End Of Life (Fundamentals 10, Burke 13) Flashcards

1
Q

Loss

A

any potential, actual or perceived situation when valued object or person has changed or not accessible.

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2
Q

Maturational

A

naturally occurs over time. Death due to aging. occurs as person moves from one developmental stage to the next

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3
Q

Situational

A

in response to external events beyond person’s control

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4
Q

Categories of LOSS

A

1) significant other
2) aspect of self
3) external object
4) familiar environment (moving)

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5
Q

Grief

A
  • Intense PSYCHOLOGICAL responses that occur after loss

- necessary, normal, natural adaptive responses

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6
Q

Mourning

A
  • Period of TIME in grief.
  • Physical outward appearance (cultural aspects, i.e., Italians wear black for ever, Asians where white, Catholics wear veils etc.)
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7
Q

Bereavement

A
  • Period of GRIEF after death of loved one

- emotional aspect of suffering

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8
Q

Stages of Grief

A

SHOCK: feeling of emotional numbness
REALITY: painful experience after one consciously realizes the loss
ACCEPTANCE/RECOVERY:

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9
Q

Type of Grief

A
  • UNCOMPLICATED: Normal
  • ANTICIPATORY: before expected loss (waiting for sick grandma to die)
  • DYSFUNCTIONAL: intense, persistent pattern that is not reconciled.
  • DISENFRANCHISED: can’t grieve openly (i.e. side chick can’t grieve for married man)
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10
Q

Factors affecting Loss/Grief

A
  • Developmental Stage (teens, toddlers, adult, elderly)
  • Religion/Culture
  • Relationship w lost object (sentimental value, significant other v acquaintance)
  • Cause of death (tragic surprise, long term illness)
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11
Q

Nursing Care to grieving client

A
  • determine personal meaning of loss
  • encourage clients to feel it (let it out)
  • assess client progress through stage of grief
  • renew patients ability to do ADLs alone
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12
Q

Goals for those in Grief

A
  • accept loss
  • verbalize feelings of grief **
  • share grief w significant others
  • renew activities and relationships
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13
Q

Implantation of Goals

A
  • spend time listening
  • demonstrate acceptance
  • non judgmental attitude
  • provide reassurance, support and counseling resources
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14
Q

Death

A

last stage of life

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15
Q

PSDA

A

Patient Self Determination Act

Always ask patient about Advanced directives. (i.e. living will, Health care proxy, DNI/DNR)

legal means to specify circumstances under which life sustaining measures should or should not be rendered.

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16
Q

Advance Directives

A
  • written instructions of client wishes

- includes durable POA for health care and living will.

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17
Q

Stages of Death/Dying

A

Elizabeth Kubler Ross

1) Denial
2) Anger
3) Bargaining
4) Depression **NORMAL in this case
5) Acceptance

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18
Q

EOL care consists of

A
  • control of symptoms (comfortable as possible)
  • ID of needs
  • promotion of interaction
  • facilitation of peaceful death
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19
Q

Palliative Care

A

relief of symptoms

care delivered by interdisciplinary team to manage psychological, social, spiritual needs

20
Q

Hospice

A
  • less than 6 months to live
  • Death with dignity
  • no technology unless it is palliative
  • i.e. morphine drip to slow breathing and for pain
21
Q

2 biggest fears of dying

A
  • dying alone

- dying in pain

22
Q

How to communication and demonstrate acceptance

A

hold clients or family hand and say “ I will not leave you” etc.

23
Q

Physiological Needs of Dying

A
  • Respiration
  • fluid/nutrition
  • mouth,eyes, nose
  • mobility
  • skin care
  • eliminations
  • comfort
  • physical environment
24
Q

Signs of Impending Death

A
  • lungs can’t provide adequate gas diffusion (LOW O2)
  • LOW perfusion of heart and vessels (cold hands/feet)
  • brain shuts down
  • Cheyne Stokes respirations (death rattles, loud breathing)
25
Q

