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Lpn > FON Ch 25, 38, 40 Grief Death Nd Dying, Hospice Care, L.T.C. > Flashcards

FON Ch 25, 38, 40 Grief Death Nd Dying, Hospice Care, L.T.C. Flashcards

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1
Q

Loss

A

Aspect of self no longer available to a person

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2
Q

Griefwork

A

Process of morning

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3
Q

Mortality

A

The condition of being able to die

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4
Q

Stages of dying

A

Denial Anger Bargaining Depression Acceptance

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5
Q

Obvious losses

A

Death and divorce

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6
Q

Not so obvious loss

A

Pregnancy, babies w/challanges

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7
Q

Maturational loss

A

Consequence of aging, homesickness, leaving for school etc

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8
Q

Situational loss

A

Job, spouse, home

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9
Q

Personal loss

A

Childhood experiences, view of loss as crisis, financial impact, accumulated loss experience,

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10
Q

Bereavement

A

Response to death of a loved one

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11
Q

Mourning

A

Helps to assist in healing from loss

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12
Q

Nurse role

A

Active listening
Supportive presence
Educate them on what is expected
Explore ways to help patient make new emotional investments

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13
Q

Unresolved dysfunctional grief

A

Complicated grieving
Unresolved grief/mourning is delayed or exaggerated response to a perceived, actual, or potential loss
Stuck in grief process
Depressed/ unable to express feelings

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14
Q

Sense of presence

A

Variable sensations
Smells/visions

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15
Q

Complicated grief (saying)

A

‘I can’t believe they’re gone’

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16
Q

Exaggerated grief

A

Becoming overwhelmed by grief
Unable to function

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17
Q

Delayed grief

A

Normal grief reactions suppressed/postponed

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18
Q

Euthanasia passive

A

Permitting death by withholding treatments/meds, life support systems, feeding tubes that may extend life

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19
Q

Euthanasia active

A

Assisting in such a death

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20
Q

Living will

A

Pt makes preferences for care and tx known to drs. In the event he is not able to do so in the future

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21
Q

POA

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A

Power of attorney one or more persons act in your behalf

22
Q

Healthcare proxy

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A

Another person who will speak for the person and make decisions regarding the pt care

23
Q

Communicating w/dying pt

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A

Therapeutic communication
Express respect for patient
Offer support
Careful attention to verbal and nonverbal
Assist patient in saying goodbye
It’s ok if pt does not want to talk

24
Q

Palliative care

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A

Provide relief from pain and other distressing symptoms
Affirm life and regard life as normal process
Neither hasten/postpone death

25
Morphine
Can help relax respiratory effort Not only for dying
26
Most crucial needs
Control of pain Preservation of dignity and self worth Love and affection
27
Assessing for impending death
Can limit interventions like q 2 hr repositioning
28
Special supportive care
Perinatal death-facilitate holding the baby Reality of death Pediatric death- feelings of parental guilt Suicide Gerontologic death Sudden/unexpected death
29
S/Sx of imminent death
Pupils dilated and fixed Cheyenne- stokes respirations Pulse weaker and more rapid Bl pressure continues to fall Profuse diaphoresis Skin cool and clammy Death rattle;noisy respirations
30
Clinical signs of death
Unreceptive and unresponsive No movement or breathing No reflexes Flat ekg Absence of apical pulse Cessation of respirations
31
Postmortem care
ASAP after death to prevent tissue damage or disfigurement Offer family opportunity to view body Prepare body and room Minimize stress of the experience Body; as natural & comfortable as possible
32
Institutional settings
Subacute unit LTAC-long term acute care Psychiatric LTC-2 categories of residents Short term-rehab/skilled nursing Long term/they live there-Restorative nursing
33
Least restrictive to most restrictive
Home/community services (hospice daycare) Assisted living facility CCRC/ continuing care retirement community Institutional setting
34
Omnibus budget reconciliation act (OBRA 1987)
Defines quality of care for LTC Mandates presence of actual nurses Administered by healthcare financing administration (HCFA) Unannounced surveyors residents assessment inventory (RAI) Improved care, planning and provisions for LTC residents
35
Sources of reimbursement
Medicare-65+/disabled Limited funding toLTC Medicaid-federally funded state operated program Medical assistance to people w/low incomes, qualifying conditions Private pay
36
What are goals of LTC
Pt. centered individualized OBRA Prioritize physical and mental status Quality of life Residents rights
37
Interdisciplinary settings
Healthcare professional work together Meet needs of older adults Facility managed by administrator and DON
38
Joint commission:National or. safety
Goals- identify pt. correctly Use medicine safely Prevent infection Fall prevention Prevent pressure injuries
39
Palliative vs.curative care
Active tx no longer effective Supportive measures needed Assist terminally ill or thru dying process Offer support and safe passage from life to death Preserve dignity and important relationships Quality not quantity of life emphasized Not all palliative care is hospice care
40
Criteria for hospice admissions
Illness is terminal w/6months or less Willingness to forego further curative tx Seeking only palliative care Pt and caregiver must understand and agree Care will be planned according to comfort Life support measures may not be performed Knowledge of prognosis Willing to Participate in planning of care
41
Goals of hospice
Control/alleviate pts symptoms Allow pt and caregiver to be involved in care decisions Provide continuous support to maintain pt/family confidences Educate and support primary caregivers in chosen settings
42
Interdisciplinary team
Medical director(*mediates between hospice team + medical provider) Nurse coordinator-(*manages pt care, admits pt, assigns team) Social worth-helps with financial concerns (*evaluates psychosocial needs depression anxiety fear) Spiritual coordinator-(*spiritual support) Volunteer coordinator-respit +relief (*trains and recruits volunteers) Bereavement coordinator-(*assess and support bereaved survivor) Hospice pharmacist Dietician consultant Hospice aide-CNA-personal care
43
Common symptoms of terminally ill
Nausea + vomiting Tx w/antiemetics Constipation Dyspnea and air hunger Anorexia and malnutrition Cachexia- weakness and emaciation(thin) Psychosocial and spiritual issues Also skin. Weakness, insomnia, depression
44
Most feared symptom
Pain-priority for symptom management TREAT FIRST can be excruciating, constant , terrifying
45
Types of pain
Somatic- muscluloskeletal Visceral-organs Neuronal-nerves
46
Nursing interventions
*book/assess pain control and pain level 0-10 Assess understanding of medication administration Assess side effects Educate caregiver + pt about other pain control methods Keep pain diary
47
Pt + caregiver teaching
Honest and straight forward Fear of unknown is greater than fear of know Educate caregiver in symptom management Hands on care of pt Caring for body functions Teaching S/Sx of approaching death
48
Signs and symptoms of approaching death
Mottled extremities- different colors of paleness Irregular breathing-Cheyenne-stoke Restlessness, less urine, incontinence, less appetite and thirst
49
Bereavement period
Sometimes 1 year after death Even if family is prepared may be difficult Hospice staff goes thru grieving period for each pt that dies Hospice provides support to staff
50
Ethical issues in hospice care
Withholding/withdrawing nutrition Support right to refuse tx DNR orders hopefully wishes known in advance Nurse: be aware of facilities ethnic policy
51
Miscellaneous
Future: increase of hospice care Nursing process for hospice pt and families Stigma busting work to be done POLST orders- physician orders for life sustaining tx usually shorter than advance directives

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