Med Surg- Ch. 13

Five stages of grief?

(1) denial, (2) anger, (3) bargaining, (4) depression, and (5) acceptance.

What are the current models of palliative and end of life care delivery?

1. Institution Based (programs within hospitals or long-term care facilities) 2. Outpatient Based (outpatient clinics, ambulatory settings) 3. Community Based (consultative teams collaborate with hospice or home health agencies, to support patients not yet receiving hospice care in their place of residence) 4. Hospice care (under Medicare Part A)

What are the 6 underlying principles of hospice care?

1. death must be accepted 2. the patients total care is best managed by an interdisciplinary team whose members communicate regularly with one another 2. pain and other symptoms of terminal illness must be managed 3. the patient and the family should be viewed as a single unit of care 4. home care of they dying is necessary 5. bereavement care must be provided to family members 6. research and education should be ongoinh

What are the 4 levels of hospice care under the Medicare and Medicaid hospice benefits?

1. routine care 2. continuous care 3. respite care 4. general inpatient hospice care

Hope-hindering categories

Abandonment and isolation, uncontrollable pain/discomfort, and devaluation of personhood

Which level of hospice care, is a subcategory of routine home care?

Continuous care: ongoing nursing care is provided in the home for management of a medical crisis (care can be managed at home, and after crisis is averted, pt goes back to routine home care)

(T/F) Hospice is an option for end-of-life care that has been fully integrated into mainstream healthcare

FALSE

A four-step spiritual assessment process using the acronym FICA involves asking the following questions.... ?

Faith and belief: Do you consider yourself to be a spiritual or religious person? What is your faith or belief? What gives your life meaning? Importance and Influence: What importance does faith have in your life? Have your beliefs influenced the way you take care of yourself and your illness? What role do your beliefs play in regaining your health? Community: Are you a part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you? Address in care: How would you like me to address these issues in your health care?

Hope-fostering categories?

Love of family and friends, spirituality/faith, setting goals and maintaining independence, positive relationships with clinicians, humor, personal characteristics, and uplifting memories

Can a Medicare beneficiary receive palliative care and cure-focused care under the hospice benefit?

NO

In the hospital, the delivery of palliative care is typically through an interdisciplinary consultation service where primary teams consult specialists for one or more of the following reasons.... ?

Pain management Symptom management Goals of care discussions End-of-life issues Psychosocial distress Spiritual or existential distress

What are 3 requests for assistance in dying?

Physician aid in dying (PAD), medical aid in dying (MAD), and physician-assisted dying: A physician prescribes a lethal dose of oral medication that the patient self-administers, for the purpose of ending someone's life. PAS: A physician prescribes medications, that the patient self-administers, to end their life at the person's voluntary and competent request. Euthanasia: Greek for "good death"; has evolved to mean the intentional killing by act or omission of a dependent human being for their alleged benefit

Uncomplicated grief?

Range of emotions experienced after a loss moving toward adjustment; brief periods of relapse common Examples: Missing a deceased grandparent during holidays

Six key processes of mourning allow people to accommodate to the loss in a healthy way..... ?

Recognition of the loss Reaction to the separation and experiencing and expressing the pain of the loss Recollection and reexperiencing the deceased, the relationship, and the associated feelings Relinquishing old attachments to the deceased Readjustment to adapt to the new world without forgetting the old Reinvestment

(T/F) nursing participation in assisted suicide is a violation of the Code for Nurses

TRUE

Respite hospice care allows primary caregivers...... ?

a break through admission of the patient to an inpatient unit or nursing facility

Another phenomenon associated with spirituality at the end-of-life is spiritual pain, defined as...... ?

a pain deep in one's soul not manifested as physical symptoms, which may be experienced in the seriously ill.

Treatment of impaired secretions in the actively dying is usually achieved with the use of....... ?

anticholinergic medications to dry secretions

The determination of death is made through a physical examination that includes...... ?

auscultation for the absence of breathing and heart sounds

Medicare Hospice Benefit?

beneficiaries must make a choice between palliative care (to enroll in hospice) and cure focused treatment -this has been a barrier to earlier hospice enrollment for a long time

Currently, the most common diagnosis for hospice patients in the U.S. is...... ?

cancer

the most common primary diagnoses seen by palliative care specialists included...... ?

cancer (26%), cardiac diseases (15%), pulmonary conditions (9%), neurologic diagnoses (9%), and infectious causes (7%)

Call for Action—Nurses Lead and Transform Palliative Care, which outlined the five areas of palliative nursing care as: ?

clinical practice, education, policy, research, and administration.

A care/cure dichotomy has persisted in which health care providers may view...... ?

cure as the ultimate good and care as second best, a good only when cure is no longer possible (alleviating suffering is not as valued as curing disease)

What are the most common hospice diagnoses?

dementia heart disease lung disease

The most common reason for palliative care consultation in the hospital setting is..... ?

goals of care discussion; those referred for care planning are most often older with a serious illness other than cancer and typically have a full code status

Hospice care does not seek to.... ?

hasten death or encourage the prolongation of life through artificial means

Spirituality includes domains such as..... ?

how a person derives meaning and purpose from life, one's beliefs and faith, sources of hope, and attitudes toward death

In terminal illness, hope represents the patient's...... ?

imagined future, forming the basis of a positive, accepting attitude and providing the patient's life with meaning, direction, and optimism (When hope is viewed in this way, it is not limited to cure of the disease; instead, it focuses on what is achievable in the time remaining; improving relationships with kids)

Mourning?

individual, family, group, and cultural expressions of grief and associated behaviors

The statement in late-stage illness that exemplifies this care versus cure dichotomy is..... ?

nothing more can be done.

The sounds of breathing at the end-of-life are related to..... ?

oropharyngeal relaxation with inability to clear secretions through cough or swallowing due to somnolence

All hospice care is.... ?

palliative care (but vice versa is NOT true)

Bereavement?

period during which mourning for a loss takes place

Grief?

personal feelings that accompany an anticipated or actual loss

Complicated grief and mourning are characterized by..... ?

prolonged feelings of sadness and feelings of general worthlessness or hopelessness that persist long after the death, prolonged symptoms (depression, anxiety, insomnia, fatigue) that interfere with activities of daily living, or self-destructive behaviors such as alcohol or substance abuse and suicidal ideation or attempts

The intent of palliative sedation is to..... ?

relieve symptoms, not to hasten death (midazolam, a short-acting benzodiazepine)

Most hospice care is provided at what level?

routine home care

Which level of hospice care is primarily in the private residence of family and friends?

routine home care

What is the Inpatient respite care, level of hospice care?

short term inpatient care provided in an approved facility to relieve the primary caregivers providing at home care for the resident (gives care givers a break)

What is the goal of hospice?

to enable the patient to remain at home, surrounded by people and objects that have been important to them throughout life

Short-acting antispasmodic agents are most effective for _____?_______pain

uncontrolled

When would a patient go to the general inpatient care level of hospice?

when symptoms can't be treated/managed at home -Inpatient stay for symptom management that cannot be provided in the come (not subject to the guidelines for a standard hospital inpatient stay)

The Institute of Medicines recommendations for improving end of life care include..... ?

widespread and timely access to, and comprehensive coverage for palliative care services, improved clinician-patient communication, greater emphasis on advance care planning, professional education and development, and stronger public education and engagement