C475 Terminology Competencies 6-9
1. Loss of appetite 2. Excessive fatigue and sleep 3. Increased physical weakness 4. Mental confusion or disorientation 5. Labored breathing 6. Social withdrawal 7. Changes in urination 8. Swelling in the feet and ankles 9. Coolness in the tips of fingers and toes 10. Mottled extremities
What are the signs of impending death?
The low-dose opioid initiated for pain would also help with this shortness of breath; supplemental oxygen may also be of benefit. Morphine 5 mg q 4 hr. Also elevate head of bed, use fan.
what is Treatment of End-of-Life shortness of breath?
*Provides more specific instructions than living will: 1. Person chosen as durable power of attorney for healthcare 2. Kind of treatment the person wants 3. How comfortable they want to be 4. How they want to be treated by others 5. What they want their loved ones to know
*what is 5 wishes?
this plan covers Inpatient hospital care, hospice, blood, home health services, skilled nursing facility care (up to 100 days) *No cost for this plan but deductibles and copays apply.
What is Medicare Part A cover?
this plan covers Outpatient care, doctor visits, medical equipment, mental health services, labs. *Cost for Part B based on income and deductible & co-pays apply. Enrollment in this plan is optional
What is Medicare Part B cover?
Developed by Eric Coleman, this is a 4-week program to improve quality of care and contain costs for patients with complex care needs as they transition across care settings. 1) Assistance with self-management of meds 4 pillars: 2) patient-centered medical record that is kept by the patient 3) timely follow-up with primary physician or specialist 4) list of S&S that indicate worsening of the condition Uses a Transitions Coach who follows the patient before & after discharge from hospital.
What is Transition Care INtervention?
Position & Mobility: wheelchairs, standing aids, chair inserts Environmental Access: door openers, Braille directional signs, light switch adapters Self-Care: adaptive utensils, toilet seats, aids for grooming & dressing Sensory Impairment: AACs, hearing aids, taped books Cognitive Impairment Social Interaction & Recreation: clocks, calendars : computer games & simulations, painting with a mouth wand Computer-Based Assistive Technology movements to operate equipment, mobile apps : Eye or mouth
what are Common Applications of Assistive Technology?
Medication reconciliation, completing detailed transfer form (both written and verbal report), discharge instructions, comprehensive discharge planning, including helping to arrange follow-up medical appointments. Other duties may include home visits or follow-up phone calls.
what are Nursing responsibilities in care transitions?
"Welcome to Medicare" physical Cholesterol screening PAP smear Colorectal cancer screening Diabetes screening and diabetes education Bone densitometry Mammogram Prostate cancer screening Smoking cessation Immunizations Obesity screening & counseling Depression Screening
what are Preventive services covered by Medicare?
Neuropathic Nocioceptive
what are classification of pain?
• Improving the patient experience of care (including quality and satisfaction); • Improving the health of populations; and • Reducing the per capita cost of health care
what is "Triple Aim" of healthcare reform?
1) Acknowledge/ accept the reality of the death 2) Embrace the pain of the loss 3) Remember the person who died 4) Develop a new self-identity 5) Search for meaning 6) Receive support from others
what is 6 needs of Mourning?
It is a VIOLATION of Code of Ethics for Nurses. Instead, nurses should focus on providing competent, comprehensive and compassionate end-of-life care
what is ANA stance on assisted suicide (euthanasia)?
Medical order which provides for comfort measures at end of an illness, allowing nature to take its course. It is seen as more positive and descriptive than a DNR order
what is AND (Allow Natural Death)?
when death is brought about by an act- for example- when a person is killed by being given an overdose of pain killers
what is Active euthanasia?
helps an individual identify their personal wishes in a legal manner and to share that information with the people around them, including medical personnel.
what is Advance Directives?
• any item, piece of equipment or product system, that is used to increase, maintain or improve functional capabilities of individuals with disabilities • These devices include the entire range of supportive tools and equipment, from adapted spoons to wheelchairs and computer systems for environment control. • There is a loss of strength, balance, visual and auditory, cognitive, and/or memory changes that may occur as we age. • it is designed to help us with these losses & bridge the gap between capabilities and care needs. • It is anything that can enhance the function of some physical or mental ability that is impaired. It can be a cane, walker, glassed, hearing aids, wheelchair, bath bench, elevated toilet seat. All of this is assistive technology.
what is Assistive Technology?
