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32 Cards in this Set

  • Front
  • Back
improves the quality of care of pts and their families facing problems associated with life-threatening illness.
palliative care
what is the goal of palliative care
to prevent and relieve suffering
what is not the goal of palliative care
cure
considered aggressive care
disease focused care
what should be looked at with assessment for suffering/palliative care
pyshchosocial
spiritual
physical
emotional
what does effective care of the dying involve
adequate knowledge
attitude/behavior/philosophy
what is considered Pcare
*emotional/spiritual/psychosocial support
* control of pain/dyspnea/n/v
what can vary b/t palliative and non Pcarem (3)
transfusions
infections
tube feeding
generally not Pcare (3)
CPR
ventilation
highly burdensome interv.
what is normal for the pt and families to do when talking about Pcare
silence
fear
isolation
what is proactive communication (3)
*being available
*anticipating questions/concerns
aggressive pursuit of comfort
what are the predictable challenges in the final days of care (9)
*functional decline in toileting
*decline in transfers
*loss of appetite
*can't swallow meds
*increasing discomfort
*sleeping more
*confusion
*terminal pneumonia (dyspnea, congestion,agitation)
some concerns of the family (5)
* how could this happen
*missed the chance to say goodbye
* too drowsy
* what will it be like
*things were fine until that med was given
order of decline (4)
* steady decline
* acc deterioration/ meds changed
* rapid decline d/t illness
*meds questioned of blamed
what is the perception of sudden change
reserves ar depleted and changes seem sudden
tx for pain
opiod
tx for dyspnea
opiod
tx for secretions
drying agents/suctio
tx for restlessness
benzos
what is a common concern with the use of opiods in the final days
family worried about it speeding up or causing the death
what is seen with excessive opiod dosing (3)
pinpoint pupils
gradual slowing of RR
breathing is deep (shallow and reg)
agonal breathing
breath then no breath for several seconds
what is cheyne stokes
breathing rapid stopping and then starting over
what are the settings for nsg care at the time of death
home
hospice
hospital
what are some common misconceptions (3)
*since there is a heart beat he is still alive
*hes in a coma and will wake up
* with rehab/time hell get better
used to determin brain death (3)
* absence of brainstem reflexes (corneal cold/calorics)
* absence of gag/cough reflex
* apnea
unresponsiveness/coma
what is done with the apnea test to determine brain death
hyperoxygenate and then remove from vent to see if and activity
time of death = what
neurologic determination not when removed from vent or absent heartbeat
care for the dying (5)
*prepare family for decision making
* allow them access to pt
* removing support
* support them as vent is removed
* turn off monitors in room
AND
a natural death
what are some legal issues with death (5)
DNR
AND
living will
DPOA
assisted suicide
what to do with aftercare (2)
resources for family
referral groups