N210 Week-4 Lecture End of Life

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N210 Week-4 Lecture End of Life
2015-10-12 14:57:21
N210 Week Lecture End Life
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  1. 1. Discuss the importance of knowing one’s attitude toward death before caring for the dying patient
  2. II. Unresolved grief
    • 1. Person may have trouble expressing feelings of loss or may deny them
    • 2. Describes a state of bereavement
    • III. Inhibited grief
    • 1. Person suppresses feelings of grief and may instead manifest body symptoms
  3. 3. Describe physiologic, psychological and spiritual care of a dying patient and family
    • 1. Physiologic
    • I. Involves meeting physical needs
    • 1. Personal hygiene
    • a. Cleanliness of skin, hair, mouth, nose, and eyes
    • b. Frequent baths and linen changes
    • c. Mouth and nose should be kept free of mucus, and secretions should be wiped
    • 2. Pain control
    • a. Physician determines medication and dosage needed for pain control
    • b. Some prefer and are able to control their own medication
    • 3. Nutrition and fluid needs
    • a. Patient should be encouraged to take sips of water or chew ice chips if able to swallow
    • b. One may elect to forego artificial nutrition and hydration because of burdens
    • 4. Movement
    • a. Regular changes of position help prevent pressure ulcers
    • b. Reposition in semi-fowlers position can facilitate respirations
    • c. Position of unconscious patient in semiprone allows drainage of saliva and mucus
    • 5. Elimination
    • a. Development of incontinence, constipation, and/or urinary retention
    • b. Absorbent pads, laxatives, enemas, or catheterizations may be used
    • 6. Respiratory care
    • a. Oxygen therapy may be necessary for some patients
    • 2. Psychological
    • I. Support the patient by indicating your presence, giving full attention and showing that you care
    • II. Encourage presence of family members in room and sharing of reminiscences
    • 3. Spiritual Needs
    • I. Many terminally ill patients find great comfort in the support they receive from their faith
    • II. Help obtain services of clergy or pastoral care workers as the situation indicates
    • III. Most patients need to feel that their lives have meaning; many feel need for hope
  4. 4. Compare and contrast the five emotional stages of dying defined by Kubler-Ross (1604)
    • 1. Denial
    • I. Patient denies the reality of death and may repress what’s discussed
    • 2. Anger
    • I. Patient expresses rage and hostility and adopts a “Why me?” attitude
    • 3. Bargaining
    • I. Patient tries to barter for more time
    • 4. Depression
    • I. Patient goes through a period of grief before death
    • 5. Acceptance
    • I. When the stage of acceptance is reached, the patient feels tranquil
  5. 5. Discuss the philosophies of palliative and hospice care (1606)
    • 1. Palliative Care
    • I. Involves take care of the whole person – body, mind, and spirit, heart, and soul
    • II. Views dying as something natural and personal
    • III. The goal of palliative care is to:
    • 1. Give patients with life threatening illnesses the best quality of life they can have by the aggreesive management of symptoms
    • 2. Hospice Care
    • I. Provided for people with limited life expectancy, often in home
    • 1. Less than 6 months to live
    • II. Focuses on the needs of the dying
    • III. Concept of care when disease is no longer curable
  6. 6. Describe the signs of impending death (1604)
    • 1. Difficulty talking or swallowing
    • 2. Nausea, flatus, ABD distention
    • 3. Urinary and/or bowel incontinence or constipation
    • 4. Loss of movement, sensation, and reflexes
    • 5. Decrease body temperature with cold or clammy skin
    • 6. Weak, slow, or irregular pulse
    • 7. Decrease blood pressure
    • 8. Noisy, irregular, or Cheyne-Stokes respirations
    • 9. Restlessness and/or agitation
    • 10. Cooling, mottling, and cyanosis of the extremities and dependent areas
    • 11. Decrease LOC or agitated delirium
  7. 7. Identify factors that affect loss, grief, and dying (1612)
    • 1. Developmental Considerations
    • I. Children do not understand death on the same level as adults do, but their sense is just as great
    • II. Terminally ill children require parental love and support as well as social interaction
    • III. Death of a parent or significant person can retard a child’s development or regress developmentally
    • IV. Children need to go through same grief reactions as adults to accept such a loss
    • V. Older people may lose a spouse or friends and relatives their own age
    • 1. Put their lives and the purpose of living in perspective, and prepare themselves for their death
    • 2. Family
    • I. Family needs to accept reality of situation
    • II. Have opportunities to talk and to be listened to
    • III. Experience of being able to express themselves behaviorally in a nonjudgmental environment
    • 3. Socioeconomic Factors
    • I. Family may suffer more acutely if there’s no health or life insurance
  8. 8. Use nursing process to plan and implement care for dying patients and their families (1614-1624)
    • 1. Planning
    • I. Demonstrate freedom to express feelings, needs, fears, and concerns
    • II. Identify and use effective coping strategies
    • III. Accept need for help as appropriate and use available resources
    • IV. Make health care decisions reflecting personal values and goals
    • 1. Ultimately feel peaceful about role in decision making
    • V. Declare preferences regarding treatment options
