care of the dying and their families

Question 1

things to remember when caring for the dying

Answer 1

ensure dignity Is maintained, care for the individual and for the loved ones, routine interventions maintained (hygiene, clean linens, assess for pain/ comfort), call for support services, provide loved ones with comfort

Question 2

clinical signs of impending death: CV

Answer 2

weak, slow, irregular pulse, decreasing BP

Question 3

clinical signs of impending death: respiratory

Answer 3

noisy, irregular, cheyne stokes respirations, apnea

Question 4

clinical signs of impending death: GI/GU

Answer 4

nausea, flatus, abdominal distention, constipation, incontinence, decreased urine output

Question 5

clinical signs of impending death: neuro

Answer 5

difficulty talking or swallowing, loss of voluntary movement, sensation, reflexes; restlessness, decreased level of consciousness, agitation, hallucinations

Question 6

clinical signs of impending death: skin

Answer 6

cold, clammy skin, mottling and cyanosis

Question 7

legal definition of death: uniform definition of death act (1981)

Answer 7

an individual who has sustained either (1) irreversible cessation of all functions of circulatory and respiratory functions (2) irreversible cessation of all functions of the entire brain, including the brainstem is dead

Question 8

medical criteria used to certify a death has occurred:

Answer 8

cessation of breathing, no response to deep painful stimuli, lack of reflexes (gag reflex, corneal reflex), and spontaneous movement

Question 9

changes of the body after death: primary flaccidity then rigor

Answer 9

stiffening

Question 10

changes of the body after death: algorithms mortis

Answer 10

cooling

Question 11

changes of the body after death: liver mortis

Answer 11

discoloration

Question 12

nursing responsibilities at the time of death

Answer 12

notification of: physician, loved ones, spiritual care, organ donation consultant; facilitation of legal requirements, care of the deceased, care of the loved ones

Question 13

nursing responsibilities at the time of death: physician

Answer 13

they pronounce the time of death, legal time of death

Question 14

nursing responsibilities at the time of death: loved ones

Answer 14

next of kin or guardian

Question 15

nursing responsibilities at the time of death: care of the deceased

Answer 15

place a sign on the patients door, relocate room mate, prepare the loved ones to visit

Question 16

Management of personal belongings

Answer 16

remove jewelry, glasses, religious items, personal blanket, distribute the personal items not worn by the patient (medical devices- walkers), document what items went to family, document where items are stored

Question 17

nurses are responsible for

Answer 17

the management of the patients belongings

Question 18

care of the deceased: loved ones

Answer 18

provide conference room for private space, provide access to phones, provide opportunity to meet with chaplain, chairs at side of bed & side rails down

Question 19

before loved ones leave do what for the deceased

Answer 19

offer to call funeral home, determine if there are special religious practices, obtain contact info in case, distribute patients personal belongings

Question 20

post mortem care

Answer 20

bath the body, perform interventions required for organ donation, close eyes, place dentures in mouth, patient supine/ HOB 30 degree/ arm at sides, remove all tubes, change dressings (if corner case, leave all tubes and lines in), obtain morgue pack, patient appropriately identified (wrist band, tag on toe, tag on bag), place abd pads between buttocks, secure chin

Question 21

transferring the deceased

Answer 21

be aware of special handling that is required for communicable diseases, transfer to morgue or funeral home following facility policy, RN signs to release the body to the next location

Question 22

nursing documentation for deceased patient

Answer 22

time of death, persons notified/ time of notification, list & disposition of personal belongings, time deceased was transferred from your care/ destination/ who transported the deceased

Question 23

organ donation

Answer 23

at time of death, nurses notify organ donation consultant, nurses provide info to the organ donation consultant regarding the deceased, consent for donation is obtained by the consultant (Ohio offers advanced authorization on drivers license)

Question 24

autopsy

Answer 24

medical examination after death (used to determine cause of death), consent must be obtained prior ro completion of an autopsy, coroner can over ride the families decision in some cases

Question 25

code blue

Answer 25

when a person experiences cardiac or respiratory arrest

Question 26

full code

Answer 26

all attempts will be made to resuscitate

Question 27

DNR (do not resuscitate)

Answer 27

no attempts will be made to resuscitate

Question 28

DNR specified

Answer 28

determines what type of resuscitate efforts will be made at the time of arrest (compressions only, medications only, do not intubate(DNI))

Question 29

DNR CC (comfort care)

Answer 29

only comfort measures will be used, no further diagnostic measures (oxygen administered, medications are administered, routine hygiene and wound care)

Question 30

living will

Answer 30

addresses wishes regarding extraordinary measures

Question 31

durable power of attorney for healthcare

Answer 31

indicates who the patient wishes to make their healthcare decisions

Question 32

advanced directives are not the same as

Answer 32

DNR orders

Question 33

what are advanced directives

Answer 33

legal documents that the patient completes to indicate the patients wishes should he or she be unable to make decisions

Question 34

palliative care

Answer 34

focus on providing relief for the symptoms and stress of a serious illness, goal is to improve quality of life, a subspecialty of medicine that is helpful for persons of any age, with many different diagnoses

Question 35

hospice care

Answer 35

the middle for quality compassionate care for people facing a life limiting illness or injury, focuses on medical management/ pain management/ emotional & spiritual support

Question 36

what is grief

Answer 36

characteristic patterns of physiological and psychological response to a loss

Question 37

what is mourning

Answer 37

socially prescribed behaviors of one who has experiences a loss (usually a loved one)

Question 38

what is bereavement

Answer 38

persons total response to the loss; physical, social, emotional, and cognitive responses

Question 39

disenfranchised grief

Answer 39

experience of grieving a loss that is not acknowledged by society

Question 40

engels 6 stages of grief: 1.

Answer 40

shock and disbelief

Question 41

engels 6 stages of grief: 2.

Answer 41

developing awareness

Question 42

engels 6 stages of grief: 3.

Answer 42

restitution

Question 43

engels 6 stages of grief: 4.

Answer 43

resolving the loss

Question 44

engels 6 stages of grief: 5.

Answer 44

idealization

Question 45

engels 6 stages of grief: 6.

Answer 45

outcome

Question 46

kubler- ross 5 stages of grief: 1.

Answer 46

denial

Question 47

kubler- ross 5 stages of grief: 2.

Answer 47

anger

Question 48

kubler- ross 5 stages of grief: 3.

Answer 48

bargaining

Question 49

kubler- ross 5 stages of grief: 4.

Answer 49

depression

Question 50

kubler- ross 5 stages of grief: 5.

Answer 50

acceptance

Question 51

self care: examine and clarify your own feelings about death and loss. do what

Answer 51

take time ti grieve (find supportive listener), it is acceptable to show your emotions to the deceased loved ones

Question 52

the patient asks the nurse to explain a living will. What is the nurses best response?

Answer 52

It lists specific instructions for health care

Question 53

a terminally ill patient says to her nurse "my situation is hopeless; I have no control over anything" which of the following interventions does the nurse implement?

Answer 53

encourage her to tell you more about how she is feeling, sit in a chair next to her, hold her hand

Question 54

your patient has just returned from a diagnostic test. the results show that he has very advanced cancer. who is responsible for what, when and how the patient is told

Answer 54

his physician