426 Exam 3 - End of Life
What are appropriate interventions for increased respiratory secretions?
Begin anti-cholinergics, elevate head of bed, reduce/stop IV fluids/enteral feedings, provide reassurance and calm environment
What are three important decisions that need to be made prior to death?
Decisions about organ tissues donation, advanced directives and resuscitation
What treatment is appropriate for delirium in a dying patient?
Environmental/use of antipsychotics (if indicated)
T/F: frequent suctioning is appropriate for increased respiratory secretions experienced near death?
False
What nursing interbential is appropriate for pain in a dying patient?
Oral/transdermal medications
What should you do if a patient is seeing people or things that are not there?
ask the patient for more information about what they are seeing
What are some respiratory signs of impending death?
change in breathing pattern (apnea, panting, cheyne-stokes, mandibular breathing), audible secretions
What are possible causes of delirium?
changes in sleep/wake cycle, ICU psychosis, restraints
What is the death rattle?
loud rattling sounds when breathing caused by respiratory secretions due to inability to clear the secretions
What are some of the common symptoms in the last 48 hours of life?
pain, agitation, urinary incontinence, dyspnea, N&V, myoclonus, excess respiratory secretions (avoid the term death rattle)
What are some cardiovascular signs of impending death?
cold extremities/mottling, change in vital signs
What are some communication signs of impending death?
decrease interaction with others (withdrawn, using metaphors, expressing emotions and/or fears)
What are some gastrointestinal signs of impending death?
decreased intake, nausea, vomiting, diarrhea, constipation, incontinence
What are some genitourinary signs of impending death?
decreased urine output
What are some interventions for respiratory secretions?
elevate head of bed, begin anticholinergic drugs, rude or stop IV fluids/enteral feedings, provide reassurance and education, provide peaceful calming environment, role model comforting
What are some metabolic signs of impending death?
fatigue, surge of energy, temperature changes/diaphoresis
What is hypoactive delirium?
lethargic, somnolent, appear to be in a stupor
What is the role of a nurse for a dying patient?
normalize the experience for the patient/family be proactive in assessing for symptoms allow the expression of emotion don't underestimate the power of your presence
What will be absent once death has oocurred?
pulse, blood pressure, respirations, response to stimuli, blinking/corneal reflex
What is hyperactive delirium?
restless, calling out, agitated, disoriented, crawling out of bed, delusions
What nursing intervention is appropriate for restlessness in a dying patient?
Assess for reversible causes, provide calm/comforting environment, meds as orderd
What may be seen once death has occured?
B/B incontinence, eyes slightly open, jaw relaxed, mouth open, waxy, pasty appearance to skin
What nursing interventions are appropriate for dyspnea in a dying patient?
Oxygen, positioning, cool environment (fan), calming environment/reassurance
What is bereavement?
The period following the death of a loved one during which grief is experienced and mourning occurs.
