chapter 39: hospice care

Spiritual coordinator

Seminary degree Serves as liaison between the patient and the spiritual community Coordinates spiritual support

Hospice care does not conclude once the patient dies but usually continues for up to _____ year with bereavement support. The __________, especially the _________ caregiver, continues to need support after the patient dies

1, family, primary

morphine sulfate: immediate-release (Roxanol)

Acute and severe pain Constipation, nausea and vomiting, sedation Assess pain control by using pain assessment; instruct about administration routinely

psychosocial

a combination of psychological and social factors

terminal illness

a disease in an advanced stage with no known cure and poor prognosis

interdisciplinary team

a multiprofessional health team whose members work together in caring for a terminally ill patient

respite care

a period of relief from responsibilities of caring for a patient

primary caregiver

a person who assumes ongoing responsibility for health maintenance and therapy for the illness

Because constipation has the capacity to cause other symptoms, such as _________ pain, nausea, or vomiting, prevention of the problem is important

abdominal

When a patient with a life-threatening illness has undergone all reasonable treatment and the disease has not been arrested or cured, it is necessary for the patient to decide whether continued _________ therapy is feasible or beneficial. This situation leads the patient and family to decide whether to continue with _________ treatments or to transition to __________ measures

active, curative, palliative

On occasion, a hospice patient goes into the hospital and receives hospice services for control of _______ pain or for 5-day __________ care for the family or care provider on an occasional basis. Patients sometimes receive hospice care intermittently and sometimes on a ___________ basis

acute, respite, continuous

adjuvent

additional drug or treatment that is added to assist in the action of the primary pain treatment

The patient and the hospice _________ often develop a close relationship, and in some cases, the patient shares feelings with the aide more ______ than with any other member of the team.

aide, easily

_______ ________ is sometimes caused by tumor ________, fluid and electrolyte _________, or anemia. Anxiety resulting from ______ or panic may accompany this problem.

air hunger, pressure, imbalance, fear

The nurse instructs the caregiver to reposition the patient for comfort, use alternating _______ or ______-_______ mattresses, and to perform good ____________ to prevent skin impairment.

air, egg-crate, hygiene

senna (Senokot)

Constipation Nausea and vomiting, diarrhea, abdominal cramping Encourage patient to drink fluids; assess gastrointestinal status, and administer the laxative routinely if patient is taking pain medication

Volunteer coordinator

Experience in volunteer work Recruits and trains the volunteers Coordinates assignments of volunteers

The goals of bereavement counseling for loved ones during the patient's illness and after the death are

(1) to provide support and (2) to assist survivors in the transition to a life without the deceased person. It is appropriate to incorporate grief support into the plan of care.

The idea of hospice was renewed in the ______s in ________, when Dame Cicely __________, a nurse and physician, realized that terminally ill patients needed a different kind of care. She had a patient who was dying of a terminal illness, and she found that ____________ of life was not the main emphasis of his care.

1960, London, Saunders, quality

In ________, St. ___________ __________ of London was opened, and this hospice continues to serve as a national and international education, training, and research center for professionals involved in the hospice approach to care of terminally ill patients.

1968, Christopher's hospice,

The philosophy of hospice migrated to the United States in the early ______s; the first hospice program opened in __________ in 1971. Since then, health care providers, nurses, _________, social workers, and many nonprofessional volunteers have worked together to develop more than _______ hospice programs serving more than 1 million patients throughout the United States

1970, Connecticut, clergy, 3400

The Medicare Hospice Benefit came into effect in _______, and today hospice services are reimbursable through ___________, ____________, and most private insurance companies. Medicare certification or state licensure ensures __________ hospice services

1983, medicare, medicaid, quality

Pain assessment begins with the patient's self-report, and the patient rates the pain on a scale of 0 (no pain at all) to 10 (the worst imaginable pain). Any pain the patient rates at ______ or higher on the pain scale has a great effect on the ___________ of life.

