EOL/Hospice/Palliative

Question 1

Palliative Care

Answer 1

• optimizes quality of life
• interdisciplinary model of care
• reduce burdensome care transitions
• at any age and at any stage
• underutilized

Question 2

Hospice Care

Answer 2

• <6 moths of life (decision by 2 physicians)
• primary goal is to provide comfort
• does not seek to hasten death
• focus is on quality of life
• recognized by Medicare

Question 3

Principles of Hospice Care

Answer 3

• death must be accepted
• patient’s total care best managed by interdisciplinary team members who communicate regularly
• pain and other symptoms must be managed
• patient/family should be viewed as a single unit of care
• home care of the dying is necessary
• bereavement care must be provided to family members
• research and education should be ongoing

Question 4

Physician Ordered Life Sustaining Treatment (POLST)

Answer 4

• form that translates patient preferences expressed in advanced directives to medical “orders” that are transferable across settings and readily available to all HCP including emergency medical personnel
• can be completed at any age
• Color: green in NJ
• Covers: CPR, intubation, artificial nutrition and hydration, ABX, other medical interventions
• needs 2 witnesses

Question 5

Normal Physical Expressions of Grief

Answer 5

• crying
• HA
• difficulty sleeping
• fatigue

Question 6

Normal Emotional Expressions of Grief

Answer 6

• feelings of sadness and yearning

Question 7

Normal Spiritual Expressions of Grief

Answer 7

• questioning in the reason for your loss
• the purpose of pain and suffering
• the purpose of life and the meaning of death

Question 8

Normal Social Expressions of Grief

Answer 8

• feeling detached from others and isolating yourself from social contact

Question 9

5 Stages of Grief

Answer 9

DABDA
- Denial
- Anger
- Bargaining
- Depression
- Acceptance

Question 10

How long are bereavement services available for?

Answer 10

12 months

Question 11

NURSE Acronym

Answer 11

• N: Name that emotion
• U: Understand the emotion
• R: Respect (or praise) the patient
• S: Support the patient
• E: Explore the emotion

Question 12

Expected Physiological Changes During Dying Process + Additional Common S/S

Answer 12

• pain
• dyspnea
• impaired secretions
• anorexia, cachexia
• anxiety, depression
• terminal delirium
• additional common s/s: progressive fatigue, fever, oliguria/anuria, incontinence/retention, difficulty swallowing, decreased ADLs, skin breakdown, n/v, constipation

Question 13

Expected Physiological Changes: Pain

Answer 13

• important to educate that there will always be a last dose, but this dose did not cause death
• alternative therapies: short light massage therapy, therapeutic touch
• pharmacology: antispasmodics and analgesics
• morphine is the most used opioid for EOL

Question 14

Morphine Considerations for EOL

Answer 14

• oral route when possible
• IV or SQ for escalating pain
• SQ or oral route in home setting
• frequently require increase dose/frequency as death is imminent
• IV drip can be titrated based on HCP orders and pain assessment (inpatient hospice facilities or hospital settings)

Question 15

Expected Physiological Changes: Dyspnea

Answer 15

• not often associated with visible signs of distress or low O2 sat
• Interventions: HOB elevated, side lying position in bed
• Pharmacology: bronchodilators and corticosteroids, low doses of opioids (morphine), low-flow O2 (psychological comfort)

Question 16

Expected Physiological Changes: Cheyenne Stokes Breathing

Answer 16

• rapid breathing with long pauses
• fully unconscious
• assess nonverbal cues to distinguish this process from dyspnea and respiratory distress (not grimacing or gasping)
• can’t treat; patient is not experiencing pain
• occurs in last hours of life

Question 17

Expected Physiological Changes: Terminal Secretions

Answer 17

• unable to clear secretions through cough or swallowing d/t somnolence
• grunting, gurgling, or noisy congested breathing (“death rattle”)
• occur within 24-48 hours prior to death (indicates final stage of death)
• Anticholinergics: atropine, hyoscyamine, scopolamine
• Oral Care: wipe mouth of secretions, moisten mouth with swabs, reposition patient on side lying and elevated position, reduce oral fluids, avoid suctioning

Question 18

Expected Physiological Changes: Anorexia/Cachexia

Answer 18

• different from starvation
• body can not longer replenish protein loss with supplemental nutrition or hydration
• assess for causes: n/v, constipation, diarrhea, anxiety/depression, dysphagia
• do not force food/fluids
• allow patient preferences (cravings)
• small frequent sips of liquids or ice chips
• avoid strong odors
• antiemetics/laxatives (ondansetron, prochlorperazine)
• ginger drinks may help

Question 19

Anorexia

Answer 19

inadequate nutritional intake

Question 20

Cachexia

Answer 20

severe lean muscle loss

Question 21

Expected Physiological Changes: Terminal Delirium/Agitation

Answer 21

• provide education and engage family in periods of lucidity
• decrease/remove stimuli, maintain calm environment, do not restrain
• talk to patient
• causes: pain, retention, n/v
• lorazepam, haloperidol

Question 22

Physician Assisted Death

Answer 22

• less than 6 months of life
• must meet specific criteria
• Criteria: adult, state resident, mentally capable, able to self-administer and ingest medications, have a terminal diagnosis with a prognosis of 6 months or less to live
• NO EXCEPTIONS
• can’t be included in advanced directives