICU admissions |
|
|
Who is less likely to agree to a DNR, withhold or withdraw care and less likely to have advanced directives
|
nonwhites
|
|
|
Asian culture
|
obligation of children to care for their aging parents in gratitude for the parent's caring and sacrifice
|
|
|
Many view Hospice as...
|
giving up on God
|
|
|
What can influence end of life decisions?
|
religion
|
|
|
Common feature and independent poor prognostic sign in persons living with cancer?
|
weight loss
|
|
|
Does nutrients (enterally or parenterally) improve quality of life or survival in persons with weight loss and cancer
|
it has always proved ineffective so far
|
|
|
Indiana Law on withholding or withdrawing life sustaining treatments
|
protects those who do not want to be kept alive by invasive means (Quinlan case 1976) established that artificial nutrition could be withdrawn even from a patient in a persistent vegetative state (also Cruzan case 1990 and Schiavo 2005)
|
|
|
It is legal and ethical to withhold or withdraw nutrition and hydration for the person...
|
who lacks decision making capacity (may differ for hospital)
|
|
|
Aritifical nutrition
|
ordinary care: to provide nutrition to persons who want to eat
bring food to the mouth if person can't or provide by another route |
|
|
Is there evidence that artificial nutrtiion alone improves functional ability or energy, relieves fatigue, or improves survival or symptom control if cancer is responsible for anorexia and weight loss?
|
No, there is no evidence
|
|
|
Effects of Enteral Nutrition on Survival
|
no reduction in aspiration, no reduction in risk for pneumonia, no evidence of better symptom control
Evidence shows no benefit inpersons with cancer but actually may cause faster death |
|
|
Hypodermoclysis
|
underutilized and decreases risk for IV access
type of artificial hydration that uses 2 large needles subQ to help absorb nutrition |
|
|
Pathophysiology of dehydration
|
know
|
|
|
Do IV fluids relieve thirst in the person with advanced cancer
|
no, there is no supporting evidence
|
|
|
Relieve thirst
|
stop meds with anticholinergic side effects, good lip and mouth care
|
|
|
SPIKES
|
Setting: know policies and statues
Perception: ask the patient and family what they understand Invitation: discuss general goals of care Knowledge: discuss treatment preferences/ educate Emotions: respond to emotions Subsequent planning: establish plan and implement: revise as needed |
|
|
Family misconceptions about end of life
|
"I don't want him/her to starve to death"
"Dehydration is a miserable way to die" "We can't let her/him die" |
|
|
Help the family with end of life and no nutrition
|
activities that do not center on eating
read or watch a movie together look at photo albums participate in mouth care massage extremities if not painful reminisce and tell stories |
|
|
Normal dying process
|
loss of appetite
decreased oral fluid intake decreased urine output artificial food/fluids may make the situation worse by: (significant hypalbuminemia), breathlessness, edema, ascites, N/V |