5, quality

lorazepam (Ativan)

Anxiety Dizziness, drowsiness, orthostatic hypotension, tachycardia Administer routinely; instruct patient in safety issues regarding rising slowly and not driving

Primary spiritual leader

As required by religious group Supports patient and caregiver in coping with fears and uncertainty about spiritual issues

Social worker

Bachelor's degree in social work Evaluates the patient's psychosocial needs Serves as resource for potential community services Assists with counseling in grief issues

Hospice aide

Certified as a home health aide Administers personal care and assistance with bathing

Hospice volunteer

Completion of volunteer training Provides companionship for patient and caregiver Available for short periods of respite care

prochlorperazine (Compazine)

Emesis Extrapyramidal symptoms, dry mouth, depression Assess control of nausea, and ensure that caregiver is administering the antiemetic appropriately and routinely

droperidol (Inapsine)

Emesis Hypotension and tachycardia, drowsiness, dizziness Ensure that caregiver is administering the antiemetic appropriately and routinely

hospices

From the Latin word hospitum, meaning hospitality; a resting place for travelers on a difficult journey; philosophy of care that provides support to terminally ill people and their families.

Medical director

Licensed physician Mediates between the hospice team and attending medical provider Provides consultation relative to the medical aspect of care

Primary health care provider

Licensed physician Responsible for the medical aspect of symptom control for patient

Nurse coordinator

Licensed registered nurse Manages the patient's care Explains the service, admits the patients, assigns the primary team

Primary nurse

Licensed registered nurse Serves as liaison between (1) patient and (2) caregiver, health care provider, and interdisciplinary team Evaluates patient's response to treatment Educates the patient and family in disease process and care Assesses symptom management Provides emotional support to patient and caregiver

Hospice pharmacist

Licensed registered pharmacist Provides drug consultation

fentanyl transdermal system (Duragesic patch; an opioid)

Moderate and severe pain Confusion, hypoventilation, nausea and vomiting, constipation Instruct caregiver to clean patient's skin with water only and dry before application

morphine sulfate: controlled-release (MS Contin)

Moderate and severe pain Constipation, nausea and vomiting, sedation Assess pain control and medication effectiveness

___________, ____________ & __________ drugs are often effective in treating somatic pain.

NSAID's, nonopioids, opioids

Bereavement coordinator

Professional with grief experience Assesses and supports the bereaved survivor Facilitates support groups

POLST may be used in addition to or instead of the _________ ________; it has proven to be more effective in preventing medical ________ that arise from not following patients' wishes. Completion of this form is encouraged for all nursing home patients and for patients entering a hospital or hospice.

advance directive, errors

curative treatment

aggressive care in which the goal and intent is curing the disease and prolonging life at all cost

An advance directive is a document prepared while an individual is ______ and __________,. It provides guidance to the family and the health care team in the event that the individual is no longer capable of making decisions.

alive, competent

The goal of therapy is to prescribe a dose of effective drug sufficient to ___________ pain and at the same time allow the patient to remain ______ enough to participate in activities of daily living

alleviate, alert

As the pain increases, it is important to monitor the ________ and __________ of medications administered. Increases in dosages may be needed to manage ___________ pain.

amount, frequency, breakthrough

__________ and _________ are major anxiety-producing symptoms of terminal illness. Poor appetite potentially arises from nausea, vomiting, constipation, _________, _________, tumor invasion, general deterioration of the body, depression, or infections.

anorexia, malnutrition, dysphagia, stomatitis

Health care providers typically prescribe an _____________ medication alone or as an adjuvant to ____________ or _______ for visceral pain.

anticholinergic, nonopioids, opioids

The patient is encouraged to take the ordered __________ routinely, 30 minutes before _________ and at __________.

antiemetics, meals, bedtime

The main nursing focus is in relieving the ________ and supporting the patient and caregiver. Education on _________, use of a fan to circulate air, use of ________ to decrease the work of respiration, use of anxiolytics to ease anxiety, and maintaining good oral hygiene help the patient and ease the caregiver's anxiety

anxiety, positioning, morphine

__________ has also been known to cause nausea, which then leads to _________. Patients who vomit are typically anxious about why they are vomiting, which often _________ the symptoms.

