Study guide for Ch. 25 & 40

The hospice spiritual coordinator can be affiliated with any religion, assists with the spiritual assessment of the patient, and develops the plan of care regarding spiritual matters. To work in a hospice, what degree should the spiritual coordinator possess?

Seminary degree

During a pain assessment, the patient tells the nurse that the pain is aching, stabbing, and throbbing. What type of pain is the patient describing?

Somatic

List the signs and symptoms of approaching death:

The arms and legs of the body sometimes become cool to the touch and the underside of the body sometimes becomes darker. The patient may spend more time sleeping during the day and at times is difficult to arouse. The patient may become increasingly confused about time place and identity of close and familiar people. Incontinence of urine and bowel movements often happens when death is imminent. Sometimes there is a significant decrease in urine output. Oral secretions sometimes become more profuse and collect in the back of the throat. This produces the sound often. Referred to as the death rattle. Clarity of hearing and vision decrease slightly. Restlessness, pulling at bed linen, and having visions if people or things that do not exist sometimes occur. The patients need for food and drink decreases. Breathing patterns change to an irregular pace they are sometimes 10 to 30 second periods of no breathing. Changes in vitals occur with decreased BP and elevated pulse.

A nurse is caring for the dying mother of a 7-year-old child. What is important for the nurse to understand regarding the child?

The child associates death with aggression.

What is an interdisciplinary team and who are generally members of this health care team?

A multi-professional Health team whose members work together in caring for a terminally ill patient develops and supervises the plan of care in conjunction with all those involved with the care. The core interdisciplinary team members are the medical director, the nurse coordinator, the social worker, and the spiritual coordinator. To promote support to the dying patient and the caregiver the interdisciplinary team considers all aspects of the family unit. They include the family and all decisions and Care planning because families also experienced the stresses of the terminal illness and death of the patient. These stresses also extend into the bereavement period After the patient dies.

How does a perceived loss differ from an actual loss?

A perceived loss is easily overlooked.

What are the tasks that may facilitate the healthy adjustment to loss?

Accepting the reality of the loss, experiencing the pain of grief, adjusting to an environment that no longer includes the lost person, object, or aspect of self, reinvesting emotional energy into new relationships. The successful completion of these tasks leads to healthy adjustments to loss.

The home health nurse assesses that the goal of grief resolution has been accomplished when the nurse observes that a widow has performed which activities? (Select all that apply.)

Adjusted to an environment without the spouse; Sought new relationships

The hospice nurse recommends that the patient prepare the document that provides guidance to the family concerning the patient's wishes regarding life-support measures and organ donation. What is this document called?

Advance directive

When a deficiency in nutritional status of a patient is assessed, what action should be taken by the hospice nurse?

Alert the licensed medical nutritionist.

What are the goals of hospice service? (Select all that apply.)

Alleviating symptoms of approaching death; Educating and supporting primary caregivers; Using family input for designing a plan of care; Encouraging patients and caregivers to enjoy life

What is the most common problem of the terminally ill patient that is caused by narcotics?

Constipation

The nurse should educate the patient and caregiver that large doses of narcotics are required to control pain. What is the optimal dose for pain medications?

The dose that provides pain relief

A young nurse caring for a dying patient hastens through the care and leaves the room as quickly as possible. What common reaction to the care of the dying is the nurse exhibiting?

Withdrawal

A dying patient uses the call light frequently to ask the nurse to do simple tasks. The nurse recognizes this as a fear of:

abandonment

What are the drugs of choice when caring for the hospice patient?

Morphine derivatives

The patient informs the hospice nurse, "I'm not sold on this hospice thing. I'm not looking for Jesus, I'm just dying." What would be the most therapeutic response by the nurse?

"Hospice service is about how to make your remaining time meaningful."

When educating a patient concerning ways to prevent nausea, the nurse suggests that eating slowly in a pleasant atmosphere will help, as well as taking an antiemetic before meals. How many minutes before meals should the patient take the antiemetic?

30

The hospice nurse explains that to qualify for admission to a hospice, the attending health care provider must certify that the patient has a life expectancy of fewer than how many months?

6 months

Palliative care:

An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems psychosocial and spiritual.

Because the family is confused about the meaning of palliative care, the hospice nurse needs to explain the focus of care. What is the focus of palliative care?

An integrated service of support for alleviation of symptoms

Which of the following is an expected part of the end-of-dying process?

Anorexia

The nurse warns that nausea is a common side effect with opioid treatment. What is the best treatment for nausea caused by opioids?

