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SUMGERI > Death > Flashcards

Death Flashcards

1
Q

What 2 forms of care are included in End of Life Care?

A

Palliative care and hospice care.

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2
Q

What is the difference between palliative care and hospice care?

A

Palliative care is not always hospice care, but hospice care ALWAYS involves palliative care.

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3
Q

What are the 3 goals of palliative care?

A
  • Symptom relief - Improvement of function - Improvement of quality of life
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4
Q

Describe the 4 principles of hospice care.

A
  1. less than 6 months to live. 2. “cure” to “comfort.” 3. may leave and return to hospice care during EOL time.
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5
Q

What are the 5 types of attitudes about dying?

A
  1. Medical 2. Societal 3. Cultural 4. Individual 5. Familial
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6
Q

What is the “fantasy death” that most people hope for? What percentage of deaths actually occur here?

A

old, at home with loved ones, quick, without suffering, and peaceful. <20% of deaths occur at home bc lower property value

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7
Q

In what setting do most people die?

A

In an acute care setting (60%). >40% of people in acute and LTC settings. Less than 7% in hospice

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8
Q

What are the 3 hospice eligibility requirements for a pt with CHF?

A
  1. Class IV failure 2. EF < 20% 3. 2-3 admission to acute care in one year.
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9
Q

What are the 6 hospice eligibility requirements for a pt with COPD?

A
  1. O2 dependent 2. Poor response to bronchodilators, resting PCO2 >50. 3. O2 sat on RA <88 4. PO2 <55 on O2 5. Cor pulmonale, weight loss 6. HR > 100, 2-3 acute admissions in one year.
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10
Q

What are the 2 hospice eligibility requirements for a pt with renal failure?

A
  1. Creatinine > 8.0 2. Off dialysis
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11
Q

What are the 4 hospice eligibility requirements for a pt with cirrhosis/liver failure?

A

1.bed bound 2. Albumin < 2.5 3. INR > 1.5 MAJOR INDICATOR OF LIVER FAILURE 4. + 1: encephalopathy, spontaneous, bacterial peritonitis, refractory ascites, recurrent variceal bleed, hepatorenal syndrome.

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12
Q

What are the 6 hospice eligibility requirements for a pt with dementia?

A
  1. Bed bound 2. Mute (except for occasional vocalization). 3. Unable to ambulate 4. Aspiration pneumonia 5. weight loss 6. And at least 1 of the following in past year: pyelonephritis, sepsis, pressure ulcers, fever after antibiotics, dysphagia.
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13
Q

What are the 3 hospice eligibility requirements for a pt with a stroke?

A
  1. Poor nutritional status 2. Albumin < 2.5 3. Recurrent medical problems as with dementia.
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14
Q

Is DNR a requirement for a patient to go into hospice?

A

**Strongly encouraged.

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15
Q

What is the sudden death trajectory IN sudden death trajectory?

A

Sudden decline of health to death.

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16
Q

What is the cancer life trajectory?

A

Slow decline over time.

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17
Q

What is the dementia life trajectory?

A

Scraping the bottom of the health curve. Small ups, but mostly staying down until death.

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18
Q

How can you help a patient prepare for death when they have the erratic, sine wave trajectory?

A
  1. Pre-planning for urgent situations 2. Life closure 3. Prevention of exacerbations 4. Decisions making about benefits of low yield treatments. 5. Support at home 6. Prepare family for “sudden death”
19
Q

What percent of physicians are overly optimistic with patients who are near death?

A

63%-They overestimate life expectancy by a factor of 5!

20
Q

How can you as a provider deliver bad news in the best way possible?

A
  1. Know about the diagnoses, treatments, and medications.
  2. Know your patient, be familiar with the cultural differences, the patient’s family.
  3. Speak in general terms, avoid technical details. Go SLOWLY.
  4. Do not give false hope….but do not take all hope away.
  5. Leave time for questions and schedule a follow up appt within a week.
  6. Involve the patient’s support system.
  7. Refer to ancillary services as needed (SWS, psych, spiritual, etc).
21
Q

“how long do I have to live”?

A

Admit uncertainty, AVOID definitive. hours - days, days - weeks, weeks- months, or months - years.