anxiety, vomiting, worsens

Premedicating the patient with an __________ and an _________ before the removal of an impaction may help the patient better tolerate the procedure

anxiolytic, analgesic

These complications lead to difficulty in eating, which in turn causes loss of ___________. _________ of food cooking, inability to tolerate _________ foods, or a ________ taste in the mouth also contribute to the problem. This makes food less enjoyable, and so the patient does not eat.

appetite, odors, sweet, bitter

The hospice aide follows the plan of care that the interdisciplinary team develops and assists the patient with ________ and _________, including hair, nail, oral, and skin care. The hospice aide sometimes also assists the patient or the caregiver with light __________ services.

bathing, hygiene, homemaker

The __________ coordinator follows the plan of care for the bereaved caregiver for at least a ________ after the death. The bereavement coordinator facilitates _________ groups and __________ bereavement volunteers to visit the caregiver.

bereavement, year, support, assigns

When families are responsible for the total care of the patient in the home, caregiver "__________" becomes a concern. This is when the services of volunteers become _____. They provide ____________, caregiver ________ through respite care

burnout, vital, companionship, relief

Hospices serve patients with various primary disease processes, the most common being cancer, which accounts for ______% of the patient population. Dementia-related disease processes account for _____% of the client population, and cardiac and lung diseases account for almost ______% of the primary diagnoses of the patients served by hospice

cancer, 37.7, 13.9, 20

The medical director, with consultation from the interdisciplinary team, medically _________ the patient's eligibility for__________ care. The medical director is a ___________ between the interdisciplinary team and the health care provider. He or she __________ the plan of care, ensuring that the care being provided and ordered is __________ in nature.

certifies, hospice, mediator, oversees, palliative

Nausea is a possible side effect of __________ and can result from obstruction, _______, uncontrolled ______, ___________, and even food smells.

chemotherapy, tumor, pain, constipation

The patients usually wear their own clothes, move about the hospice as they _________, and socialize with each other and with the staff. The _________ is always open for individually prepared food, as well as for conversation.

choose, kitchen

The patient and the caregiver must understand that it is possible to control pain and that using large doses of opioids is _________ and __________ to achieve that control. The ________ assists the caregiver in setting a schedule for administering the medications and then monitoring the patient's response to and compliance with the established plan.

common, necessary, nurse

The volunteer ___________ ensures that the volunteer is adequately __________ and prepared for working with the dying patient. Responsibilities also include assigning the proper volunteer to the appropriate patient. Each year, more than _____________ hospice volunteers donate time to hospice patients

coordinator, trained, 400,000

Palliative care can serve as a bridge between __________ care and ________

curative, hospice

palliative care

defined by the World Health Organization, is the active, complete care of a patient whose disease has not responded to curative therapy

When the nausea and vomiting have subsided, the patient may begin drinking liquids to avoid ________ or start eating ______, ________ foods. Small, light, bland meals should be served, and _______, greasy, _______, or strong-smelling foods should be avoided

dehydration, soft, bland, sweet, spicy

The interdisciplinary team _________ and __________ the plan of care in conjunction with all those involved with the care. The core interdisciplinary team members are the medical ____________, the nurse __________, the social __________, and the __________ coordinator.

develops, supervises, director, coordinator, worker, spiritual

Licensed medical nutritional therapists (LMNTs) or licensed _________ are available for hospice __________ and for diet counseling. The hospice nurse performs the nutritional assessment at the patient's _________

dietician, consultations, admission

The patient is asked to rate each of these areas on a scale of 0 to 10. Having the patient participate in this way allows the patient to say where he or she has the most ____________ or area of ___________ concern

discomfort, greatest

__________ processes change the body's metabolism and appetite; these changes sometimes lead to ____________ , usually in association with a serious disease such as __________ and resulting in muscle __________ and weight loss.

disease, cachexia, cancer, weakness

The goal of palliative care is to control pain and other symptoms for the prevention of _________

distress

One assessment tool that is often used is the__________ ___________ ___________ System. This tool addresses the areas of pain, tiredness (lack of energy), drowsiness, nausea, appetite, shortness of breath, depression (feeling sad), anxiety or nervousness, and overall feeling of well-bein

edmonton symptom assessment

If the nurse notes nutritional problems, a referral may be made to the LMNT or dietitian for assistance with diet counseling and meal planning. The LMNT or dietitian also assists with __________ the caregiver about nutritional issues in ____-_______ diseases.