Antiemetics

Somatic pain:

Arises from the musculoskeletal system and as described as a teen stabbing or throbbing. NSAIDS , non-opioid drugs, and opioid drugs are often effective in treating somatic pain.

Neuropathic pain:

Arises from the nerves and the nervous system. Tingling burning or shooting pains often have neuropathic causes.

What is the first thing the nurse should do before involving the family in the care of a dying patient?

Ask family members if they want to assist with care.

What should the nurse do before approaching a grieving family member?

Assess level of resolution

The hospice nurse requests that the patient designate a primary caregiver for himself. What is true of the primary caregiver?

Assumes ongoing responsibility for health maintenance of the patient.

The social worker evaluates and assesses the psychosocial needs of the patient. To work in a hospice, the social worker must have at least which degree?

Bachelor's

What are the duties of the nurse once the patient has been pronounced dead by a physician or a professional nurse and before the family views the body?

Because of the therapeutic nurse-patient relationship the nurse may be the best person to provide post-mortem care. Keep in mind the need to care for the patient's body with dignity and sensitivity. Provide post-mortem care as soon as possible after death to prevent tissue damage or disfigurement. If the family has requested organ donation take immediate measures as appropriate. Know the state laws and policies and procedures of the employing institution. Prepare the body and the room to keep the stress of the experience to a minimum after the patient has been pronounced dead by a healthcare provider or professional nurse and before the family views the body. Remove supplies and equipment from site. Remove clamp or cut tubes that remain in the body with the one-inch of the skin and tape them into place. Care of tubes and specimens depends on agency policy and whether an autopsy will be performed. Net however remove tubes dressing strains and other equipment that is in place on or in the patient when an autopsy is to be performed. Clear Away soiled linen and other clutter. You spray deodorizer to help eliminate unpleasant odors. Prepare the body by making it look as natural and comfortable as possible. Place the body in the Supine position with arms at the sides Palms down or across the abdomen but not one hand over the other this helps a mortician better prepare it for interment. Discoloration of the face can result if blood is allowed to pull to prevent this place a small pillow or folded towel under the head silage usually remain closed if gently hold on for a few seconds. If not a moisten cotton ball can hold them in place. Insert the patient's Dentures to remain normal facial features. A rolled-up towel under the chin keeps their mouth closed. At the time of death making notation of any valuable such as watches Rings or money and securities article so they may be delivered to the family according to agency policy. Documentation of all valuables and their disposition in the patient's medical record is required. Offer the family opportunity to view the body and often helpful suggestion is that this is an opportunity to say goodbye to their loved one especially if they were not present at the time of death. It's a family has a taste of you the body and let them think about it. If they decide not to view the body except a decision without judgment. I said family decides to view the body assure them that they will not be alone if they prefer the nurse to be present. Offer to accompany them or ask him to call on someone else to be present if they would like. Spend as much time as possible assisting The Grieving family and offer to contact other support services such as social services and the spiritual advisor. Many Healthcare facilities employed full-time chaplain who may be summoned in the event of death. The family now becomes the patient.

Describe "attending behavior" when communicating to the dying patient:

Behavior that indicates listening to the patient is called attending Behavior. It includes appropriate I contact a tenant body language and verbally acknowledging that the nurse is listening by using terms such as aha I understand what you're saying or go on. Demonstrate attentiveness and nonverbal and verbal ways. For instant sit in the chair close to the patient's bed to reduce the physical distance and the emotional distance it implies. When appropriately used touching is a highly effective means of communication. Later in the illness when strength for or interest in verbal communication has dwindled a patient arrives benefit from being touched. Patting a hand, gently wiping away tears , indicates attending behavior and concern and care. Remember that you cannot solve the problem of dying but you can have a positive impact of a Dying patient's feelings and fears. Communicate openly and sensitively with the patient. This facilitates the expression of emotion and affirms that the patient is a living human who is your support and compassion.

The nurse spends a great deal of time in the room of a dying 12-year-old because the nurse knows that most children are aware of their condition and want the nurse to do which of the following?

Care about them.

Who was responsible for renewing the hospice philosophy in the 1960s?

Cicely Saunders

When air hunger is assessed in the dying patient, the nurse can perform which interventions? (Select all that apply.)

Circulate the air with a fan; Use a tranquilizer to decrease anxiety; Provide good oral hygiene; Raise the head of the bed 30 degrees.

The hospice nurse clarifies that hospice service is initiated when what type of treatment is no longer effective?

Curative

The nurse differentiates between curative and palliative care. What is true of curative treatment?

Curative treatment is focused on prolonging life.

What is the final stage of human growth and development?

