276 Arnold- End of Life
A client in the final stages of terminal cancer tells the nurse: "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I continue my chemotherapy and radiation treatments only because my family wants me to." What is the nurse's best response? a. "Would you like to talk with a psychologist about your thoughts and feelings?" b. "Would you like to talk with your minister about the significance of death?" c. "I'll contact the healthcare provider to cancel your treatments." d. "Would you like to meet with your family and your healthcare provider about this matter?"
"Would you like to meet with your family and your healthcare provider about this matter?" The nurse has a moral and professional responsibility to advocate for clients who experience decreased independence, loss of freedom of action, and interference with their ability to make autonomous choices. Coordinating a meeting between the healthcare provider and family members may give the client an opportunity to express wishes and promote awareness of feelings as well as influence future care decisions. Without additional information from the client, recommending a psychologist or minister or contacting the healthcare provider to cancel treatment would be premature responses.
A seriously ill client's spouse tells the nurse, "I would like to be physically closer with my spouse, but I am afraid of causing pain if I touch my spouse." How should the nurse respond? - "I hear you saying you do not feel close to your spouse. Can you tell me why you feel this way?" - "You will not hurt your spouse through simple touch. Intimacy is important and encouraged now." - "I can provide pain medication to prevent any pain. Would that make you feel comfortable?" - "It is normal to fear causing pain. What kind of contact did you want to have with your spouse?"
"It is normal to fear causing pain. What kind of contact did you want to have with your spouse?" Wishing for physical contact with a seriously ill loved one is normal, but fear of causing pain is common. The first action the nurse needs to take is to clarify the type of physical contact the spouse wishes to have with the client. The spouse may desire more intimacy than "simple touch" so this should be explored. Simply offering analgesia does not explore the spouse's desire for intimacy. The spouse did not say he or she did not "feel close" to the spouse in an emotional sense, but expressed the desire for physical contact.
An infant's death is deemed due to sudden infant death syndrome (SIDS). The parents want to know the cause of SIDS and if they could have done something to prevent it. What explanation should the nurse provide these parents? -"Unfortunately the cause of SIDS is unknown." -"SIDS occurs in babies who sleep on their abdomen." -"SIDS occurs only in premature infants." -"SIDS occurs after an upper respiratory infections."
"Unfortunately the cause of SIDS is unknown." Unfortunately, while there are many theories as what causes SIDS, no one specific cause has been identified. SIDS is more frequent in male than female infants. Although cigarette smoke may have an association with SIDS, exposure to respiratory infection has not been proven to be correlated with an increased incidence of SIDS. Although SIDS is more common in preterm infants, it is often associated with multiple births, infants with low Apgar scores, and infants born to mothers who smoked during pregnancy. SIDS can also occur in babies who sleep face down on soft surfaces. That is why back sleeping is now recommended.
Which nursing action is appropriate to include in the plan of care for a dying child to meet the child's emotional needs during the last days of life? Restrict visitors to the parents to avoid overtaxing the child. Focus on the child's physical needs to attempt to prevent sadness. Encourage the child to play quietly with a roommate to provide pleasure. Answer the child's questions about illness and death honestly.
Answer the child's questions about illness and death honestly. Most clients, even children, are aware when death appears imminent. The best policy is to answer the child's questions honestly, thus helping the child feel less isolated and alone.
A hospitalized client who has a living will is being fed through a nasogastric (NG) tube. During a bolus feeding, the client vomits and begins choking. Which action should the nurse take? Stop the feeding and remove the NG tube as specified in the client's living will. Start cardiopulmonary resuscitation. Clear the client's airway. Make the client comfortable as specified in the client's living will.
Clear the client's airway. A living will gives information about what the client wants if they are in a terminal or permanently unconscious state. A living will doesn't apply to nonterminal events such as choking on an enteral feeding device. In this situation, the nurse should clear the client's airway. Making the client comfortable ignores the life-threatening event. Cardiopulmonary resuscitation isn't indicated. Removing the NG tube would exacerbate the situation.
The nurse is caring for a client with terminal lung cancer. What is the priority nursing intervention for this client? Provide pain control. Provide education about end-of-life. Provide nutritional support. Provide emotional support.
