Exam 3- Hospice and palliative care
Judaism beliefs
may have views that restrict TPN/PPN are able to enroll in hospice
Who is eligible for palliative care?
only hospice is covered currently
Music Therapy may be helpful to Mrs K in what way? • 1) "Music therapy will increase her basal metabolic rate."• 2) "Music therapy can help her verbally express emotions."• 3) "Music therapy will improve her appetite and decrease the nausea."• 4) "Music therapy works as a distraction and can help alleviate her pain."• 5) "Music therapy can help facilitate movement in some clients who have mobility limitations."
"Music therapy can help her verbally express emotions" is correct. Music therapy helps improve communication and develop emotional expression. "Music therapy works as a distraction and can help alleviate her pain" is correct. Music therapy helps distract people from pain. Music often calms and relaxes clients, diverting their attention away from the pain."Music therapy can help facilitate movement in some clients who have mobility limitations" is correct. Music therapy improves physical movement, especially for clients who are ill or have disabilities.
living will
A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.
client on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many client care dilemmas at the end of life? • A. Poor communication between the family and the care team• B. Denial of imminent death on the part of the family or the client• C. Limited visitation opportunities for friends and family• D. Conflict between family members
A. Correct Many dilemmas in client care at the end of life are related to poor communication between team members and the client and family, as well as to failure of team members to communicate with each other effectively.
Medications for EOL care
Acetaminophen Anticholinergics Antidepressants Anxiolytics Antipsychotics Narcotics Bowel regime
The terminally ill client asks the nurse for information about hospice care. The nurse would best respond by stating: "Hospice care is home nursing care provided to terminal cancer clients". "The client qualifies for hospice care at the time of diagnosis with a terminal illness". "The main focus of hospice is to educate the client concerning treatment options and alternatives". "Hospice regards dying as normal part of life and proves support for a dignified and peaceful death".
Answer D Rationale: the focus of hospice is improving the quality of life and preserving dignity for the client in death. Hospice care may be provided by nurses, volunteers, or other members of the heath care team, in a variety of settings. It is available to any client who has a terminal illness with a life expectancy of 6 months or less.
Which of the following would be consistent with promoting nutrition in terminally ill patients? A Maintaining a balanced diet B Offering small portion of favorite foods C Avoiding arguments at mealtime D Offering cool foods rather than hot foods
B,C,D Correct: Offering small portions of favorite foods, avoiding arguments at mealtime, and offering cool foods rather that hot foods are all tips that promote nutrition in terminally ill patients.
Hospice care principles
Death must be accepted Pain management Patient and family are considered single unit of care Home care of the dying is necessary Bereavement care must be provided for family Research and education should be ongoing
Someone who fixed in the anger stage of grieving and continues to blame themselves for the death of their spouse is exhibiting what type of grief?
Distorted Maladaptive Grief
Spiritual Assessment: FICA
F: Faith or Beliefs I: Importance or influence C: Community A: Address F: What is your faith or belief? I: Is it important in your life? What influence does it have on how you take care of yourself? How have your beliefs influenced your behavior during this illness? What role do your beliefs play in regaining your health? C: Are you part of a spiritual or religious community? Is this of support to you and how? Is there a person or group of people you really love or who are really important to you? A: How would you like me, your healthcare provider, to address these issues in your healthcare?
Physiologic responses at end of life
Pain Dyspnea Nausea Weakness Anxiety
Palliative Care Domains
Structure & Process of Care Physical Aspects of Care Psychological & Psychiatric Aspects of Care Social Aspects of Care Spiritual, Religious, & Existential Aspects of Care Cultural Aspects of Care Care of the Imminently Dying Patient Ethical & Legal Aspects of Care
Nursing Care at End of Life
Patient Comfort Medicate for pain Oral and eye care Protect skin from breakdown Discontinuing measures Communication Family Support and Education
Maladaptive Grief: 3 types
Prolonged: intense preoccupation with memories of the lost entity for many years after the loss Delayed or inhibited: individual becomes fixed in the denial stage of the grieving process. Development of anxiety disorders, sleeping, and eating disorders. Distorted: fixed in the anger stage of grieving; individuals turn the anger inward on the self, consumed with overwhelming despair. Depression may develop.
Signs of approaching death
Refusal of food, fluids •Urinary output decreases •Weakness, sleep •Confusion, restlessness •Impaired vision, hearing •Secretions in throat •Breathing pattern •Incontinence •Decreased temperature control Skin molting usually around a week prior BP drop, tachycardia, o2 decrease, RR decrease
levels of hospice care
Routine: healthcare comes on certain days/times, family takes care of patient when home healthcare is not present. Respite: home hospice patients spend a short time in an inpatient hospice facility so their primary caregivers can take a break. Continuous: around the clock care at home Inpatient: patients can not be managed at home-received around the clock care in a facility until the patient can return home.
Who is eligible for hospice?
Serious progressive illness Limited life expectancy accepted terminal signed waiver to deny curative/ medical treatment
The nurse is caring for a dying client in a hospice setting. The family is unsure whether to go home for rest or spend the night with the client. Which body system would the nurse assess to provide the first data on decline? ' A. Central nervous system B. Cardiovascular system C. Respiratory system D. Gastrointestinal system
The key word is "first". Failing of cardiac functioning is one of the first signs that a condition is worsening. Symptoms within the other systems can also denote deterioration over time.
A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what? A. Complicated grief and mourning B. Uncomplicated grief and mourning C. Depression stage of dying D. Acceptance stage of dying
Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations, such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity
NODA
Volunteers to be with Pt during time of death to bear witness during transition, training, on call.
Match Each sign/symptom with the appropriate Palliative Care Domain (Aspects of Care): Vomiting Caregiver Crisis Hopes/Fears Language/Rituals Anxiety/Depression
Vomiting: Physical Aspect of Care Caregiver Crisis: Social Aspect of Care Hopes/Fears: Spiritual, Religious, & Existential Aspects of Care Language/ Rituals: Cultural Aspects of Care Anxiety/ Depression: Psychological & Psychiatric Aspects of Care
durable power of attorney
a legal agreement that allows an agent or representative of the patient to act on behalf of the patient
Cheyne-Stokes respiration
an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes.
Five stages of grief
denial, anger, bargaining, depression, acceptance
death rattle
distinctive sound that a person may make as they are coming to the end of their life and may no longer be able to swallow or cough effectively enough to clear their saliva.
Palliative Care goal
improve the patients and family's quality of life.
bereavement
includes both grief and mourning (the outward display of loss) as the individual deals with the death of a significant person in their life.
Islam beliefs
pray 5x a day god alone heals decisions are made as family pain can compensate for sin pain relief and hospice are okay
Hinduism beliefs
reincarnation bodies are cremated Karma Worst death is suicide
Buddhism beliefs
same gender care is preferrable cremation is preferred may not want pain meds can use hospice reincarnation
MOLST form
stands for Medical Order for Life-Sustaining Treatment, a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis
Christian beliefs
suicide bad pain meds okay may want to repent before death
