End-Of-Life Care

Question 1

What are Hospice care and Palliative care?

Answer 1

1. Hospice care
   - Admission criteria: Terminal illness, Pt. agrees to palliative care, Pt. choose hospice over other care
   - Interprofessional/holistic care: HCP, Nurse, CNA, spiritual leader, Social workers, etc
   - Care of the Family
2. Palliative Care
   - Relief & Prevent discomfort/sufferings
   - Improves quality of life for clients & families

Question 2

What are the nursing assessments & interventions for end-of-life care?

Answer 2

1. Assessments:
   - Depends on diagnosis, note the intensity, frequency, duration, what triggers & relieves, AND HOW s/s affect sleep and ADLs
2. Educate family & patient:
3. What to EXPECT in DYING process
4. SYMPTOM causes & treatments to promote comfort
5. ASSURANCE of palliative care, DISCUSS fears & what can and can’t be done in palliative care
6. Assurance:
   - That will do all you can to help them be comfortable

Question 3

What are the physiological alterations you would notice at the end of life?

Answer 3

1. Breathing & respiration
   - Dyspnea and retention of secretion. A sound they usually make before dying is the “Death Rattle” due to secretion! They might have irregular RR/ Cheyne-stoke’s breathing!
2. Pain:
   - GIVE them scheduled & PRN meds to make sure they’re comfortable
3. Temperature (Low temp. & Marbling of skin/purple-reddish of the skin)
4. Vision & hearing
   - They become hallucinated & see and hear things that aren’t there
5. Physiological alterations
   - IF THEY ARE UNRESPONSIVE and not talking, continue to have convo w them. BUTTT… REORIENTATION ISN’T important! just support; not correct!

Answer 4

1. Fatigue: from Metabolism needs of tumor & poor nutrition
   - Frequent resting periods & PRIORITIZE tasks to save energy
2. Pain: general or specific pain/discomfort
   - Pain meds, Positioning, Bath, Back rub, Oral hygiene & Artificial tears
3. Dyspnea: TREAT CAUSE (Tumor, Pneumonia, Anemia, and Fever)
   - Fowler’s position, Oxygen & Open airway. Decrease fever. Use branchodilators, inhaled steroids, & cough suppressants. Cool air & Cold face towel!
   - IF BC OF PANIC: use SMALL AMNTS of ANTI-ANXIETY meds
4. FLUID RETENTION: systematic or pulmonary
   - Positioning, Skin care, and DIURETICS!!!
5. Anorexia, Nausea, and Vomiting
   - ANTI-EMETIC MEDS, oral hygiene q2-4hrs. Clear liquid diet, ICE CHIPS, & AVOID Acid stimulating food: Coffee, Milk, & Citrus!!!1
6. Restless & Agitation:
   - Listen, asses & treat cause. Use pain meds carefully
7. “DEATH-RATTLE” : Mucus in resp. tract of unconscious
   - Suction and ANTICHOLINERGICS to decrease mucus, BUT be watch for side effects: Drowsiness, Constipation, and Urinary retention!