Death

Upon being told of her father's death, the daughter cries out, "No! Oh, God, no!" What stage of grief is the daughter in?

Denial

When a nurse informs a patient's spouse that the patient has died, the spouse states, "You must be mistaken." Which of Kübler-Ross's stages of dying is the spouse demonstrating?

Denial

A patient whose spouse died 1 year earlier complains of feeling overwhelmingly lonely and has withdrawn from interpersonal interactions. The patient is demonstrating what stage of dying according to Kübler-Ross's stages of dying theory?

Depression

The hospice nurse instructs the family that they have access to a hospice pharmacist, who is available for consultation on the drugs the hospice patient may be taking. What other role does the hospice pharmacist fill?

Evaluate drug interactions with food and other medications.

List the factors that influence grief in older adults:

Factors that influence grief in older adults include the following physical changes that accompany aging, loss of employment, loss of social respect, loss of relationships, loss of self care capabilities, fear of loss of control, sense of fulfillment and contributions maid, personality traits, feelings of self-worth, degree to which functional ability is retained.

What special considerations should be addressed so that parents and family can grieve after experiencing a perinatal death?

Give special consideration to permitting the parents and family to grieve adequately. Loved ones have few or no memories about the child to hold onto and acting as though it never happened places parents in Jeopardy of living with unresolved grief. When possible and Mabel the parents to see touch and hold the infant so that they can face the reality of the situation and resolve their grief. Listen attentively and allow the parents to express their feelings over their loss. Refer to the baby as your baby your son or your daughter or use the given name to reinforce that the baby was a unique individual who was loved and will be missed. Support the usual cultural rituals after death for the baby such as a funeral or memorial service. Some agencies give a lock of the baby's hair a blanket the baby was wrapped in or an identification bracelet to the parents. In some cases parents have refused these items only to express a desire for these memories later on. Most agencies hold these items until a time when the parents may desire the objects. A disposable camera may even be provided to the family. Agencies also often acknowledged the first year anniversary of the infant's death. Other agencies provide Angel boxes which are decorated or painted Memorial boxes contain some mementos for the bereaved parents. Suggested items for the angel boxes are booklets on loss and coping with the loss a wooden Angel a crocheted angel that was touched by the newborn or used during the pictures a quote or crocheted blanket a lock of hair of the newborn if the hair is long enough Footprints and handprints a clay imprint of the foot sees the plant in remembrance of the infant and the digital camera card with pictures of the infant. The angel gown program provides Comfort to the bereaved families through the gift of a beautiful custom-made gown or vest for final photos and for the burial services along with support resources and mentoring programs for the family. Now I lay me down to sleep provides a specially trained photographer to take pictures of the infant and the family for free. Each agency handles the death of an infant in a specific way please check with your facility for the nursing practices being used.

The hospice nurse introduced the family to the volunteer coordinator who will assign a volunteer to the patient. What can a hospice volunteer do for a patient and caregiver?

Give the family respite.

After a health care provider in the emergency department has pronounced a 2-year-old dead following a swimming pool accident, the mother tearfully says to the father, "I am so sorry. I am so sorry." What is the mother expressing?

Guilt

Who conducts the nutritional assessment at the time of admission to hospice care?

Hospice nurse

What are the two laws that impact organ donations?

In most States National Organ transplantation ACT public law required request laws stipulate that at the time of a person's stats a qualified health care provider must ask family members to consider organ and tissue donation. Required request laws are the result of the shortage of suitable organs for transplant. The uniform Anatomical Gift Act addresses many problems of organ donation and stipulates that the healthcare provider who certifies death shall not be involved in removal or transplantation of the organs. The National Organ transplantation act which governs this area of medical and nursing practice prohibit selling or purchasing organs. Organ and tissue donation to remain voluntary.

What is the most important source of information regarding the assessment of pain?

Initial and routine assessments are vital for managing pain and the patient is the primary source of information. The patient's self-report of intensity quality and management of paints provides the most significant data. The pain assessment evaluation of the factors that Olivier or exaggerate a patient's pain should include information about the severity and the history of the pain and what brings relief to the patient. Pain assessment begins with the patient self-report and the patient rights of pain on the scale of 0 no pain at all to 10 the worst imaginable Pain. Any pain the patient rates at a 5 or higher on the Pain Scale has a great effect on the quality of life. Clinicians may use different pain assessments.