Provide pain control. A client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce this discomfort. Preparing the client and their family for impending death and providing emotional support are also important, but shouldn't be the primary focus until the pain is under control. Nutritional support may be provided, but as the terminal phase advances, the client's nutritional needs greatly decrease.
The nurse is reviewing the lab report for a client in hospice care with breast cancer and brain metastasis. According to the information in the chart, what should the nurse do next? Report the elevated calcium level immediately. Document these results on the medical record. Refrain from reporting the results because the client is in hospice care. Report the elevated potassium level immediately.
Report the elevated calcium level immediately. The normal calcium level is 9.0 to 10.5 mg/dL (2.25 to 2.63 mmol/L). Hypercalcemia is commonly seen with malignant disease and metastases. The other laboratory values are normal. Hypercalcemia can be treated with fluids, furosemide, or administration of calcitonin. Failure to treat hypercalcemia can cause muscle weakness, changes in level of consciousness, nausea, vomiting, abdominal pain, and dehydration. Although the client is on hospice care, she will still need palliative treatment.
When developing a care plan for an older adult, a nurse should consider which challenges that clients in this age-group face? -adjusting to retirement, deaths of family members, and decreased physical strength -selecting vocation, becoming financially independent, and managing a home -managing a home, developing leisure activities, and preparing for retirement -developing leisure activities, preparing for retirement, and resolving empty-nest crises
adjusting to retirement, deaths of family members, and decreased physical strength Challenges faced in older adulthood include adjusting to retirement, deaths of family members, and decreased physical strength. Challenges faced in young adulthood include selecting a vocation, becoming financially independent, and managing a home. Challenges faced in middle adulthood include developing leisure activities, preparing for retirement, and resolving empty-nest crises.
When planning pain control for a client with terminal gastric cancer, a nurse should consider that - only low doses of opioids are safe; higher doses may cause respiratory depression. - a client who can fall asleep isn't in pain. - pain medication should be given only when a client requests it. - clients with terminal cancer may develop tolerance to opioids.
clients with terminal cancer may develop tolerance to opioids. Clients with cancer may develop a tolerance to opioids, causing them to need higher doses to provide adequate pain relief. Although a nurse should always remain alert for adverse effects of opioids, clients may develop a tolerance for these effects. Therefore, it isn't likely that higher doses would cause respiratory depression. Administering pain medication around the clock maintains steady blood levels of opioids.
The nurse observes an unlicensed assistive personnel (UAP) sharing extensive stories of her own mother's death with a dying client's husband. Which statement demonstrates appropriate feedback for the nurse to offer to the UAP? -"It's probably best to avoid talking about your personal experience very much; keep communication client centered." -"You provided excellent client education by sharing your stories." -"I thought that was really great how you talked with him; he seemed really scared." -"I think it helps clients to see us as real people, and friends too, when you share your own stories."
"It's probably best to avoid talking about your personal experience very much; keep communication client centered." Therapeutic communication is always purposeful, goal-directed, and client-centered. If self-disclosure is used by the nurse or the UAP, it should be very focused and limited to just enough to support further communication with the client. It is not always helpful (or educational) and often inappropriate to share personal stories with clients.
A nurse is caring for a client with advanced cancer. Based on the accompanying nursing progress notes, what should be the nurse's next intervention? Explain the use of an advance directive to express the client's wishes. Tell the client that only in the hospital can there be adequate pain relief Call the client's spouse to discuss the client's statements. Reread the document on patient/client rights to the client.
Explain the use of an advance directive to express the client's wishes. An advance directive is a legal document used as a guideline for life-sustaining medical care of a client with an advanced disease or disability who can no longer indicate their own wishes. This document can include a living will, which instructs the healthcare provider to administer no life-sustaining treatment, and a durable power of attorney for health care, which names another person to act on the client's behalf for medical decisions if the client cannot act for self. By explaining the use of an advanced directive to the client at this time, the client has the opportunity to document future wishes. The document on client rights does not specifically address the client's wishes regarding future care. Calling the spouse is a breach of the client's right to confidentiality. Stating that only a hospital can provide adequate pain relief in a terminal situation demonstrates inadequate knowledge of the resources available in the community through hospice and home care agencies in collaboration with the client's healthcare provider.