    • VI. Report sufficient relief of pain to interact with family and to attend to everyday concerns
    • VII. Experience a dignified and comfortable death
    • VIII. Resolve grief after a suitable period of mourning and resume roles and ADLs
    • 2. Implementing
    • I. Develop a Trusting Nurse-Patient/Family Relationship
    • 1. Patients initiate conversations about dying, you may feel unprepared
    • a. Keep the lines of communication open with the patient
    • 2. Do not provide false reassurance
    • 3. Nonverbal communication is important
    • 4. Hearing is to be the last sense to leave the body
    • a. Many patients retain their hearing almost to the moment of death
    • II. Explaining Patient’s Condition and Treatment
    • 1. All healthcare team should know what the patient and family have been told
    • 2. Explain condition and treatment to both patient and family
    • III. Teaching Self-Care and Promote Self-Esteem
    • 1. Encourage patient to retain independence and make decisions as long as possible
    • 2. Allow patient to manage personal hygiene practices and self-feeding for as long as possible
    • 3. Have familiar objects in view
    • a. Makes patient feel more comfortable and secure
    • IV. Teaching Family Members to Assist in Care
    • 1. Teach family members how to provide care to the patient
    • 2. Explain patient’s condition, what treatments, and what results the family can expect
    • V. Meeting the Needs of Dying Patient
    • VI. Meeting the Needs of the Family
    • VII. Providing Post Mortem Care
  9. 9. Outline nursing interventions when providing post mortem care (1622-1624)
    • 1. Caring for the body
    • I. Body is placed in anatomic position to avoid pooling of blood
    • II. Soiled dressings are replaced
    • III. Tubes are removed
    • 1. Leave if patient is going for an autopsy
    • IV. Nurse must place ID tags on either the shroud or the garment body is in and the ankle
    • 1. Place ID tag on dentures or other prostheses so mortician receives them
    • 2. Caring for the family
    • I. Nurse provides support and care to the patient’s family
    • 1. Listen to family’s expressions of grief, loss, and helplessness
    • II. Offer solace and support by being an attentive listeners
    • III. Allow family members to express grief and provide emotional support
    • 1. Acknowledge their shock and listen to their grief
    • IV. Family needs guidance in making plans and help in making decisions
    • V. Appropriate for nurse who took care of patient for a prolonged period to attend funeral
    • VI. Follow-up visits are important to give support to the family
    • 3. Caring for other patients
    • I. Nurse must continue to provide care to the other patients
  10. 10. Ethical and legal issues in end-of-life care, including advance directives, physician order and euthanasia (1606-1611)
    • 1. Advance Care Planning
    • I. Advance directives
    • 1. Living wills
    • a. Provide specific instructions about kinds of health care to be provided or not
    • 2. Durable power of attorney
    • a. Appoints an agent the person trust to make decisions if incapable of doing
    • 3. Physician order for life-sustaining treatment form
    • a. Medical order indicating a patient’s wishes regarding treatments used in medical crisis
    • b. Must be completed and signed by health care professional, not by patient
    • 2. Allow Natural Death, DNR, or No-Code Orders
    • I. Do-Not-Resuscitate
    • 1. No attempts are to be made to resuscitate a patient whose breathing or heart stops
    • II. Standard of care obligates health care professionals to attempt resuscitation if breathing or heart stops and there’s no DNR
    • 3. Comfort Measures Only and Other Special Orders
    • I. Comfort measures-only order
    • 1. Goal of treatment is comfortable, dignified death and that further life-sustaining measures are no longer indicated
    • II. Do-not-hospitalized order
    • 1. Used in long-term care and other residential settings
    • 2. Patients who elect not to be hospitalized for further aggressive treatment
    • 4. Terminal Weaning
    • I. Gradual withdrawal of mechanical ventilation from a patient with terminal illness or irreversible condition
    • II. Competent patients and fam. members should be prepared for all possibilities
    • III. Supporting patient’s family and managing sedation and analgesia are critical nursing responsibilities
    • 5. Voluntary Cessation of Eating and Drinking
    • I. Competent patients choose to refuse food and fluid w/ intention of aiding death
    • 6. Euthanasia
    • I. Active euthanasia
    • 1. Doing something to end a patient’s life
    • 2. Clinician acts directly to cause death of the patient
    • a. Administers a lethal dose of medication
    • II. Passive euthanasia
    • 1. NOT doing something to preserve a patient’s life
    • III. Assisted suicide
    • 1. Clinician provides the patient with means to cause one’s own death
    • a. Provides prescription for a lethal dose of barbiturates
  11. 11. Discuss role of nurse in caring for family of a dying patient (1623)
    • 1. Nurse provides support and care to the patient’s family
    • I. Listen to family’s expressions of grief, loss, and helplessness
    • 2. Offer solace and support by being an attentive listeners
    • 3. Allow family members to express grief and provide emotional support
    • I. Acknowledge their shock and listen to their grief
    • 4. Family needs guidance in making plans and help in making decisions
    • 5. Appropriate for nurse who took care of patient for a prolonged period to attend funeral
    • 6. Follow-up visits are important to give support to the family