EndOfLife

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Author:
madelynlee
ID:
70482
Filename:
EndOfLife
Updated:
2011-03-03 16:45:58
Tags:
nursing terminal illness terminal end life hospice death dying
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Description:
Nursing management of terminally ill patients across the lifespan 3/2/11
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  1. death is defined as
    the irreversible cessation of respiratory and circulatory fxn or the irreversible cessation of all fxns of the entire brain
  2. can RNs declare death
    • depends on state
    • otherwise, coroner must declare
  3. loss def.
    a potential or actual situation in which sth that is valued is changed, or no longer available, or gone.
  4. ex. of situational losses
    • job
    • time w/ kids
  5. ex. of developmental losses
    • innocence
    • abilities (like walking)
    • self-image
    • appearance (like wrinkles)
    • independence
  6. 4 srcs of loss
    • loss of an aspect of oneself
    • loss of an object
    • separation from an accustomed envt
    • loss of a loved one
  7. 2 types of loss
    • perceived
    • actual
    • *both of these can be anticipatory
  8. RNs responsibility re: how help person cope w/ loss
    open doors to create opportunities for discussion; don't shove people through the door tho
  9. grief def.
    an emotion experienced in rel. to loss
  10. how is grief manifested
    • thoughts
    • feelings
    • behavior
  11. 2 types of processes grief is...
    • indv. process
    • social process
  12. purpose of grief
    allows indv to cope with and accept the loss
  13. stages of grieving
    • denial
    • anger
    • bargaining
    • depression
    • acceptance
  14. 2 types of grief responses
    • dysfunctional/pathological grief
    • healthy/adaptive grief
  15. factors that influence the grief and loss responses (9)
    • age
    • life experiences
    • culture
    • spiritual beliefs
    • gender
    • socioeconomic status
    • support system
    • cause of loss of death
    • relationships
  16. infant to 5 yr old - beliefs about death
    death is reversible
  17. 5 to 9 yrs - beliefs about death
    death is final, but also avoidable
  18. 9 to 12 yrs beliefs about death
    inevitable end of life
  19. 12 to 18 yrs - beliefs about death
    various beliefs/attitudes
  20. 18 to 45 yrs - beliefs about death
    religious/cultural beliefs
  21. 45 to 65 yrs - beliefs about death
    accepts own mortality
  22. 65+ yrs - beliefs about death
    multiple meanings
  23. 3 things to explore as RN re: assessmenjt of loss and grief
    • nursing history - explore previous losses and coping abilities
    • assess personal coping resources
    • physical assessment
  24. word of caution re: nursing diagnoses for loss and grief
    be alert to projecting judgment and/or your own values
  25. list some nursing diagnoses for loss and grief
    • risk for loneliness
    • dysfxnal grieving
    • interrupted family processes
    • impaired adjustment
    • ineffective coping *bad, says KK!
    • spiritual distress
    • fear
    • anticipatory grieving
  26. ex. of dysfxnal grieving
    • alcohol abuse
    • anger
    • violence
    • w/drawal
  27. in planning stage, what would an RN's goal be to help w/ "loss of fxn"?
    redirect energy into rehabilitation and adjust to the change
  28. in planning stage, what would an RN's goal be to help w/ "grieving the loss of a loved one"?
    adjust to the actual or impending loss and decrease painful feelings with memories
  29. what are patients most concerned with when they find out they're sick
    being a burden to the family
  30. what are families most concerned about when they find out a family member is sick
    physical pain of that person
  31. how can a nurse facilitate grief work
    • encourage routine and self care
    • explain expectations
    • set realistic goals
    • encourage reflection
    • explore values
  32. how can a nurse provide emotional support
    • presence
    • referral
    • acknowledgement
    • therapeutic communication
    • promote autonomy/self-care
  33. for nursing evaluation re: grief, how do you evaluate the goals/outcomes?