A client with stage IV pancreatic cancer is admitted to hospice. The spouse breaks down crying, stating "I just don't know what I will do if my partner dies!" What is the best response by the nurse? "What has helped you cope with the illness so far?" "Your spouse has the best doctors and is receiving good care." "I see you are upset. I will come back in 10 minutes and we can talk." "Do you want to speak with someone in the same situation?"
"What has helped you cope with the illness so far?" The nurse needs to identify coping mechanisms in order to support the spouse. Peer support may be indicated but does not address the spouse's immediate statement nor does stating that the doctors are capable. The spouse should not be left alone before the nurse addresses the statement.
The nurse is collaborating with the healthcare provider to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan would be most appropriate for managing the client's pain? - Administer analgesics when the client's vital signs indicate that the severity of the pain is increasing. - Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain. - Encourage the client to avoid intravenous pain medication until the client's condition has reached the terminal stage. - Administer analgesics when the client reports pain greater than 5 out of 10.
Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain. Maintaining a steady blood level of analgesics is beneficial for the client with chronic cancer pain. Administering analgesics on a regular basis helps to control pain more efficiently. It may also be necessary for the client to have additional doses of medication ordered to be administered for breakthrough pain. Numeric pain scales are more effective in treating acute pain. Intravenous analgesics are more effective at controlling pain as they are more predictable in their distribution than many oral medications. Vital signs are not a reliable indicator of how much pain the client is experiencing.
The nurse is caring for four clients. For which client would it be most appropriate for the nurse to collaborate with a healthcare provider regarding hospice care? a client with late-stage acquired immunodeficiency syndrome (AIDS) a client who is undergoing treatment for heroin addiction a client with ovarian cancer receiving chemotherapy treatments a client who has dysphagia of non-thickened liquids following a stroke
a client with late-stage acquired immunodeficiency syndrome (AIDS) Hospices provide supportive, palliative care to terminally ill clients, such as those with late-stage AIDS, as well as their families. Hospice services would not be appropriate for a client with dysphagia of non-thickened liquids resulting from a stroke or a client who is undergoing treatment for heroin addiction, because these health problems are not necessarily terminal. The client with ovarian cancer who is receiving chemotherapy treatments would also not be appropriate, because chemotherapy is not considered palliative care.
A client with amyotrophic lateral sclerosis (ALS) is admitted with weight loss and malnutrition. The client can swallow without difficulty. While caring for the client, the nurse discovers that the weight loss is related to the client's refusal to eat. The client states to the nurse that they would rather die than remain alive with this disease. How should the nurse intervene? - Ask the physician to consult a psychiatrist because the client is exhibiting suicidal behavior. - Explore the client's feelings about dealing with ALS using open-ended questions. - Report this finding to the client's family, and suggest they talk with the physician about having a feeding tube placed. - Support the client's decision because they have a fatal disease.
Explore the client's feelings about dealing with ALS using open-ended questions. The nurse shouldn't just support the client's decision. Instead, using open-ended questions, the nurse should explore the client's feelings about living with ALS. After obtaining more information, the nurse should notify the physician of the client's wishes. The nurse shouldn't discuss the client with family members without the client's permission; doing so is a breach of client confidentiality. After evaluating the client, the physician can determine whether a psychiatric consult is necessary.
An older adult client is speaking to the nurse about the expected death of a spouse due to cancer 3 weeks ago. The client says, "My spouse is in a better place now, and I'm happy my spouse is not hurting anymore. But I just miss my spouse!" How should the nurse respond? -Explore the client's expression of denial about the death of the spouse. -Refer the client to a counselor to work through the complicated grief. -Validate the client's statement as evidence of a normal grieving process. -Commend the client's faith and reinforce the belief that the spouse is at peace.