educating, end-stage

The nurse's role is to focus on the ____________ of the care plan: that is, to ensure that the plan achieves good ________ of the symptoms

effectiveness, control

An _____-crate mattress, ___________, or an _____-flotation mattress, as well as heel and elbow protectors, help cushion the bony areas. The hospice ______ is often very helpful to the patient in assisting with personal care, hygiene, and bathing.

egg, sheepskin, air, aide

The nurse coordinator also __________ that the plan of care is being ____________, coordinates assignments of the hospice nurses and aides, ___________ meetings, and determines methods of ________.

ensures, followed, facilitates, payment

The concept originated in ___________, where hospices were resting places for __________. Monks and nuns believed that service to one's neighbor was a sign of _______ and dedication to _______

europe, travelers, love, god

pain assessment

evaluation of the factors that alleviate or exacerbate a patient's pain

To provide support to the dying patient and the caregiver, the interdisciplinary team considers all aspects of the _________ unit.

family

They include the ________ in all decisions and care planning because families also experience the stresses of the terminal illness and death of the patient. These stresses also extend into the ____________ period after the patient ______.

family, bereavement, dies

The caregiver is sometimes an immediate _________ member and sometimes a significant other, a friend, or a hired caregiver. If a patient resides in a freestanding hospice residence, a long-term care facility, or a residential home, the __________ staff is designated as the ___________ caregiver.

family, nursing, primary

The spiritual coordinator is vital in assisting the patient and caregiver to cope with _______ and ___________. Possible support includes dealing with __________ business and regrets and providing opportunities for __________, prayer, and spiritual healing

fears, uncertainty, unfinished, reconciliation

Spiritual assessments are meant to gather information regarding the patient's _________ and ________. When confronted with a terminal illness, some patients question their faiths and beliefs, and some search for the spiritual support that they have never had.

feelings, needs

The social worker does not "______" the conflicts but ________ in problem solving. The development of trust between the patient and the interdisciplinary team is critical and is invaluable in dealing with these issues.

fix, assists

Nevertheless, only a _________ of people who have the option of hospice care choose to participate in it.

fraction

The patient or family sometimes believe that availing themselves of the services of hospice denotes _________ ____ hope, and some health care providers are hesitant to prescribe hospice care if they perceive the patient's worsening condition a personal _______ on their part

giving up, failure

Some teams facilitate a bereavement support _______ that meets on a regular basis, providing these families the opportunities to communicate and share their feelings. _________ and ________ keep in touch by visits, phone calls, cards, and remembering the bereaved person on holidays and anniversaries.

group, volunteers, pastors

many caregivers think that a reduced diet will _________ death, and therefore, if they manage to get the patient to eat, the food will prolong life. Nurses often must reassure the patient and the caregiver that anorexia is part of the _____-____-_______ process and that forcing the patient to eat may be _________

hasten, end-of-dying, harmful

Initially, the __________ __________ __________ may order diagnostic tests to determine the exact cause of the pain. Findings may reveal the pain to be related to tumor invasion, compression of organs or nerves, erosion of tissue, or other pathologic factors

health care provider

Dyspnea is a symptom that arises from a variety of possible conditions, such as ______ failure, _________, infection, _______, or tumor growth. ________ effectively is difficult for many patients, especially during the final stage of the illness

heart, dysrhythmias, ascites, breathing

It is never acceptable for hospices to exclude or refuse patients who need _____-_____ care; their mandate is to serve everyone regardless of ability to _____. Services are to be available 7 days a week, 24 hours a day.

high-cost, pay

Some hospices are operated by a _______ ______ agency or _____________-based organization in which care is usually provided in the patient's home, wherever that home may be. Hospice care may also be given in a ________-term care setting.

home health, community, long

The ___________ ____________ _________ covers all expenses for palliative care related to the terminal illness, including professional staff visits, medication, equipment, respite care, and acute care.

hospice medicare benefit

It is also necessary for a ___________ nurse to be especially adept in _______ and ________ control

hospice, pain, symptom

"Hospice" is from the Latin word , __________ meaning "__________" and "__________."