Curative treatment:

Is aggressive care in which the goal and intent are curing the disease and prolonging life at all cost. 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's is to decide weather continued active therapy is feasible or beneficial. By that time the patient already may have experienced many debilitating physical and emotional symptoms as a result of the treatments or the progression of the disease. This situation leads the patient and family to decide whether to continue with Curative treatments or to transition to palliative measures. Palliative care is not Curative the aims to relieve pain and distress and to control symptoms of disease. It is important to give the patient and caregiver honest and accurate information so that they are able to make a appropriate decisions.

How is a durable power of attorney helpful to an incapacitated patient?

It directs an agent to make health care decisions.

Which are signs and symptoms of approaching death? (Select all that apply.)

Mottled extremities; Increased restlessness and pulling at bed linens; Alteration in rhythmic respiration; Increased pulse rate

How would a hospice patient's care wishes be made known in advance?

It is helpful when the patient makes his or her wishes known in advance as in a living will or an advance directive or signs a durable power of attorney. An advance directive is a document prepared while an individual is live incompetent it provides guidance to the family and the Healthcare team in the event that the individual is no longer capable of making decisions. The directive States the individuals preferences concerning life support measures and organ donations and sometimes gives authority to another person to make decisions for the individual who at that point maybe in a coma. Physicians orders for life-sustaining treatment is a form completed by the medical provider and the patient to inform Healthcare Providers of the patient's wishes. This or may be referred to by other names in different states. It is a shorter form then the advance directive with a few simple questions that can be filled out in a few minutes. This may be used in addition to or instead of the advance directive it has proven to be more effective in preventing medical error that arise from not following patients wishes. Completion of this form is encouraged for all nursing home patients and for patients entering the hospital or hospice.

Why should the hospice nurse delay the use of oropharyngeal suctioning?

It will be uncomfortable for the patient.

What is the overall objective of hospice service?

Keep the patient comfortable as death approaches.

Describe the two basic advance directives:

Living wills and durable Powers of Attorney for Health Care. Many patients have instituted one or both. Advance directives are signed and witnessed documents that provide specific instructions for healthcare treatment if a person is unable to make these decisions personally at the time they are needed.

Following the death of a day-old infant, the nurse brings the baby to the parents. What is the rationale for the parents' visit with the deceased baby?

Make the death a reality.

The hospice nurse documents an assessment finding of cachexia in the patient record. What does cachexia describe?

Marked weakness and emaciation

The hospice nurse educates the patient and family about the members of the interdisciplinary team. Which caregivers are included? (Select all that apply.)

Medical director; Nurse coordinator; Social worker; Spiritual coordinator

Changes in health care reimbursement measures have resulted in which of the following changes regarding care of the terminally ill?

More patients die at home.

Which medication relaxes the patient's respiratory effort and thus increases the efficiency of the patient's respiratory status?

Morphine

Explain the acronym "OLD CARTS.":

O- Onset L-location D- duration C-character of pain A- aggravating factors R- relieving factors T- treatments S- severity A pain assessment tool

The hospice nurse tells the family that the nurse coordinator, an RN, will visit them. What is the role of the nurse coordinator?

Officially admit the patient to the hospice service.

When supporting and educating the hospice patient and caregiver regarding the treatment of constipation, what points should be covered with the patient and caregiver?

One of the most common problems of terminally ill patients is constipation. Constipation has many possible causes and assessment as to the cause is fundamental for treating it adequately. Sometimes this problem causes more anxiety and discomfort then pain itself. Cause constipation has the capacity to cause other symptoms such as abdominal pain, nausea, or vomiting prevention of the problem is important. Factors that contribute to constipation are poor dietary intake for fluid intake hypercalcemia hyponatremia tumor compression of the bow use of opioids for pain control and decrease in physical activity. Opioid Administration can be followed by administration of a stool softener and a stimulant as well. Some opioids are more likely to cause constipation and others in such cases a different opioid may be helpful. Changing the rate of administration sometimes also provide some relief. As well as other drugs if inability to swallow or nausea and vomiting are also a problem other routes such as suppositories or enemas should be considered. A rectal examination may be necessary to check for an impaction along with manual removal of stool. It's more volume and a might help soften and dissolve a hard impaction whose removal is otherwise a painful procedure. Pre medicating the patient with an anxiolytic and an analgesic before the removal of an impaction may help the patient better tolerate the procedure. Supporting and educating the patient and the caregiver are the nurses primary concerns. The following points should be covered with the patient and caregiver: a decrease in oral intake will decrease the amount of stool expelled, even though a patient doesn't have oral intake bowel movements can still occur in some cases, opioids pose a risk of constipation 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 the abdomen must be assessed before any active treatment.

The hospice nurse instructs the family that they have access to a bereavement coordinator who follows the plan of care focused on the caregiver after the death of the patient. For how long of a period of time will the caregiver and family have access to the bereavement coordinator?

