Lecture 2 Flashcards
Palliative Care & Inflammation and Wound Healing
“an approach that improves the quality of life of patients and their families facing the problems associated with a life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”
Palliative care
Body and mind
Symptom management
Psychosocial
Quality of life
Comfort measures
Desires and goals
Pain management
are things we supply to ____________ during palliative care
Patient and family
What are the 3 layers of care?
Palliative care
End-of-life care
Terminal care
Changes to body systems:
Urinary system
Integumentary
Musculoskeletal
Sensory
Gastro Intestinal
Respiratory
Cardiovascular
Physical and psychosocial manifestations of the end of life
Taste, smell, hearing, and sight
Hearing usually last sense to disappear
↓ With disease progression
Blurring of vision
Sinking and glazing of eyes
Blink reflex absent
Eyelids may remain half-open
will occur during…
End of life
Mottling on hands, feet, arms, and legs
Cold, clammy skin
Cyanosis on nose, nail beds, knees
“Waxlike” skin when very near death
skin changes at end of life
↑ Respiratory rate
Cheyne–Stokes respirations
Inability to cough or clear secretions
Grunting, gurgling, or noisy congested breathing
Irregular breathing
Slowing down to terminal gasps
are things that happen at…
End of life
Gradual decrease UO
Incontinent of urine
Unable to urinate
Urinary system changes for end of life
Loss of appetite and thirst sensations
Slowing of digestive tract and possible cessation of function
Accumulation of gas and abdominal distention
Nausea
Loss of sphincter control
Bowel movement may occur before imminent death or at the time of death
Physical Manifestations:Gastrointestinal System
Gradual loss of ability to move
Sagging of jaw resulting from loss of facial muscle tone
Difficulty speaking
Swallowing can become more difficult
Difficulty in maintaining body posture and alignment
Loss of gag reflex
Physical Manifestations:Musculoskeletal System
↑ Heart rate
Later slowing and weakening of pulse
Irregular rhythm
Decrease in blood pressure
Delayed absorption of drugs administered intramuscularly or subcutaneously
Peripheral edema
Physical Manifestations:Cardiovascular System
Altered decision making
Anxiety about unfinished business
↓ Socialization
Fear of loneliness
Fear of meaninglessness
Fear of pain
Helplessness
Life review
Peacefulness
Restlessness
Saying goodbyes
Unusual communication
Vision-like experiences
Withdrawal
Psychosocial Manifestations at the End of Life
____ is a normal reaction to loss
Grief
Anger, guilt, anxiety, sadness, depression, despair, or a combination of these
These are the _______
Stages of grief
_____ & _____ can cause Disruption in sleep, changes in appetite, physical symptoms, and illness
Grief & bereavement
Grief that takes place before the actual death
Anticipatory grief
Period after the death of a loved one during which grief is experienced and mourning occurs
Time spent is individual.
______ and grief counselling are components of patient- and family-centred hospice palliative care.
Bereavement
Beliefs, values, and practices that relate to the search for existential meaning and purpose
Assessment is a key consideration.
Respect the patient’s wishes with regard to spiritual guidance or pastoral care services and make referrals as appropriate.
Spiritual needs
Ways in which people understand and experience death varies across cultures
Understanding care of dying patients and of practices or rituals concerning the care of the body upon and immediately after death
Culturally competent care
_______ & ______ issues affecting end of life care:
Patients and families struggle with many decisions during the terminal illness, such as
Organ and tissue donations
Advance directives
Cardiopulmonary resuscitation
Medical assistance in dying
Legal & ethical issues
The intrinsic value and uniqueness of each person, the person’s right to self-determination, and autonomous decision making
Advance care planning (substitute decision maker)
Process of a patient’s thinking about and sharing one’s wishes for future health and personal care
Advance directives
These are all examples of _____ & _____ issues affecting end-of-life care
Legal & ethical issues
Health care providers should always speak with patients about their wishes for care and treatment
A way to ensure you have a say in health care decisions that lie ahead
Advanced Care Planning (ACP) status (goals of care)
Not to be confused with MAiD
Infrequent and extraordinary intervention
To intentionally produce sedation in order to relieve intractable symptoms in the last days of a patient’s life
The principle of double effect justifies the use of medications that cause sedation as an adverse effect, an unintended harm, as its primary role is to relieve suffering and not to hasten death.
Palliative sedation
All persons who are 16 years of age or older and are competent may choose _____ & _______ donation.
Only patients who have sustained a nonrecoverable injury and are on life support may donate, as can MAiD patients.
All patients have the potential to donate
Should be on patient’s medical record.
Organ and tissue donation
Nursing _______ is Holistic
Psychosocial, physical needs
Respect, dignity, and comfort
Focuses on:
What is important for the patient and their family
Management of symptoms of the disease rather than on the disease itself
Management
Varies with:
Patient condition
Proximity of approaching death
Comprehensive or limited to essential data
Document-specific change that brought patient into health care facility
Nursing assessment
Planning requires ______ and ______
Coordination of care
Goals
Patient’s needs
Family and significant others’ needs
Education counseling, advocacy, support
Coordination of care
