426 Exam 3 - End of Life

What are appropriate interventions for increased respiratory secretions?

Begin anti-cholinergics, elevate head of bed, reduce/stop IV fluids/enteral feedings, provide reassurance and calm environment

What are three important decisions that need to be made prior to death?

Decisions about organ tissues donation, advanced directives and resuscitation

What treatment is appropriate for delirium in a dying patient?

Environmental/use of antipsychotics (if indicated)

T/F: frequent suctioning is appropriate for increased respiratory secretions experienced near death?

False

What nursing interbential is appropriate for pain in a dying patient?

Oral/transdermal medications

What should you do if a patient is seeing people or things that are not there?

ask the patient for more information about what they are seeing

What are some respiratory signs of impending death?

change in breathing pattern (apnea, panting, cheyne-stokes, mandibular breathing), audible secretions

What are possible causes of delirium?

changes in sleep/wake cycle, ICU psychosis, restraints

What is the death rattle?

loud rattling sounds when breathing caused by respiratory secretions due to inability to clear the secretions

What are some of the common symptoms in the last 48 hours of life?

pain, agitation, urinary incontinence, dyspnea, N&V, myoclonus, excess respiratory secretions (avoid the term death rattle)

What are some cardiovascular signs of impending death?

cold extremities/mottling, change in vital signs

What are some communication signs of impending death?

decrease interaction with others (withdrawn, using metaphors, expressing emotions and/or fears)

What are some gastrointestinal signs of impending death?

decreased intake, nausea, vomiting, diarrhea, constipation, incontinence

What are some genitourinary signs of impending death?

decreased urine output

What are some interventions for respiratory secretions?

elevate head of bed, begin anticholinergic drugs, rude or stop IV fluids/enteral feedings, provide reassurance and education, provide peaceful calming environment, role model comforting

What are some metabolic signs of impending death?

fatigue, surge of energy, temperature changes/diaphoresis

What is hypoactive delirium?

lethargic, somnolent, appear to be in a stupor

What is the role of a nurse for a dying patient?

normalize the experience for the patient/family be proactive in assessing for symptoms allow the expression of emotion don't underestimate the power of your presence

What will be absent once death has oocurred?

pulse, blood pressure, respirations, response to stimuli, blinking/corneal reflex

What is hyperactive delirium?

restless, calling out, agitated, disoriented, crawling out of bed, delusions

What nursing intervention is appropriate for restlessness in a dying patient?

Assess for reversible causes, provide calm/comforting environment, meds as orderd

What may be seen once death has occured?

B/B incontinence, eyes slightly open, jaw relaxed, mouth open, waxy, pasty appearance to skin

What nursing interventions are appropriate for dyspnea in a dying patient?

Oxygen, positioning, cool environment (fan), calming environment/reassurance

What is bereavement?

The period following the death of a loved one during which grief is experienced and mourning occurs.