Validate the client's statement as evidence of a normal grieving process. This client is experiencing the uncomplicated grief that normally follows a significant loss. Nothing about this scenario leads the nurse to believe the client is experiencing abnormal grieving or denial. The nurse should refrain from expressing personal beliefs about spirituality and focus on the grieving process while providing room for the client to share the client's own beliefs.
A 6-year-old boy has experienced the death of his mother in the last 3 months. He and his father are involved in a grief support program that has sessions for all ages. A nurse is educating the parents in the group about the normal grief reactions of children to help them distinguish normal behavior from behavior that is unusual and possibly indicative of depression or other psychological issues. Which represents normal grief behavior for this young child after the death of his mother? Select all that apply. a. talking to his mother as if she were present in the room b. crying followed in a few minutes by laughing c. playing with a rope, saying he is going to be with his mother d. playing with a friend right after saying he misses his mother e. yelling and being angry at his mother for leaving him
a. talking to his mother as if she were present in the room b. crying followed in a few minutes by laughing d. playing with a friend right after saying he misses his mother e. yelling and being angry at his mother for leaving him Young children cannot be sad all the time after a loss, but that does not mean they grieve less. Their moods change more quickly and they often work out their issues through play rather than talking. Because young children do not have a full understanding of death's finality, they may talk to a deceased loved one as if they are present. They also may not understand the circumstances of the death and so may think the loved one left voluntarily and be angry at the deceased for leaving them. Play involving a dangerous object such as a rope, coupled with a stated desire to join the deceased parent, would be cause for alarm as the child could harm himself either purposely or accidentally.
A hospitalized client with end-stage heart failure does not want to be resuscitated. The health care provider (HCP) has written the do-not-resuscitate (DNR) prescription on the client's record. The client has a cardiac arrest, and the wife tells the nurse she wants the client to be resuscitated and asks the nurse to "do something." What should the nurse do? Discuss the DNR prescription with the wife. Begin CPR. Call a "code." Page the HCP.
Discuss the DNR prescription with the wife. The nurse must respect the wishes of the client who has indicated that he does not wish to be resuscitated and not to initiate CPR. Nurses who resuscitate clients who have directed otherwise may be considered to be battering the client. In this situation the HCP has written the DNR prescription, and it is not necessary for the nurse to page the HCP. The nurse can be most helpful by explaining the client's decision to the wife and helping her manage her understand her husband's wishes and manage her own grief.
The parents of a school-age child with a brain tumor have elected to have only comfort measures instituted for their dying child. The child has been experiencing significant discomfort and has been receiving pain medication. A nurse knows that the pain-management principle most effective in controlling the child's pain is: using an age-appropriate tool for effectively assessing pain. administering pain medication promptly when the child requests it. striving to prevent pain by routine administration of pain medication. alternating stronger opioid pain medications with nonopioid agents.
striving to prevent pain by routine administration of pain medication. When providing comfort measures for a child, the nurse should strive to prevent pain by providing routine pain medication. Although the nurse should administer pain medication promptly, the goal of treatment should be to prevent pain rather than simply respond to it. Assessing pain with an age-appropriate tool is important; however, the effective assessment of pain shouldn't take precedence over the effective treatment of pain. Alternating stronger opioid medications with nonopioid medications may be effective, but the nurse should individualize the treatment to meet the child's needs.
The nurse is collaborating with the health care provider (HCP) to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan is most appropriate for preventing and reducing the client's pain? -Encourage the client to avoid intravenous pain medication until the condition has reached the terminal stage. -Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain. -Keep the client sedated with tranquilizers to prevent awareness of pain sensations. -Administer analgesics when the client's vital signs indicate that the severity of the pain is increasing.
Administer analgesics on a regular basis with administration of additional analgesics for breakthrough pain. Maintaining a steady blood level of analgesics is beneficial for the client with chronic cancer pain. Administering analgesics on a regular basis helps to control pain more efficiently. It may also be necessary for the client to have additional doses of medication ordered to be administered for breakthrough pain. Keeping the client overly sedated may not help to control pain, and intravenous analgesics are more effective at controlling pain as they are more predictable in their distribution than many oral medications. Vital signs are not a reliable indicator of how much pain the client is experiencing.
