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