22
Q

Should you share your opinion with patients who are making decisions about a fatal diagnosis/end of life care?

A

YES. Offer your opinion AFTER listening to others. The patient needs to know what you think and support your opinion with facts. Validate the beliefs of others. EXPLAIN the risk-benefit analysis!!!!- MIRROR technique if escalates

23
Q

How should you document these end of life discussions?

A

List the participants of all discussions, what decisions were made, and what was deferred. Current and Advance directives list what the patient wants now and might want for the future.

24
Q

What are the 4 requirements on a DNR order?

A
  1. The meaning of resuscitation explained. 2. Mechanical vs chemical resuscitation. 3. Use of paddles and chest compressions 4. Potential effectiveness.
25
Q

Who can make decisions based on the patient’s health care legally?

A

DPAHC: designated power of attorney for HEALTH CARE decisions. DPA-Designated Power of Attorney- patient’s finances, etc, NOT their health care.

26
Q

What is a living will?

A

Less detailed document about their finances and belongings. This is NOT a legal document in most states.

27
Q

What are necessary risks you need to discuss with a patient regarding adequate pain control?

A
  • somnolence, confusion, diminished respiration’s, constipation
28
Q

What are 2 treatment considerations to maintain a patient’s health in hospice care?

A

Nutrition and hydration.

29
Q

Do enteral feedings reduce the risk of aspiration or mortality?

A

NO!!!!- Remove if imminent death due to Malabsorption. DOES not reduce dry mouth

30
Q

What are the 2 uses of morphine and fentanyl?

A

Pain and anxiety. **Morphine is avoided in renal failure.

31
Q

What 2 medications are used for agitation if a patient is at risk for seizures?

A

Haloperidol or Thorazine

32
Q

How can you modify a patient’s environment to make it more comfortable?

A

Reduce noise, add soft music, and limit light.

33
Q

What is the central factor to the interdisciplinary approach to a patient in end of life care?

A

THE PATIENT and the patient’s wishes and well being.

34
Q

What is the death rattle?

A

moist respirations seen at the very end of life. The patient typically does not last more than 24 hours after this.

35
Q

What is the main job of psychiatry in end of life care?

A

Regular assessment of psychological reactions to illness including stress coping strategies and anticipatory grieving is documented and validated. Treat depression, suicidal ideation, anxiety, delirium associated with comorbidities.

36
Q

What is spirituality?

A

The aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.

37
Q

What are the 4 requirements for a pt to achieve the “right to die” or physician assisted suicide?

A
  1. Patient must be 18 and with only 6 months or less to live.
  2. 2 doctors must sign off on the diagnosis and deem the patient mentally competent.
  3. Pt must make an oral request for the prescription 2x and 15 days apart, AND make a written request.
  4. Patient must be able to administer drugs themselves without help.
38
Q

Will insurance cover physician assisted suicide?

A

Medi-Cal and Medicaid will, but Medicare and the VA will NOT as it is not legal under federal law.

39
Q

What are the signs and symptoms patients typically experience within their last 48 hours of life?

A

Typically are in a dream like state, or delirious. - Delirium, confusion - Hallucinations - Nausea/vomiting - Sweating - Restlessness, agitation - Jerking, twitching, plucking - Mottling and coolness of extremities.

40
Q

Senses typically diminish within the last 48 hours, which go first and last?

A

1st- vision first 2nd touch 3.hearing last. *Pain may INC but diminishes.

41
Q

What are the Herald Signs? When do they typically occur?

A
  • 23 hrs before death = death rattle, frequently more distressing to loved ones. - 2.5 hrs before death = respirations with mandibular movement. - 1 hr before death = cyanosis and lack of radial pulse.
42
Q

What are ways to support family prior to death?

A
  1. Review expectations. 2. find the words to say to the patient I love you, we’ll miss you 3. find things to do —> talk to the patient, read to them, touch, and stroke them. 4. Reassure they are doing well. 5. permission to rest.
43
Q

When is withdrawal of life support appropriate?

A
  1. When a capable patient requests it. 2. Prognosis for recovery to acceptable baseline is poor. 3. Death is near and inevitable. 4. Coma is expected to persist.

SUMGERI (14 decks)

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