Physical signs of Death

A
  • absence of hearbeat
  • cease respirations
  • mottling of skin (patchy)
  • eyelids slightly open
  • jaw relax, slight open mouth (tie post mortem)
  • no reponse to name, touch, sound
  • eyes fixed on certain spot, no blinking
  • release of bowel/bladder contents (GI shut down)
  • LOW output, due to LOW intake
26
Q

Nurse care after death

A
  • treat body w respect
  • bath, clean gown
  • remove dressings/tubes
  • body w elevated head
  • dentures in denture cup (send w body)
  • comb hair
27
Q

Legal Aspects

A
  • MD certifies death (EMT, MEDIC only if it’s obvious like decapitation)
  • Autopsy
28
Q

Shadow Grief

A
  • loss of energy, spark, joy or meaning
  • detachment from surroundings
  • powerlessness
  • UP smoking/drinking
  • unusual forgetfulness
  • constant criticism of others
  • trouble completing projects
  • outbursts of anger
  • surrendering hobbies/interests
29
Q

How do you prevent mottling of the face?

A

elevate head post mortem.

30
Q

Reasons for Autopsy

A
  • unaccompanied death
  • suspicious death (family not required to give consent)
  • crime (family not required to give consent)
  • If doc has suspicion of malpractice by nurse, family must give consent.
31
Q

Gate Control Theory

A

whichever sensation makes it out the gate to the brain, is the sensation the body feels. (i.e. Icy Hot to distract brain and make it feel less of main pain. )

32
Q

Salicylates

A
  • NSAIDs, nonsteroidal anti-inflammatory drugs. ASPIRIN
  • treatment of mild to moderate pain
  • inhibit synthesis of prostaglandin and other mediators in the process of inflammation and have anti-inflammatory, antipyretic and analgesic properties.
  • Salicylates can be used to reduce fever, pain and inflammation such as in arthritis.
33
Q

Salicylates Toxity

A
  • Nausea
  • vomiting
  • diaphoresis
  • **-tinnitus (8th cranial nerve damage)
  • vertigo,
  • hyperventilation,
  • tachycardia,
  • hyperactivity.

As toxicity progresses,

  • agitation,
  • delirium,
  • hallucinations,
  • convulsions,
  • lethargy,
  • stupor

severe toxicity
-Hyperthermia

34
Q

When administering pain meds, when should you initiate?

A

BEFORE pain is bad.

35
Q

Steroids, Opiates

A

Problems

36
Q

?? Tylenol drug class and toxity?

A

analgesics (pain relievers) and antipyretics (fever reducers).

relieves pain by elevating the pain threshold, by requiring greater amount of pain to develop before a person feels it.

reduces fever through heat-regulating center of the brain. tells the center to lower the body’s temperature when the temperature is elevated.

Toxicity???

37
Q

Pain Threshold

A

point which person recognizes pain (varies little mi people)

38
Q

Pain Tolerance

A

Amount and duration one can stand before seeking relief. (varies among all)

39
Q

Type of Pain meds

A
  • Analgesics: relieve reduce pain
  • non opioods: pain releif not derived from Opium (Tylenol)
  • Opiods
  • adjuvant analgesics
40
Q

Non Opiod/ NSAIDs

A

Mild Pain, NSAID

Act on peripheral nervous system
reduce pain by interfering w prostoglandin synthesiss (ibuprofen, aspirin, ketorolac)

There IS an analgesic ceiling

41
Q

Opiods

A
  • Mild - Severe pain
  • analgesia by binding to opioid receptors in CNS (brain, spinal cord)

Types:
Agonist: morphine, hydromorphone, codeine
Antagonist: buprenophine, nalbuphine

42
Q

Nurse responsibility in Perinatal care

A

Make sure family sees body of deceased baby to ensure acceptance and knowing it’s real.

43
Q

Types of Pain

A

Neuropathic: diabetic neuropathy, numbing, tingle
Cutaneous: sharp, cut, skin
Somatic: deep muscle

44
Q

Active vs Passive Euthanasia

A

z

45
Q

5 aspects of human function

A

physical, emotional, intellectual, socio-cultural, spiritual

46
Q

Morbidity

A

about sickness and disease

47
Q

Mortality

A

about death