Hospice Care chapter 40

Primary nurse

Serves as a liaison 2 patient, caregiver healthcare provider, and to interdisciplinary team 2. Evaluates patient response to treatment 3. Educates a patient and family in disease processes and care. 4. Assess symptom management 5. Provides emotional support to patient and caregiver.

Titrated

Slowly increase to the level at which the drug is therapeutic

Oral hygiene and anorexia

Stomatitis and infection good oral hygiene is important. If sores appear the patient will have a hard time eating.

How does the interdisciplinary team provides support to the patient and the

Take into consideration. All aspects of the family unit. they include the family and all decisions in care planning because family also experiences the stress of terminal illness and death to the patient.

Anxiolytics

.... are for anxiety and reduced anxiety helps to decrease the subjective experience of pain

Antiemetics

...are for nausea and vomiting

Anticonvulsants

...are prescribed for neuropathic pain.

Opioid constipation

1 opiate Administration can be followed by administration of stool softener and stimulants. Some opioids are more likely to cause constipation and others 2. Changing the administration rate can prevent constipation 3.Enemas 4. Stool softeners

After a patient vomits what step should be done?

1. Avoid eating for a while 2. Give the patient liquids 3. Graduate too small Bland non smelly Foods

How to assess a patient for anorexia

1. Complete nutritional assessment routinely and apply to finding to the hospice plan of care 2. Assess and treat causes of manifestations such as nausea vomiting and constipation 3.

What are the goals for hospice?

1. Controlling or alleviating the patient's symptoms 2. allowing the patient and caregiver to be involved in decisions regarding the plan of care 3. encouraging the patient and caregiver to live life to the fullest 4. providing continuous support to maintain patient and family confidence 5. educating and supporting the primary caregiver in the home setting that the patient chooses.

Indications of unmet spiritual needs

1. Depression 2. Need to suffer 3. Bitterness 4. Anger 5. Hallucinations 6. Dreams of Fire

Nursing intervention for Disney and air hunger

1. Educate on positioning 2. use of fan to circulate air 3. use of morphine to decrease the work of respiration 4. use anxiolytic to ease anxiety 5. maintain good oral hygiene 6. Kmlsuction should be performed

Pain assessment questionnaire

1. Have you had pain and other than everyday kinds of pain today? 2. Where is the pain? (The use of body charts often helps the patient identify the location) 3. Using the scale of 0 to 10 with zero being no pain and 10 being the worst pain imaginable right the pain at its worst in the past 24 hours. 4. Using the same scale of 0 to 10 rate the pain at its lowest point in the past 24 hours. 5. Using the same scale of 0 to 10 rate the pain on the average. 6. Describe your pain. (The words of the patient uses to describe the pain help you understand the type of pain for treatment purposes.) 7. What treatment or medications are you using to control the pain? 8. Using the scale of 0 to 10 zero being no relief and ten being complete releaf write the amount of relief received from the treatment. 9. What causes or increases the pain? 10. Does the pain interfere with any of the following? General activity. Mood. Walking ability. Normal work. Relationships with others. Sleep. Appetite. Enjoying life.

What are some myths about hospice?

1. Hospice means giving up hope 2. Hospice means I must sign a DNR order 3. Hospice is only for cancer patients. 4. Hospice is only for patients actively dying or close to death

Iorazepam (Ativan)

1. Indication anxiety 2. side effects drowsiness dizziness orthostatic hypertension tachycardia 3. nursing interventions administer routinely. Instruct patient in safety issues regarding Rising slowly and not driving

Interdisciplinary team

A multi Professional Health team whose members work together and caring for a terminally ill patient

Primary caregiver

A person who assumes ongoing responsibility for health maintenance in therapy for illness.

What type of atmosphere should be provided to avoid nausea and vomiting?

A pleasant atmosphere with relaxation

Medical director

Acts as a consultant for healthcare provider They are mediator between into disciplinary team and health care provider

What should happen before treating constipation?

Assessing the abdomen for firmness discomfort bowel sounds

Why is there not a consistent amount of pain med given?

The dosage is tirated (balanced out) to manage pain while the patient is alert to interact with family.

Death rattle

Which is the result of an accumulation of mucus and fluids in the posterior area of the pharynx

Pain control.