hospitium, hospitality, lodging

Rarely do artificial _________, total parental nutrition, and _______ feedings come into consideration. These may ________ the overall cachexic effect, but they have the potential to do more _________ than good, and the long-term result and quality of life will not change.

hydration, tube, slow, harm

Comments regarding suicide do not always come from the actual desire to kill oneself but are, in some cases, rather a statement of a desire for______________

independence

This group of professionals (listed above), along with the _____________ team, develops and is responsible for carrying out the _______ ____ ______.

interdisciplinary, plan of care

bereavement

is a period of mourning or an expression of grief in reaction to the death of someone close

Saunders began her work at St. _________ Hospice, operated by the ______ ______ of Charity.

josephs, irish sisters

The directive states the individual's preferences concerning ______-________ measures and organ ________and sometimes gives authority to another person to make decisions for the individual, who at that point may be in a _____

life-support, donations, coma

Hospice places the emphasis on ______ and not dying.

living

It is helpful when the patient makes his or her wishes known in advance, as in a _____________ __________ or an __________ ________, or assigns a durable power of attorney.

living will, advance directives

The sound that air makes as it passes through the mucus is coarse and _______ and can upset the caregiver. __________ drugs, such as transdermal scopolamine or atropine given sublingually, are sometimes helpful in preventing excess _________.

loud, anticholinergics, secretions

cachexia

malnutrition marked by weakness and emaciation)

The goal and emphasis of hospice is symptom ___________ and __________ care. The team of caregivers routinely assesses, reassesses, and documents the severity, the treatment, and the control of symptoms of the illness.

management, palliative

Physician Orders for Life-Sustaining Treatment (POLST) is a form completed by the _________ ________ and the patient to inform health care providers of the patient's _______. It is a ________ form than the advance directive with a few simple __________ that can be filled out in a few minutes.

medical provider, wishes, shorter, questions

The team provides comfort measures, as well as ___________ and ________. The team members also ________ the patient and the caregiver with regard to disease processes, medication administration, and how to provide daily care. Expert help and support is available to the patient and the caregiver ______ hours a day, either by phone or in person

medication, therapy, educate, 24

The medical director has a doctorate of _____________ or __________ and assumes overall responsibility for the medical component of the hospice patient's care program. The medical director does not take the place of the patient's _______ _______ provider but acts as a __________ for the health care provider.

medicine, osteopathy, health care, consultant

____________ (Reglan) is effective in controlling mild to moderate ____________ and _________ (National Comprehensive Cancer Network, n.d.). Because it increases __________ motility, its use is contraindicated in patients with suspected bowel _________

metoclopramide, vomiting, nausea, gastric, obstruction

_________ to ____________ pain can sometimes be managed with nonsteroidal anti-inflammatory drugs; as the pain increases in severity with progression of the patient's condition, the health care provider often switches the analgesic regimen to an _______ drug, with or without _________ drugs

mild- moderate, opioid, adjuvant

Suctioning should be __________ because it actually ________ mucus production and is very uncomfortable for the patient. Suctioning should be performed only if the patient is ________ and unable to recover.

minimized, increases, choking

Typical medieval hospices run by _______ and ______ were a combination guesthouse and _____________

monks, nuns, informatory

__________ derivatives are often the drugs of choice in caring for hospice patients because they can be delivered by ____ routes and the dosage can be titrated to control the pain. Breakthrough pain management is a primary need of hospice patients. ___________ should be administered as needed

morphine, all, analgesics

Some respiratory distress is relieved by oxygen, ___________, or ____________.

morphine, bronchodilators

Long-acting medications such as ___________ sulfate (MS Contin), ____________ (OxyContin), or __________ (Duragesic) patches often provide _______ pain control and are more convenient for the patient and the caregiver.

