Chapter 40: Hospice Care (Theory)

Titrate

Slowly increase the amount of drug to find the therapeutic dose.

What is the function of the hospice volunteer:

-volunteer training -provides companionship -available for short periods of respite care

What criteria must be met to be admitted into hopsice:

1. Attending physician has to certify that the patient's illness is terminal and the patient has a prognosis of 6 months or less to live. 2. For Medicare/Medicaid, 2 physicians are required to state dying patient's prognosis 3. It is mandatory that the patient desires the services.The patient has to be willing to forgo any further curative treatment and be willing to seek only palliative care. 4. 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. 5. The patient and caregiver are required to understand the prognosis and be willing to participate in the planning of care.

Goals of Hospice:

1. Controlling/alleviating the patient's symptoms 2. Allowing patient/caregiver be invovled in all decision regarding plan of care. 3. Encouraging the patient&caregiver to live life to the fullest. 4. Providing continuous support to maintain patient & family confidence. 5. Educationg and supporting the primary caregiver in the homest setting that the patient chooses.

What does palliative care emphasize:

The control of pain, relief of symptoms, and provision of psychological, social, and spiritual assistance.

Respite Care

A period of relief from responsibilities of caring for a patient

Hospice

A philosophy of care about providing support to patients with terminal illness and their families.

What does dyspnea arise from:

A variety of possible conditions such as heart failure, dysrhythmias, infections, ascites, or tumor growth.

Adjuvant

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

Where and when did the first hospice program open in the United States:

Connecticut in 1971

What is one of the most common problems of the terminally ill patients:

Constipation

Palliative Care

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

Pain Assessment

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

What is the function of the Nurse Coordinator:

- RN nurse -Does initial assessment -Manages the patient care - Explains the service, admits the patients, assigns the primary team

What is the function of the Social Worker:

-Bachelor's Degree -Evaluates the psychosocial needs -Resource for potential community services -Assists with counseling in grief issues

What is the function of the Volunteer Coordinator:

-Experience in volunteer work -recruits and trains the volunteers -coordinates assignments of volunteers

What is the function of the Medical Director:

-Licensed Physician -Mediator between the hospice team and attending physician - Provides consultation relative to the medical aspect of care.

What is the function of the Primary Physician:

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

What is the function of the Hospice Pharmacist:

-Licensed registered pharmacist -provides drug consultation

Factors that contribute to constipation:

-Poor dietary intake -Poor fluid intake -Hypercalcemia -Hyponatremia -Tumor Compression of Bowel -Use of opioids for Pain Control -Decrease in physical activity.

What is the function of the Bereavement Coordinator:

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

What is the function of the Primary Nurse:

-RN -Liasion between patient and caregiver, physician, and interdisciplinary team -Evaluates patient's response to treatment -Educates the patient and family in diseease process and care -Assesses symptom management -Provides emotional support to patient caregiver.

What is the function Primary Spiritual Leader:

-Religious group -Supports patient and caregiver to cope with fears and uncertainty of spiritual issues.

What is the function of Spiritual Coordinator:

-Seminary Degree -Liasion between the patient and spiritual community -Coordinates spiritual support

What are ethical issues that are dealt with in hospice patients:

-Withholding nutritional support -Right to refuse treatment -DNR

Educating patient and families regarding constipation:

-a decrease in oral intake will decrease amount of stool expelled -a patient does not have oral intake, bowel movements will still be possible in some cases. -opioids pose a risk of constipation, so it is necessary to give laxatives. -comfort is the all important factor.

Signs and symptoms of approaching death:

-arms and legs of body sometimes become cool to the touch -spends more time sleeping during the day and difficult to arouse -increasingly confused about time, place, and identity of close/familiar people. -incontinence of urine and bowel movement -oral secretions more profuse and collect in the back of th throat -clarity of hearing and vision decrease slightly -restlessness -decrease need for food and drink -breathing patterns change -changes in vital signs occur.