1. It is never right for the patient to suffer in pain. 2. Ask the question are you experiencing any pain? If the answer is yes ask the patient to describe the pain using the pain assessment questionnaire. 3. Pain is treated with medication such as morphine singular or in combination with other medications to provide maximal relief at the same time avoiding maximal side effects. 4. Proper pain relief is provided on a regular around-the-clock basis. 5. Non-pharmacological interventions should be included in the plan of care. 6. I need for palliative care worldwide is enormous and will continue to increase. Symptom management and adequate pain control must be the prime objective for the hospice nurse. At the same time the nurse must always strive to maintain the patient's dignity and capacity to contribute to society as a full human being.

What are some long-acting medications?

1. Morphine sulfate MS Contin 2. Oxycodone (Oxycontin) 3. Fentanyl (duragesic)

What treats somatic pain?

1. Non steroidal anti-inflammatory drugs. 2. Non opioid drugs. 3. Opioid drugs

Teaching the patient about constipation

1. a decrease in oral intake will also decrease the amount of stool expelled 2. Bowel movement can still occur without eating 3. Should take laxatives because opioids cause constipation 4.

Edmonton Symptom Assessment System

1. pain 2. tiredness 3. drowsiness 4. nausea 5. appitite 6. SOB 7. anxiety and neurvousness 8. Overall feeling of well being

What is the criteria for being admitted into a hospice?

1.The patient's illness must be terminal and they have to have 6 months to live 2. This must be verified by two health care providers if they want to be qualify for Medicare Medicaid even if they live beyond the time. 3. The patient must desire the services. 4. The caregiver and patient must accept palliative care and not Curative Care. 5. And caregiver must be willing to understand the prognosis and be willing to participate in the planning of care

Who is usually the primary caregiver and hospice situations?

A member of the immediate family such a spouse or adult child.

What is prescribed for neuropathic pain?

Anti convolute as an edge of Dove to assist with pain control

Drugs that prevent excess secretion

Anticholinergics drugs such as transdermal scopolamine atropine.

Prochlorperazine

Antiemetic

Promethazine

Antiemetic

When a patient has dysphasia what are some things that are discouraged from applying to their care?

Artificial hydration Total parenteral Nutrition and Tube feedings That goes under the category of Curative Care. For hospice this is palliative care.

Lorazepam

Benzodiazepine for antianxiety

What are the most common cases in hospice that you'll see?

Cancer 27.2% dementia 18% cardiac and lung diseases 18.7%

Air hunger

Caused by tumor pressure fluid and electrolyte imbalance or anemia anxiety resulting from Fear panic

Hospice aide

Certified nurse assistance. Follows the plan of care that the interdisciplinary team develops and assists the patient with bathing and personal care, also assist the patient or the caregiver with light homemaker services.

Neuropathic pain

Characteristics are tingling burning or shooting pains often have neuropathic causes pain from damage to neurons of either the peripheral or central nervous system

How to handle nausea and vomiting.

Close lab monitoring of lab since your electrolyte balance are correct rehydration administration of anti emetic medications

Anticonvulsants Side Effects

Dizziness. Drowsiness. Fatigue. Nausea. Tremor. Rash. Weight gain.

Anxiolytics

Drugs that alleviate the symptoms of anxiety. Benzodiazepines

Anticholinergics

Dry mouth. Blurred vision. Dry eyes. Constipation. Urinary retention. Dizziness due to drop in blood pressure on standing up (postural hypotension) Cognitive problems (confusion) Heart rhythm disturbance.

Social worker

Evaluates and assesses the psychosocial needs of the patient 1. Assist with assessing Community Resources and filing insurance papers 2. supports the patient and caregiver with emotional grief issues and 3. assists in counseling

If a patient does not want to take morphine, what is a nursing intervention?

Have them take non pharmacological drugs, or something in the relm that would help that is already prescribed.

What kind of drugs treat visceral pain?

Health Care Providers typically prescribed a anticholinergic medication by itself or adjunct an additional drugs or treatment that is added to assist in the action of the primary pain treatment

Where can Hospice Care be delivered?