morphine, oxycodone, fentanyl, better

Patients who have oral ulcerations may experience discomfort with ________; therefore, ________-soaked swabs may be a better option. Small ___________ drinks, __________ ice, or ____________ saliva are often useful in relieving a dry mouth

mouthwash, water, frequent, crushed, artificial

To effectively treat pain, it is important to determine which of the three main types of pain the patient is experiencing. Somatic pain arises from the ____________ system and is described as _________, ___________, or throbbing

musculoskeletal, aching, stabbing

Many patients consider ________ to be worse than vomiting because at times it is noticeable only to the patient and therefore is ____________ by caregivers and health care professionals

nausea, overlooked

Appropriate services for the volunteer to provide are what are considered typical of a good _________: perhaps grocery shopping, ______ work, __________ to the patient, or keeping the patient _________ while the caregiver leaves the home for short periods.

neighbor, yard, reading, company

____________ pain arises from the nerves and the nervous system. __________, _________, or shooting pains often have neuropathic causes. Health care providers sometimes order ___________ to be administered as an adjuvant to assist with pain control.

neuropathic, tingling, burning, anticonvulsants

Removing the cause is _______ always possible in some cases; therefore, ___________ the symptoms becomes central to the successful management of pain for terminally ill patients

not, controlling,

Palliative care is _______ curative in _________ but aims to relieve pain and distress and to control ________ of the disease

not, nature, symptoms

Ethical issues that sometimes arise when dealing with hospice patients include withholding or withdrawing _________ support, the right to refuse __________, and ________ orders.

nutritional, treatment, DNR

Bronchodilators sometimes ease respiratory __________ and ease the respiratory distress. In many cases, ____-____ hours before death, the patient exhibits the "________ _________," which is the result of an accumulation of mucus and fluids in the posterior area of the _______.

obstructions, 24-48, death rattle, pharynx

Clinicians use many different pain assessments, such as OLD CARTS, which stands for:

onset location duration character of pain aggravating & alleviating factors relieving factors treatments severity

Nausea is a common side effect with the initiation of _________ treatment. This side effect usually subsides after a time, and the best response is to use an antiemetic rather than ___________ the opioid

opioid, discontinue

Nonsteroidal drugs can be administered along with the _________ to enhance the medication's effectiveness. _________ administration of analgesics is not always feasible because of nausea and vomiting, obstruction, or inability to swallow, and other routes may be considered

opioids, oral

If anorexia is related to stomatitis or infections, good _______ _________ is important. A technique to alleviate discomfort of the mouth is to use sponge-tipped oral __________ soaked in ___________.

oral hygiene, swabs, mouthwash

______ medications may be preferable because they help the patient and the caregiver manage the __________ and administration more easily. After the severity of pain and the type of medication to be used are determined, the dosage of the medication must be ________

oral, scheduling, titrated

________ may not actually relieve the dyspnea, but it often eases the ________ of both the patient and the caregiver. Sublingual morphine helps ______ the patient's respiratory effort, thus enabling greater respiratory efficiency.

oxygen, anxiety, relax

Of all the symptoms that a dying patient experiences, ________ is the most dreaded and _________; therefore, pain management is a _________ in hospice

pain, feared, priority

Saunders devoted her life to improving ______ management and _________ control for people who were dying. She believed it is important for each patient to know his or her own ___________ to life and that his or her life had meaning

pain, symptom, contribution

Palliative care emphasizes the control of _______, relief of _________, and provision of ___________, ________, and spiritual assistance. It is possible to begin palliative care ________ in the dying process, whereas hospice is usually available only in the last 6 months of life.

pain, symptoms, psychological, social, early

hollistic

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

Once the criteria are met and a patient is admitted to hospice, the staff performs complete __________l, ___________, and _________ assessments, and those involved discuss the care openly.

physical, psychosocial, spiritual

Other services, if needed, are available from a ___________ therapist, a ___________-language pathologist, and an ___________ therapist. These services are available not for rehabilitative purposes but to assist with improving the ___________ of life and care for the patient and the caregiver

physical, speech, occupational, quality

If poor oral intake of either food or fluids is affecting the quality of life, it is necessary to make adjustments to the ________ _____ ______

plan of care

The occupational therapist helps with____________ for comfort, providing adaptive ___________ for the patient, or other assistance for comfort and for ________

positioning, equipment, adl's

If the odor of food causes anorexia, the patient should not be in the kitchen during meal ___________, or family, friends, or volunteers may bring in meals. The meals should be made as ___________ as possible, consisting of foods the patient _________.

