Week 16 - Palliative Care & End of Life

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?

"I will notify the physician that the current dose of medication is not relieving your pain."

The nurse is caring for a 90-year-old client who has never completed an advance directive. The client has a child but has not seen the child in several years. A neighbor has assisted the client with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged offspring wants the client to be treated aggressively. Which would be the nurse's initial step?

Assess the client's ability to state wishes

During unplanned, spontaneous moments, dying clients usually discuss fears or concerns that nurses should not ignore or rush. What is the nurse's best response in such situations?

Communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact

Which nursing intervention is appropriate with regard to pain control in the dying client?

Give pain medications on a routine schedule

A client is diagnosed with a terminal illness and has been given less than 6 months to live. What type of referral should the nurse make to assist this patient and family at home?

Hospice

A hospice nurse should be aware that the most effective pain medication used at the end of life that also relieves dyspnea and anxiety is which of the following?

Morphine

Advanced Directives decide:

how a client would like to be treated in case they are unable to decide/communicate those wishes

Describe Hospice Care

type of healthcare that focuses palliation of a terminally ill patient's pain/symptoms and attending to their emotional and spiritual needs at the end of life **for patients who have less than 6 months

Principle of Double Effect

using pain meds/other meds to provide comfort/relieve pain, but using this med also puts the patient at risk/might die

What statement made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

"Tell me who or what gives you strength."

Advanced Directive Includes:

- determining health proxies (POA) - goals of care (Advanced Directives) - code status (DNR or DNAR)

Describe Palliative Care

- interdisciplinary medical caregiving approach aimed at optimizing quality of life & mitigating suffering among people with serious, complex illness - interventions may be palliative OR curative

Indications for End of Life Sedation

- unbearable/unmanageable pain or manifestations - approaching last hours or days of life - palliative or pain services have verified that all other therapies have been exhausted

Palliative End of Life Sedation

- used ONLY when all interventions have failed - goal is to produce level of obtundation to relieve suffering WITHOUT hastening death

5 Recommendations to Improve Palliative Care by IOM

1. Delivery of person centered, family oriented end of life care 2. Clinician-patient communication and advanced care planning 3. Professional education and development 4. Policies and payment systems to support high quality end of life care 5. Public education and engagement