Better Outcomes for Older Adults through Safe Transitions. Resource site provides tools to support nurses in improving care transitions.
what is BOOST?
1) Detailed assessment info 2) Treatments 3) Wounds 4) Current Meds 5) Allergies 6) Level of independence 7) Recent diagnostic tests 8) Primary care provider notification upon discharge & admission to the receiving facility
what is Basic information on Transfer Form?
Promotes healthy lifestyle choices, encourages active patient participation, and facilitates better self-management. Nurse works as a COACH and supporter, uses coaching & motivational techniques. Focus is on improving continuity of care.
what is Care Coordination?
Focuses on movement between facilities for the elderly & chronically ill. Goal is to provide seamless transition that does not result in duplication of services or fragmented care. Primary focus is preventing complications & hospital re-admission (since Medicare will not pay for re-admission for the same diagnosis within 30 days)
what is Care Transitions Models?
Life-prolonging treatment focusing on a cure
what is Curative Treatment?
Medical order that indicates CPR will not be done if a patient has respiratory or cardiac arrest. Can be viewed as harsh & may promote feelings of abandonment
what is DNR?
· Phenobarbital · Secobarbital Nembutal
what is Drugs used for Active euthanasia?
1. Free of avoidable distress & suffering 2. In accord with patient & family's wishes 3. Consistent with clinical, cultural & ethical standards 4. Instilling good memories 5. Becoming spiritually ready 6. Saying goodbye 7. Dying quietly
what is Elements of a "good death"?
Focuses on improving the quality of care for low-income seniors. Uses a geriatric interdisciplinary team including NP, social worker, primary care provider & geriatrician. Uses care protocols to evaluate & follow common geriatric conditions. The team uses community-based care management programs.
what is Geriatric Resource for Assessment & Care of Elders (GRACE)?
The natural and normal response to loss of any kind, and is experienced psychologically, behaviorally, socially, and physically
what is Grief?
Based in primary care offices, care provided by nurse-physician teams. Patient receives 8 services by nurse, focusing on medication management, symptom monitoring, nutritional & activity interventions. Nurses work both in the clinic setting as well as the patient's home.
what is Guided Care?
1) Must have life expectancy of not more than 6 months. 2) Hospice provides care and support for persons in the last phases of incurable disease so they may live as fully and comfortably as possible 3) • Uses team approach to address physical, emotional, social & spiritual needs of patient & family 4) Affirms life and neither hastens nor postpones death
what is Hospice Care?
Document that direct preferences for end-of -life care issues, providing an "if...then..." plan
what is Living Will?
Financed jointly by state and federal governments, administered by states. (State will determine eligibility guidelines.) 1. Health insurance for low-income and people with disabilities families 2. Long-term care (LTC) for low-income older Americans and persons with disabilities 3. Supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare **So low-income patients may have both Medicare & Medicaid
what is Medicaid?
These plans are offered by private insurance companies (like Humana) and are considered managed care programs. Includes all covered benefits for traditional Parts A & B, except hospice. May include additional benefits such as dental, vision, wellness programs
what is Medicare Part C ("Medicare Advantage")?
this plan is optional, it covers prescription meds. Multiple plans are offered which vary in prescriptions covered, deductibles, premiums, and co-payments.
what is Medicare Part D (Remember "D" for Drugs)?
Cultural and/or public display of grief through one's behaviors
what is Mourning?
Injury to peripheral nerves or central nervous system. May be described as shooting, stabbing, burning, or shock-like. May be constant or intermittent. Less responsive to opioids; responds best to anticonvulsants (like Neurontin) or tricyclic antidepressants.
what is Neuropathic pain:?
Provides info & advice to help family caregivers & healthcare providers plan safe & smooth transitions for chronically or seriously ill patients. Has easy-to-use guides
what is Next Step in Care?
Peripheral pain receptors, from somatic or visceral injury. Somatic pain is sharp, well-localized. Visceral pain is diffuse, deep ache. Treated with NSAIDs, steroids, Tylenol, opioids
what is Nocioceptive pain?