What is the function of the Hospice Aide:

-home health aide -administers personal care and assistance with bathing.

Types of Medications for Hospice Care patients:

-morphine sulfate (pain) -fentanyl (pain) -Droperidol (antiemetic) -prochlorperzine (atiemetic) -Senna (constipation) -lorazepam (antianxiety)

Who are the core interdisciplinary hopsice team members:

1. Medical Director 2. Nurse Coordinator 3. Social Worker 4. Spiritual Coordinator

What are 3 main types of pain:

1. Somatic Pain 2. Visceral Pain 3. Neuropathic Pain

Who is part of the primary hospice team:

1. Volunteer Coordinator 2. Bereavement Coordinator 3. Hospice Pharmacist 4. Primary physician 5. Primary nurse 6. Primary spiritual leader 7. Hospice Volunteer 8. Hospice Aide

Psychosocial

A combination of psychological and social factors

Bereavement

A common depressed reaction to the death of someone close

Terminal Illness

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

What level of pain effects quality of life:

Any pain over 5 on the 1-10 scale.

Somatic Pain

Arises from the musculoskeletal system and is described as aching, stabbing, or throbbing. NSAIDs, Nonopioid Drugs.

Neuropathic Pain

Arises from the nerves and the nervous system Tingling, burning, or shooting pains. Anticonvulsants

How long does the bereavement coordinator follow the plan of care following the death:

At least 1 year

What person renewed the idea of hospice in 1960 in London:

Dame Cicely Saunders

What do patients often experience 24 to 48 hours before death:

Death Rattle

Emphasize on Hopsice Care:

Hospice care emphasizes quality and not quantity of life.

What leads to an increased risk for skin impairment:

Increased weakness

Curative Treatment

Is aggressive care in which the goal and intent is curing the disease and proloning life at all cost.

Interdisciplinary Team

Multiprofessional health team working together in caring for the terminally ill patient

Cachexia

Malnutrition marked by weaknes and emaciation

What member is not part of the Hospice Team in any way?

Mental Health provider

What is often the drug of choice for the hospice patient:

Morphine

What does poor appetite potentially arise from:

N&V, constipation, dysphagia, stomatitis, tumor invasion, general deterioration of body, depression, or infections.

Primary Caregiver

One who assuems ongoing responsibility for health maintenance and therapy for the illness.

When should you use suctioning:

Only when a patient is choking and unable to recover.

Visceral Pain

Originates from the internal organs. Describe cramping, pressure dull, or squeezing pain. Anticholinergic Meds. or Opioids

What is the priority for symptom management:

Pain

What is the symptoms most dreaded and feared in a dying patient:

Pain

What is the idea around palliative care:

Palliative care is not giving up hope; it is full of hope of a good, fulfilling life.

Holistic

Pertaining to the total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person.

What type of other services are available for a person on hospice:

Physical therapist Speech language pathologist Occupational therapist

Death Rattle

The result of accumulation of mucus and fluids in the posterior area of the pharynx.

What are the goal of hospice:

To maximize the quality of life and keep the patient as comfortable as possible in the home setting that he or she chooses.

What is the philosophy of hospice:

To promote comfort and use compassion, interest, and genuine concern to allow the patient to live a better lifestyle during the dying process.

What is air hunger caused by:

Tumor pressure, fluid and electrolyte imbalance, or anemia

When is hospice care appropriate:

When active, curative treatment is no longer effective and supportive measures are necessary to assist the terminally ill patient through the dying process.

What are major anxiety producing symptoms of terminal illness:

anorexia and malnutrition

Examples of unmet spiritual needs:

depression the need to suffer bitterness anger hallucinations dreams of fire

Is palliative care curable:

palliative care is not curative in nature but aims to relieve pain and distress and to contorl symptoms of the disease.

What will lead to a decrease in soft tissues:

weight loss and dehydration