preparation, attractive, chooses

At times, the treatment of the nausea is as simple as bringing in food already ____________ so that the cooking smells do not bother the patient. Sometimes the _______ used for pain control cause nausea; __________ may be administered with the opioid analgesic.

prepared, drugs, antiemetics

Even though the family feels they have _________ for the death, facing the future without the person who died is difficult. Many people believe that _____ full seasons must pass before bereaved persons are able to think of the deceased without feeling intense emotional pain, but this period is ________ for everyone.

prepared, four, different

Antiemetic drugs such as ___________ (Compazine) and ___________ (Phenergan) suppositories may be administered if possible until the _________ is controlled, and then oral drugs may be administered _____________ to prevent the nausea from returning.

prochlorperazine, promethazine, nausea, prophylactically

High-__________ supplements are helpful when eating is difficult. The nurse should avoid ____________ the patient because sometimes the patient becomes depressed and discouraged by attention to weight loss.

protein, weighing

Each hospice patient is assigned a primary team that consists of the patient's own health care ___________, the primary hospice _________, the _________ worker, a primary hospice ______, a primary ____________, and a __________ leader.

provider, nurse, social, aide, volunteer, spiritual

Skilled team members, including health care __________, _________, hospice ________, ________ workers, __________ leaders, __________ coordinators, and ___________ make visits to the home or wherever the patient most often resides.

providers, nurses, aides, social, spiritual, bereavement, volunteers

___________ therapy, _________ blocks, and psychological or physical methods all can be tried in appropriate circumstances. Hot or cold packs at the _______ of discomfort, repositioning the patient, music therapy, relaxation techniques, acupuncture, and even transcutaneous electric nerve stimulation (TENS) are sometimes good alternatives.

radiation, nerve, site

Changing the ________ of administration sometimes also provides some relief. Transdermal _________ has proven to be associated with significantly less constipation than has sustained-release oral ________ (the drugs were equally effective in treating pain)

rate, fentanyl, morphine

A ________ examination may be necessary to check for an _________, along with manual removal of stool. The Fleet enema helps soften and __________ a hard impaction whose removal is otherwise a __________ procedure

rectal, impaction, dissolve, painful

The nurse coordinator is a ___________ nurse who coordinates the ____________ of the plan of care for each patient. The nurse coordinator often performs the _________ assessment, admits the patient to the hospice program, and develops the plan of care along with the interdisciplinary team.

registred, implementation, initial

The use of alternative treatment such as music therapy and relaxation methods to aid in pain control should also be encouraged. It is important to give encouragement and positive _____________ to the patient and the family in their efforts at following the plan.

reinforcement

If pressure ulcers occur, cleaning with normal _________, drying well, and applying a skin ___________ are helpful measures. Caregivers must be able to prevent falls and injuries, and the nurse should provide information regarding home safety

saline, protector

Sleeplessness and insomnia sometimes occur as a result of an accumulation of ____________ and ______________, and exhaustion has the potential to cause an __________ of all other signs and symptoms.

signs, symptoms, exacerbation

Benzodiazepines are not for use as _________-agent ____________, but they are often extremely effective when used in ______________ with other antiemetics or for treating nausea and vomiting associated with anxiety. Drugs in this class, such as lorazepam (Ativan) or alprazolam (Xanax), reduce anxiety, although they tend to be sedating.

single, antiemetics, conjunction

titrated

slowly increased to the level at which the drug is therapeutic

Eating ________ and in a pleasant ____________, with relaxation and _______ periods after eating, is a good way to control the nausea. If vomiting occurs, the nurse should discourage eating for a short time until peristalsis ________

slowly, atmosphere, rest, stabilizes

The skin should be inspected frequently and kept as dry and clean as possible. The nurse must stress the need to avoid harsh_____________, strong ____________, and irritation by ___________, __________, or food __________.

soaps, detergents, buttons, snaps, crumbs

It is essential for the assessor to be nonjudgmental and accepting of the patient's and the caregiver's spiritual beliefs. The _________ _______ may also assist with the relationship between the patient and the caregiver and provide _________ to resolve conflict

social worker, counseling

Weight loss and dehydration sometimes lead to a decrease in ________ ________, especially on the bony areas of knees, hips, elbows, and buttocks, which can lead to skin impairment.