One year

What symptom of hospice patients is the most dreaded and feared, and should be a priority of symptom management?

Pain

Visceral/dull/squeezing pain:

Pain that originates from the internal organs.

Define palliative care:

Palliative care the prevention relief reduction or soothing of symptoms of the disease or disorders without affecting the Cure. Palliative care allows patients to make more informed choices achieve better alleviation of symptoms and have more opportunity to work on issues of Life closure. Palliative care is a philosophy of Total Care. Palliative care is appropriate to deliver at any time and two patients of any age with any diagnosis. Although it has particular relevance to the care of the terminally ill it is not served for only the last few months of Life. The approach to care usually involves an interdisciplinary team of healthcare providers nurses social workers Pastoral Care Professionals physical and occupational therapist and pharmacist. Massage therapist or music or art therapist who provide alternative therapies are also part of the team. In the context of end-of-life a palliative care approach ensures that a patient experiences a good death free of avoidable pain and suffering and a cord with the patient's and family's wishes and recently consistent with clinical cultural and ethical standards.

What is the termination of tube feedings to a dying patient considered?

Passive euthanasia

Which of the five aspects of human functioning must a nurse address when dealing with a grieving person? (Select all that apply.)

Physical; Emotional; Intellectual; Spiritual

The hospice nurse instructs caregivers in repositioning the patient because the patient spends most of the time reclining. What problem can this cause?

Pressure injuries

The patient must meet what criteria before being admitted to a hospice?

The health care provider must certify that the patient's illness is terminal and that the patient has a prognosis of six months or less to live. The healthcare provider must have a doctorate of medicine or osteopathy to make the prognosis determination. For the patient to qualify for Medicare or Medicaid assistance to healthcare providers are required to verify that the patient is dying and has less than 6 months to live. This must be 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. 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-supporting measures. The patient and caregiver or if the patient is unable to her to participate the caregiver are required to understand the prognosis and be willing to participate in the planning of care.

Describe the role of the hospice aide:

The hospice aide is a certified nurse's aide who works under the supervision of the hospice nurse. The hospice aide follows the plan of care that the interdisciplinary team develops and assist the patient with bathing and he hygiene including hair male Oral & Skin Care. The hospice aide sometimes also assist the patient or the caregiver with light housekeeping services. The patient and the hospice aide often develop a close relationship and in some cases the patient shares feelings the aide more easily than with any other member of the team.

Which of the following would lead the home health nurse to make a patient problem of unresolved grief for a patient who was widowed 5 months ago?

The patient said tearfully, "I can't believe he is gone."

When the nurse is developing a care plan for a terminally ill patient, what might be a realistic goal?

The patient will function optimally.

Explain an "out-of-sequence" loss:

The sudden death of someone who is not "supposed to die" sometimes referred to as out of sequence desk is the most difficult grief to Bear. The clearest example is the death of a child especially one who has live long enough to have a distinct personality and position in the family. If the death is a violent and sudden won the Los is particularly devastating. Parents and siblings are often wrapped by powerful and personal emotions of guilt denial and anger as well as sorrow. 1 protective impulse is to blame someone perhaps oneself for not having been more careful or more loving perhaps a spouse and perhaps even the dead child. Blame and guilt May destroy family just one family members need one another than most. The Compassionate Friends and National self-help support organization assist families after the death of a child finds that many married couples are driven apart by their separate reactions to the desk. Perhaps one parent needs to talk about the death whereas the other cannot bear to hear child's name. Siblings suffer to partly because parents are so involved in their own groups that the surviving children are deprived of attention and partly because a child's grave may follow a different course from that of an adult's. Denial in regression are common at first with sorrow and acceptance coming much later than for adults. Each family member should try to understand and accept the many possible individual forms and paces of morning that may be exhibited by others. Children in particular need to know that questions and feelings are acceptable.

What is the role of the hospice medical director?

To function as mediator between the team and the attending health care provider

Name the five aspects of human functioning during the dying and grieving process:

To give compassionate nursing care and support to the family and the patient during The Grieving and dying process consider the five aspects of human functioning physical emotional intellectual social cultural and spiritual. SS each area using the nursing process to fully understand the patient's needs and provide appropriate interventions.

Why is it important for the hospice nurse to provide time to confer with the patient and family?

To plan for changes in the scope of care

The nurse explains to a grieving husband that the process of the resolution of the hurt and the reestablishment of his life is called the ______ process.++

grief

When the dying patient becomes confused, the nurse should _______ him or her.

reorient