EVOLVE Chapter 09 Palliative Care at End of Life

A patient with terminal cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the most appropriate response by the nurse? "What are your feelings about being so sick and thinking you may die soon?" "None of us know when we are going to die. Is this a particularly difficult day?" "Would you like for me to call your spiritual advisor so you can talk about your feelings?" "Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you."

"What are your feelings about being so sick and thinking you may die soon?" The most appropriate response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns. This option does both and is a helpful response that encourages further communication between the patient and nurse.

Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply.)? Select all that apply. Strong spiritual beliefs Advanced age of the patient Medical diagnosis of the patient Acceptance of the expected death of the patient Adequate time for the caregiver to prepare for the death

- Strong spiritual beliefs - Acceptance of the expected death of the patient - Adequate time for the caregiver to prepare for the death Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief. The age and diagnosis of the patient are not key factors in influencing the quality of the anticipatory grief of the caregiver.

The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. How would the nurse interpret the general prognosis of the patient? 3 months or less to live 6 months or less to live 12 months or less to live 18 months or less to live

6 months or less to live. There are two criteria to be eligible for hospice care. The first is that the patient wishes to receive hospice, not curative care, and the second is that the physician certifies that the patient has a prognosis of 6 months or less to live.

When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue? Euthanasia Organ donor card Advance directives Do not resuscitate (DNR)

Advance directives Advance directives are written documents that provide information about the patient's wishes for medical care and treatments and his or her designated spokesperson. Euthanasia is not a form; it is a deliberate act of hastening death. Organ donor cards only state that the patient wants to donate organs or their body for transplants or for scientific research. DNR or comfort measures is a written order from the physician that documents a patient's wishes to avoid CPR.

A dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs? Encourage more physical activity. Assess for pain, constipation, and urinary retention. Assess for spiritual distress and restrain in varying positions. Assess for quality, intensity, location, and contributing factors of discomfort.

Assess for pain, constipation, and urinary retention. Assessing for all reversible causes of delirium (i.e., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness. Encouraging more physical activity may prevent further skin breakdown, but it will be difficult because weakness and fatigue are expected at the end of life. Keeping the skin clean and dry and preventing shearing forces will better avoid further skin breakdown. Spiritual distress may be a cause of restlessness, but the patient should not be restrained.

How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient's life? Assess the individual patient's wishes. Call a pastor or priest for the family to help them cope. Assess the beliefs and preferences of the patient and family. Do not insult African Americans by suggesting hospice care.

Assess the beliefs and preferences of the patient and family. Differences among spiritual and culture beliefs and values related to death and dying are innumerable. The individual patient and family must be assessed to avoid stereotyping individuals with different spiritual and cultural belief systems.

After a patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient? Maintain daily contact with the adolescent's family for the next 2 to 3 months. Request a prescription for an anxiolytic to aid in dealing with the death of this patient. Attend a debriefing session with interprofessional team to allow expression of feelings. Avoid caring for any other patients who are terminally ill until the feelings of grief subside.

Attend a debriefing session with interprofessional team to allow expression of feelings. The nurse needs to express feelings of loss and grief. Interventions such as a peer support, professionally assisted groups, and informal discussion sessions are appropriate ways for the nurse to express feelings related to death and dying.

A patient has been receiving palliative care for the past several weeks in light of a worsening condition after a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." What should the nurse document that the patient is experiencing? Apnea Bradypnea Death rattle Cheyne-Stokes respirations

Cheyne-Stokes respirations. Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing. This type of breathing is usually seen as a person nears death.

During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness? Frustration with pain Anorexia and nausea Feelings of hopelessness Inability to carry out activities of daily living

Feelings of hopelessness. Feelings of hopelessness are likely to be present in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. The nurse should routinely assess for depression when working with patients with a terminal illness.

A patient died after a myocardial infarction experienced while performing yard work. What would indicate that his spouse is experiencing prolonged grief disorder? Initially, the spouse denied the death. Talking about the spouse extensively in year after the death Stating that the spouse will return on the anniversary of the death Crying uncontrollably and unpredictably in the weeks after the spouse's death

Stating that the spouse will return on the anniversary of the death. Denial of an individual's death that persists beyond 6 months is indicative of prolonged grief disorder. Strong emotions or denial immediately after the death are considered to be expected responses. Talking about the deceased loved one is not considered to be evidence of the disorder.

A patient near death from metastatic cancer becomes restless and confused. What interventions would be the most appropriate for the nursing management of these symptoms? Avoid administering pain medication until the patient is calm and alert. Stay physically close to the patient and use a soothing voice and soft touch. Turn on the television to provide a distraction and contact the hospital chaplain. Restrain the patient to prevent injury and ask family and visitors to leave the room.

Stay physically close to the patient and use a soothing voice and soft touch. Appropriate interventions for restlessness and confusion when a patient is near death include using soft touch and voice, staying physically close to the patient, and remaining calm. Use soothing music instead of the radio or television. Make referrals (e.g., hospital chaplain, spiritual leader) based on patient's spiritual and cultural preferences. Family visitors may provide comfort. Uncontrolled pain may be the cause of restlessness and confusion. Withholding pain medication or restraining the patient would be inappropriate and may cause more restlessness.

The nurse is evaluating whether a hospice referral is appropriate for a patient with end-stage liver failure. What is one of the two criteria necessary for admission to a hospice program? The hospice medical director certifies admission to the program. The physician guarantees the patient has less than 6 months to live. The patient has completed both advance directives and a living will. The patient wants hospice care and agrees to terminate curative care.

The patient wants hospice care and agrees to terminate curative care. There are two criteria for admission to a hospice program. The first criterion is the patient must desire the services and agree in writing that only hospice care (and not curative care) can be used to treat the terminal illness. The second criterion is that the patient must be considered eligible for hospice. Two physicians must certify that the patient's prognosis is terminal with less than 6 months to live.

When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death? The patient responds to noises. The patient's skin is mottled and waxlike. The heart rate and blood pressure increase. The patient is reviewing his life with his family.

The patient's skin is mottled and waxlike. When a patient is very near death, the skin will be waxlike, cold, clammy, and mottled or cyanotic. Although hearing is the last sense patients lose before death, it is unlikely that they will be responding to noises when very near death. Initially, the heart rate increases but later slows, and the blood pressure decreases. Near death, speaking may be slow and unusual and indicate confusion.

A patient admitted for pneumonia informs the nurse that no one is to attempt CPR. What is important for the nurse to verify in the medical record related to the patient's directive? The physician has written and signed the DNR order. The living will is signed by the patient and two witnesses. The patient's durable power of attorney agrees with the decision. There is an advance directive related to artificial nutrition and hydration.

The physician has written and signed the DNR order. CPR will be performed for respiratory or cardiac arrest unless a DNR (do not resuscitate) order is written and signed by the physician in the patient's medical record. The DNR order documents the patient's desire to avoid CPR.

The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family? The patient will be incontinent of urine after frequent seizures. The skin will feel cold and clammy, with mottling on the extremities. The patient will have increased pain, and the sense of touch will be enhanced. The gag reflex is exaggerated, and the patient will exhibit deep, rapid respirations.

The skin will feel cold and clammy, with mottling on the extremities. As death approaches, the following physical manifestations occur: cold, clammy skin; mottling on hands, feet, arms, and legs; jerking (not seizures), which occurs in patients on large amounts of opioids; bowel and bladder incontinence; decreased perception of pain and touch; loss of gag reflex; and Cheyne-Stokes respirations.