Physician's Order for Life-Sustaining Treatment: Instructs emergency personnel on what actions to take while the person is still at home, before emergency treatment is given.
what is POLST?
Comprehensive management of physical, psychological, social, spiritual and existential needs of patients who have incurable, progressive illnesses. Goal is to achieve best possible quality of life
what is Palliative Care?
when death is brought about by an omission i.e. when someone lets the person die. This can be by withdrawing or withholding treatment: · Withdrawing treatment: for example, switching off a machine that is keeping a person alive, so that they die of their disease. · Withholding treatment: for example, not carrying out surgery that will extend life for a short time
what is Passive euthanasia?
Provides an alternative to institutional care for patients age 55 or older who require nursing-facility level of care. The interdisciplinary PACE team manages all health, medical & social services. Care is provided in the home, community & PACE center. PACE functions within Medicare & Medicaid programs and replaces other coverage. Patients must live within the PACE service area. **Not available in all states. This option was part of the Balanced Budget Act of 1997.
what is Programs of All-Inclusive Care for the Elderly (PACE)?
"Respite" means to take a break. Short term intermittent care for person with chronic/debilitating conditions. For a care giver who is providing 24/7 care to anyone with continuous care needs, respite could mean taking the loved one to an agency over the weekend so that the caregiver can take a break from care giving, or having someone else come in to relieve the caregiver.
what is Respite Care?
Factors that lead to poor outcomes include: 1. Inadequate education to patients & family 2. Poor communication between patients & providers 3. Inadequate assessment at point of care 4. Medication discrepancies 5. Lack of follow-up care 6. Health literacy issues 7. Lack of support systems 8. Cultural barriers
what is Risks in Care Transitions?
Is "retirement income" based on work history. *Can start receiving SS as early as age 62, but payments will be reduced. *Age to receive full SS benefits has been slowing rising
what is Social Security?
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance *These are not linear and retrogression may occur
what is Stages of Grief?
Eliminate lifetime limits for health insurance coverage for essential services 2. Eliminate the ability of insurance companies to rescind coverage 3. Free Preventative care 4. Development of a prevention and public health fund. 5. Increase access to affordable care, including a provision for pre-existing conditions (also expand Medicaid) 6. Quality improvement and risk reduction
what is The Patient Protection and Affordable Care Act?
Nurse-led model that follows patient from hospital to home. Visits patient within 24 hours of discharge, accompanies to follow-up visits, makes weekly home visits, and ongoing telephone support for 2 months. Emphasis of TCM is care coordination and continuity of care. Specific research-based nursing protocols were developed to assist the nurse.
what is Transitional Care Model (TCM)?
•Step 1: Mild pain (1-3 on 0-10 rating scale): Tylenol or NSAIDs Step 2: Moderate pain (4-6 on 0-10 scale): Low-dose short-acting opioids in combination with Tylenol or NSAIDs. Adjuvants may also be used. Step 3: Severe pain (7 -10 on 0-10 scale): Opioids (not used in combination with Tylenol or NSAIDs so higher doses may be given). Adjuvants may also be used. **Opioids are constipating (constipation) so a concurrent bowel program is essential (usually a stimulant & stool
what is WHO Step Approach to treating pain?
Age 65 or over who have paid into the Social Security system, the railroad fund, or are diagnosed with end stage renal disease (on dialysis) is qualified for?
what is Who qualifies for Medicare?
1. Clean body, comb hair, close the eyes. Put on clean gown as needed. Position arms & legs in straight position. 2. Remove tubes, drains, etc. *unless coroner's case in which case they need to remain in place. 3. Leave dentures in place 4. Use pads or towels to absorb bodily fluids 5. If the mouth will not stay shut, place a rolled-up towel or washcloth under the chin. If this does not provide enough support to keep the mouth closed, tie with a light-weight, smooth fabric cloth. Place under chin and tie at top of head.
what is post mortem care?
1. Sudden, unexpected death (traumatic, violent, random) 2. Overly lengthy illness 3. Loss of a child, including adult children 4. Perception of the death as preventable 5. Markedly angry, ambivalent or dependent relationship 6) Unaccommodated losses, stresses or mental health problems 7) Perception of lack of social support
what is the Risk factors for complicated mourning?