End of Life

For restlessness

Benzos

A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?

Over the course of several visits.

Exceptions to parental consent

Mature Minor Emancipated minor Assent Dissent Refusal of medical treatment

What should you never do in the event that a patient is dying?

NEVER distract! "Playing video games" "Watching TV" NO!! Deal with everything as it comes directly.

Which of the following nursing interventions will encourage the dying client to continue verbalizing?

Nod and use responsive comments such as "Yes."

During a home care visit to a client in hospice, the client's spouse reveals to the nurse an understanding that the client's death is inevitable. Recognizing the spouse is exemplifying the Kübler-Ross stage of acceptance, which statement by the nurse is most appropriate?

"Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse."

A 3-month old infant is showing signs of approaching death, what is a good question that would determine if the parents should be in the room or not?

"Would you like to be in the room with the infant at the time of death?"

Anorexia/Cachexia

- Results in severe asthenia. - Lack of interest in mealtime.

5 Stages of grief

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Dyspnea interventions

1. •Blood transfusion for anemia or erythropoietin (increased blood = more HGB circulating 2. Low dose morphine 3. Corticosteroids 4. Benzos 5. Low O2 6. Diuretics - Ensure proper bed mechanics

Uncomplicated grief

5 stages of grief, normal grief 1. Sadness 2. Anger 3. Guilt 4. Numbness 5. Hollowness/tightness in chest

Complicated grief

Abnormal grief Prolonged sadness and depression

For fever

Acetaminophen suppository

Dry milk powder?

Add that mf to everythinggggg!

What major complication is associated with oral intake in the client with a decreased level of consciousness?

Aspiration.

A nurse is part of a team involved with informing a client and his wife about the spread of his cancer. When communicating with the client and wife, which of the following would be most appropriate?

Allow time for the client and wife to process this new information.

A nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client's complaint?

Ask the client to rate the distress on a scale of 0-10.

If multiple people are stating different wishes made by the patient, as the nurse your priority is to...

Assess the patients ability to provide their own wishes.

If a client at an end-stage of cancer is showing signs of clinical depression, the nurses first goal will be...

Assessing the clients pain.

After death care

Auscultate for absence of breathing and heart sounds​ Urine and stool may be evacuated​ Wash the body​ Remove soiled linens​ Remove tubes, IV's etc.​ Place in semi-fowler position​ Encourage visitation of family/friends - care of the family​ Privacy should be honored​ Bereavement Tray - some facilities

A terminally ill client asks the nurse, "Am I dying?" The family has asked the health care team not to disclose the client's terminal illness. What is the best action by the nurse with the client's question?

Communicate the client's wishes to the family. Consult with the health care provider Provide correct information to the client. NEVER lie.

Which of the following is the major long-term goal associated with end-of-life care?

Dying with dignity.

A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.

Financial pressures on health care providers Strong association of hospice care with prolonging death Advances in "curative" treatment in late-stage illness

If there are any questions including "greatest barrier to end of life care"

It will always be something along the lines of "Miscommunication within the healthcare team" or "Miscommunication with the family and patient"

POLST

Pt wishes converted to medical orders. 1. CPR 2. IV/fluids 3. Nutrition/tubes 4. Medical interventions

For pain and SOB

Small dose oral morphine

Anorexia/Cachexia syndrome

The individual loses appetite (anorexia) and muscle mass (cachexia) Treatment of disease •Dexamethasone (Decadron) •Megestrol (Megace) •Dronabinol (Marinol)

Advance directives contains...

They may contain a living will. They provide information about client wishes for health care situations.

Regarding diets...

Will never be stable. Do not worry about balance. If the pt wants to eat, let them eat and they can eat literally whatever they want. Try and include highest calorie, but don't stress it if they don't want it.

How do we decrease orolaryngeal relaxation aka the "death rattle"

• Atropine >> eyes/SL/PO/IV/IM/SC every 4 to 6 hours, this med dry's patients out • Glycopyrrolate (Robinal) >> PO every 8 hours • Scopolamine >> transdermal patch behind ears every 3 days, never let it touch eyes >> One pupil will dilate will resemble a stroke

FICA

• Faith & belief • Importance and Influence • Community • Address (how can we address)

For oral and respiratory secretions

•Atropine ophthalmic PO/SL every 4 to 6 hours •Atropine IV/IM/SC every 4 to 6 hours •Glycopyrrolate (Robinal) PO every 8 hours •Scopolamine, transdermal patch behind the ear every 3 days

Post-mortem

•Care of the patient - dignity •Label tags - toe, shroud and belongings -Place tag on toe -Place patient in shroud and zipper -Place tag on outside of shroud -Place tag on belongings •Contact transport to morgue •Complete death discharge summary - forms go with patient •Contact Lifelink within 1 hour of death

Palliative sedation

•Haloperidol, midazolam, phenobarb, ketamine, chlorpromazine

Approaching signs of death

•Refusal of food, fluids •Urinary output decreases, Incontinence •Weakness, sleep, detach from environment •Confusion, restlessness r/t hypoxia •Impaired vision, hearing •Secretions in throat, dry mouth •Irregular breathing pattern •Decreased temperature control

Nutrition

•Small portions of favorite foods •Cool foods may be better tolerated •Milk shakes, meal replacement drinks, liquid supplements •Place nutritious foods at bedside •Schedule meals with family members •Ice chips made of frozen fruit juices •Allow patient to refuse foods and fluids

Imminent signs of death

•Withdraw •Sleep for longer intervals, or become somnolent •Gradual diminishment of bodily functions •Increased intervals between respirations •Weakened and irregular pulse •Diminished blood pressure •Skin color changes or mottling