13 end of life care

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sanchez
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108663
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13 end of life care
Updated:
2011-10-13 08:14:18
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MS
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  1. •Any potential, actual, or perceived situation when valued object or person changed or not accessible
    LOSS
  2. –Occurs as person moves from one developmental stage to another
    maturational
  3. –Occurs in response to external events generally beyond person’s control
    situational
  4. major category of loss
    • SAFE
    • –Significant other
    • –Aspect of self
    • –External object
    • –Familiar environment
  5. •Series of intense psychological responses occurring after loss
    •Necessary, normal, natural, and adaptive responses
    greif
  6. –Period of grief
    –Integration and resolution of loss
    mourning
  7. –Period of grief after death of loved one
    bereavment
  8. STAGES OF GREIF
    • shock
    • reality
  9. –Painful experience that begins when person consciously realizes full meaning of loss
    reality
  10. May last days to one month or more –Person may describe feeling emotional numbness
    shock
  11. types of greif
    • uncomplicated
    • anticipatory
    • dysfunctional
    • dysenfranchised
  12. –Normally follows fairly predictable significant loss
    uncomplicated greif
  13. –Occurs before expected loss
    –Ie: terminally ill patient, expected move
    anticipatory
  14. –Intense, persistent pattern that does not result in reconciliation of feelings
    dysfunctional
  15. –Not openly acknowledged, socially sanctioned, or publicly shared
    disenfranchised
  16. provides legal means for people to specify circumstances under which life-sustaining measures should or should not be rendered
    Patient Self-Determination Act (PSDA)
  17. –Written instruction of client wishes
    –Includes durable power of attorney for health care and living will
    advance directive
  18. 5 stages of dying...E. K. ROSS
    • –Denial
    • –Anger
    • –Bargaining
    • –Depression
    • –Acceptance
  19. end of life care focus
    Focus on meeting physical and psychosocial needs of client and family
  20. •Relief of symptoms
    •Goal:
    –Assure quality of life
    palliative care
  21. •Care for terminally ill
    •When aggressive treatment no longer option or client refuses further care
    •Often in home or hospice setting without technology to prolong dying
    •Interdisciplinary program
    hospice
  22. •Lungs cannot provide adequate gas diffusion
    •Heart and blood vessels unable to maintain adequate tissue perfusion
    •Brain ceases to regulate vital centers
    •Cheyne-Stokes respirations and “death rattles” occur
    impending death
  23. •No response to name, touch, or environmental sound
    •Eyes fixed on certain spot
    •No eye-blinking in response to touch or air movement over eyes
    •Release of bowel and bladder contents
    •Absence of heartbeat
    •Cessation of respirations
    •Mottling of skin
    •Eyelids remaining slightly open
    •Jaw relaxation and slight opening of mouth
    physical sign of death
  24. –Unresolved sadness
    –May lead to burnout
    shadow grief
  25. s/s of shadow grief
    • •Loss of energy, spark, joy, or meaning
    • •Detachment from surroundings
    • •Powerlessness
    • •Increased smoking or drinking
    • •Unusual forgetfulness
    • •Constant criticism of others

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