In long-term care settings. Hospice Care can be delivered intermittently or continuously Occasionally go into hospitals and receive hospice service for control of acute pain or for 5 days respite care for family

Sienna Senokot

Indication constipation side effects nausea vomiting diarrhea abdominal cramping nurses intervention encouraged patient to drink fluids. Assess gastrointestinal status and administer the laxatives routinely if patient is taking pain medication

Dropridol inapsine

Indication emesis side effects hypotension tachycardia drowsiness dizziness nursing intervention: ensure the caregiver it is ministering the antimetic appropriately and routinely

Morphine Sulfate (extended release)

Indications acute and severe pain Side effects constipation nausea vomiting sedation Nursing intervention assess pain control by using pain assessment. Instruct about Administration routinely

Prochlorperazine

Indications emesis side effects extrapyramidal symptoms dry mouth depression nursing intervention access control of nausea and ensure the caregiver is administered the antiseptic appropriately and routinely

Morphine sulfate controlled-release MS contin

Indications moderate and severe pain Side effects constipation nausea and vomiting and sedation Nurses intervention assess pain control and medication effectiveness

Fentanyl transdermal system duragesic patch an opioid

Indications moderate and severe pain side effects confusion hyperventilation nausea vomiting constipation nurses intervention instruct caregiver to clean patient skin with water only and dry before application

Acute phases of nausea and vomiting

Intravenous administration is needed then oral medications can be used

What is Curative Care?

Is aggressive care in which the goal and intent are curing the disease and prolonging life at all cost.

What is the top drug of choice in hospice care?

Morphine. Because they can be delivered by all routes and the dosage can be titrated to control the pain.

What is palliative care?

It's meant to provide a patient to be pain-free and in a state of comfort rather than focusing on the cheering what is causing the pain.

Physician orders of life-sustaining treatment (POLST)

It's used as a advance directive or in place of an advance directive. Is a form completed by a medical provider and the patient inform Healthcare Providers of the patient's wishes.

Cachexia

Malnutrition marked by weakness and emaciation.

Nurse coordinator

Manages the patient's care explains the services admits the patient assigns the primary team ( hospice Health Care Providers pharmacist dietitian physical therapist social workers clergy certified nursing assistant and hospice volunteers) 1.

What is the core of the interdisciplinary team?

Medical director the nurse coordinator the social worker spiritual coordinator

Volunteer coordinator

Must have experience in volunteer work they provide companionship caregiver relief to respite care an emotional support Shopping yard work reading to Patient or keeping patient company while the caregiver leaves the home for short periods

What is best for mild to moderate pain?

Non steroidal anti-inflammatory drugs how's the pain increases and severity with progression of the patient's condition the healthcare provider often switches

Relieving respiratory distress

Oxygen, morphine, Bronchodilators

Somatic pain

Pain that originates from skeletal muscles, ligaments, or joints. Describe this aching stabbing or throbbing.

Holistic

Pertaining to the total patient care in which the physical emotional social economic and spiritual needs of the patient are considered.

Bereavement coordinator

Professional with grief experience. Assesses and supports the bereaved survivor, facilitates support groups and assigns bereavement volunteers to visit the caregiver, they follows the plan of care for the bereaved caregiver for at least a year following the death. the goals of bereavement counseling for loved ones during the patient's illness and following the death are to (1) provide support and (2) assist survivors in the transition to a life without the deceased person.

When is a nurse primarily designated to a patient?

The patient resides in a free-standing Hospital residents a long-term care facility or a residential home

What is the philosophy of hospice care?

The philosophy of hospice is to provide care and support to patients with a terminal illness and their families.

Relieving dry mouth

Water soaked swabs 2. crushed ice 3. artificial saliva small frequent drinks 4.

Antiemetics side effects

bismuth-subsalicylate: dark-colored tongue, grayish-black stools. antihistamines: drowsiness, dry mouth. dopamine antagonists: dry mouth, fatigue, constipation, tinnitus, muscle spasms, restlessness. neurokinin receptor agonists: decreased urination, dry mouth, heartburn

Anticholinergics

can treat a variety of conditions, including: urinary incontinence. Peripheral side effects are more physical than central side effects and therefore might be easier to diagnose.

Antimetics

control nausea and vomiting by blocking nerve impulses to the vomiting center of the brain Used for chemotherapy patients

Anticholinergics

help to manage excessive secretion.

stomatitis

inflammation of the mucosa of the mouth

Antihypertensives

lower blood pressure

Chemotherapy can result from...

obstruction tumor uncontrolled pain constipation and even food smells

Droperidol

often used as a sedative in intensive-care treatment.

Visceral pain

pain originating in the internal organs in the thorax, cranium, or abdomen Described as cramping pressure dull pain or squeezing pain

Anticoagulants

prevent blood clot formation

Anticonvulsants

prevent or control seizures. Anticonvulsants are also being used in the treatment of neuropathic pain and as mood stabilizers in the treatment of psychiatric disorders such as bipolar disorder.

Senna

stimulant laxative. it increases gastric motility.

Anticoagulant

used to prevent undesirable clotting. Blood thinners. Vitiamin K can not be used: kale , spinache