soft tissue

Funeral planning and performing funeral services are also included in the _________ __________ role, as is continued support for the family throughout the ___________ period. In addition, the spiritual coordinator is one resource to assist with _________ differences

spiritual coordinator, bereavement, cultural

Spiritual issues should be referred to the __________ _________ and not used as an opening to share personal feelings and beliefs unless the patient specifically asks for that perspective. The hospice organization determines whether the _______ or the spiritual coordinator performs the spiritual assessment

spiritual coordinator, nurse

Many symptoms such as depression, the need to _________, bitterness, anger, hallucinations, or dreams of ______ are, in some cases, indicative of _______ spiritual needs.

suffer, fire, unmet

As with other drugs, if inability to swallow or nausea and vomiting are also a problem, other routes, such as __________ or __________, should be considered

suppositories, enemas

If the cause of the anorexia is untreatable, as in the case of _______ _________, the patient and the caregiver may need additional __________ support.

tumor invasion, emotional

Ineffective pain management is usually associated with _______________ as a result of common myths and fears. The myths and fears are ____________, ___________, and ____________ depression.

undermedication, addiction, tolerance, respiratory

spiritual ________ and issues are often interrelated with __________ problems and have the potential to surface, especially when symptoms are uncontrolled. It is always necessary to respect any religious or spiritual concerns and meet the patient's wishes if at all possible.

unrest, psychosocial

f anxiety and fear are causing nausea and vomiting, ___________ the fears is often helpful. Under no circumstances is it ever acceptable to force the patient to eat food or drink fluids if he or she has no desire to eat because this also has potential to compromise _________ and be detrimental to the patient's _____-______

verbalizing, dignity, well-being

Pain that originates from the internal organs is called ____________ pain. The words people commonly use to describe this are "___________," "___________," "______ pain," or "squeezing pain."

visceral, cramping, pressure, dull

OLDCART assessment is performed with every patient __________ and every new __________ or __________ in pain. Assessment of pain is ___________; any change in the intensity

visit, complaint, increase, ongoing

Increased _________ is also notable in the last stages of a terminal illness; it often leads to activity intolerance and causes the patient to spend most of the time ___________. This leads to a risk for skin impairment and the formation of pressure ulcers

weakness, reclining

Supporting and educating the patient and the caregiver are the nurse's primary concerns. The following points should be covered with the patient and the caregiver:

•A decrease in oral intake will also decrease the amount of stool expelled. •Even though a patient does not have oral intake, bowel movements can still occur in some cases. •Opioids pose a risk of constipation, and so patients who receive opioids should also take laxatives. •Comfort is the all-important factor. If the patient has not had a bowel movement, discomfort, bowel sounds, and firmness of abdomen must be assessed before any active treatment.

HOSPICE GOALS:

•Controlling or alleviating the patient's symptoms •Allowing the patient and caregiver to be involved in the decisions regarding the plan of care •Encouraging the patient and caregiver to live life to the fullest •Providing continuous support to maintain patient and family confidence •Educating and supporting the primary caregiver in the home setting that the patient chooses

CRITERIA FOR HOSPICE:

•The health care provider must certify patient has a prognosis of 6 months or less to live & The health care provider must have a doctorate of medicine or osteopathy to make the prognosis determination. •For the patient to qualify for Medicare or Medicaid assistance, two health care providers are required to verify that the patient is dying and has less than 6 months to live. & documented by the medical provider in a narrative that supports the reason for the limited life expectancy. The hospice patient who continues to live beyond the estimated time period still qualifies for Medicare if hospice criteria are still met. •It is mandatory that the patient desires the services. The patient and caregiver must understand that all treatment will be palliative and that no further curative treatment will be rendered. •The patient and caregiver are required to understand and agree that hospice staff will plan the care according to comfort and that they will not necessarily perform life-support measures. •The patient and caregiver—or, if the patient is unable to participate, the caregiver—are required to understand the prognosis and be willing to participate in the planning of care.