    • based on the goals set by the family
    • outcomes vary according to indv. client and characteristics of the loss
    • difficult to assess due to long-term transitions
  34. bereavement programsf
    grief education and support
  35. 4 things to "consider" as an RN re: grief
    • functional vs. dysfunctional grief
    • realistic vs. unrealistic goals
    • nursing implementation
    • other stressors or factors
  36. 6 legal issues re: death and dying
    • advanced health care directives
    • DNR/DNI vs. full code
    • euthanasia
    • organ donation
    • autopsy
    • self-determination act
  37. self-determination act means pt. must be given what written info (3)
    • The right to facilitate their own health care decisions
    • The right to accept or refuse medical treatment
    • The right to make an advance health care directive
  38. 7 ethical issues
    • beneficence
    • non-malefecence
    • autonomy
    • veracity
    • justice
    • quality of life
    • w/drawal of treatment
  39. non-malefecence
    you can't intentionally make things worse for a person, i.e. "do no harm". MDs can't regard sb w/ malice
  40. beneficence
    MDs are obligated to help/benefit their pts
  41. re: w/drawal of treatment, what can a pt refuse?
    pt can choose not to eat or drink
  42. what affects a nurse's ability to care for the client and their family re: death
    whether or not the nurse has acknowledged his or her own attitude about death
  43. 4 goals for the dying person
    • maintain comfort (physiologic and psychosocial)
    • maintain dignity (personal control)
    • 'The Dying Person's Bill of Rights"
    • mgmt of physical needs/symptoms
  44. 13 physical nees/symptoms of a dying person
    • PAWN BUMRS 4D
    • pain
    • delirium/anxiety
    • restlessness
    • dehydrations
    • dysphagia
    • dyspnea
    • weakness/fatigue
    • myoclonus
    • skin integrity
    • bowel patterns
    • urinary incontinence
    • anorexia
    • nausea/vomiting
  45. KNO!! 9 signs of impending death
    • SPAMD body VAC
    • changes in alertness
    • changes in breathing pattern
    • loss of muscle tone/decreased activity
    • decrease circulation
    • sensory implairment
    • slowing of body processes
    • decrease in appetite and/or dysphagia
    • changes in VS
    • near-death awareness
  46. what is a s/s death re: decreased circulation
    splotchy blueness
  47. what is the last sense to go when sb dies
    hearing
  48. 8 nursing interventions for the dying pt
    • provide personal hygeine for pt
    • assist w/ elim, nutr, mobility
    • edu/support fam. and sig. others involved (saying bye etc)
    • refer/provide emotional support
    • assess/provide adeq. pain ctrl s/s mgmt
    • holistic approaches: life review, imagery, relaxation, rituals that have sig. meaning
    • refer to hospice (early referral)
    • collaboration w/ other HCP team members
  49. 7 things re: post mortem care
    • follow hosp/facility protocols
    • allow fam members choice to view body
    • respect religious beliefs/customs
    • wash/dress body
    • make the room comfortable for fam
    • in some facilities place ID tags and wrap in shroud
    • handle deceased w/ dignity
  50. hospice care focuses on what
    • pain and symptom mgmt
    • a shift from aggressive, curative treatment
  51. hospice care is a philosophy of care that...
    guides people w/ a terminal illness on a journey to improve their quality of life
  52. is hospice in home or facility
    both
  53. 3 institutions that pay for hospice care
    • medicare
    • medical assistance
    • private insurance
  54. 5 services included in hospice care
    • medications
    • team services
    • equipment
    • respite care
    • short-term inpatient or continuous care
  55. 7 RN roles in end of life care
    • critical thinker
    • holistic caregiver
    • advocate
    • teacher
    • leader
    • lifelong learner
    • collaborator
  56. Dying person's bill of rights: "I have the right to..."
    • be treated as a living human being until I die
    • be in ctrl
    • maintain a sense of hopefulness, however changing its focus may be
    • be cared for by those who can maintain a sense of hopefulness, however changing this may be
    • have a sense of purpose
    • express my feelings and emotions about my approaching death in my own way
    • participate in decisions about my care
    • expect continuing medical and nursing attn. even though "cure" goals must be changed to "comfort" goals
    • not to die alone
    • be free of pain
    • have a respected spirituality
    • have my questions answered honestly
    • not be deceived
    • have help from and for my family in accepting my death
    • die in peace and dignity
    • retain my indiciduality and not be judged for my decisions that may be contrary to beliefs of others
    • discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others
    • expect that sanctity of the human body will be respected after death
    • be cared for by caring, sensitive, knowledgeable people who will try to understand my needs and will be able to gain some satisfaction in helping me face my death
  57. situational loss
    sudden, unpredictable external events that bring about a loss
  58. actual loss
    when a person can no longer feel, hear, or know a person or object
  59. perceived loss
    • foex, perceived rejection by a friend
    • loss of status in group
    • these losses are uniquely defined by the person experiencing the loss
  60. anticipatory grief
    the unconscious process of disengaging or letting go before the actual loss or death occurs

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