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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

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

A

Power of attorney one or more persons act in your behalf

22
Q

Healthcare proxy

A

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

23
Q

Communicating w/dying pt

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

A

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

25
Q

Morphine

A

Can help relax respiratory effort
Not only for dying

26
Q

Most crucial needs

A

Control of pain
Preservation of dignity and self worth
Love and affection

27
Q

Assessing for impending death

A

Can limit interventions like q 2 hr repositioning

28
Q

Special supportive care

A

Perinatal death-facilitate holding the baby
Reality of death
Pediatric death- feelings of parental guilt
Suicide
Gerontologic death
Sudden/unexpected death

29
Q

S/Sx of imminent death

A

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
Q

Clinical signs of death

A

Unreceptive and unresponsive
No movement or breathing
No reflexes
Flat ekg
Absence of apical pulse
Cessation of respirations

31
Q

Postmortem care

A

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
Q

Institutional settings

A

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
Q

Least restrictive to most restrictive

A

Home/community services (hospice daycare)
Assisted living facility
CCRC/ continuing care retirement community
Institutional setting

34
Q

Omnibus budget reconciliation act (OBRA 1987)

A

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
Q

Sources of reimbursement

A

Medicare-65+/disabled
Limited funding toLTC

Medicaid-federally funded state operated program
Medical assistance to people w/low incomes, qualifying conditions
Private pay

36
Q

What are goals of LTC

A

Pt. centered individualized OBRA
Prioritize physical and mental status
Quality of life
Residents rights

37
Q

Interdisciplinary settings

A

Healthcare professional work together
Meet needs of older adults
Facility managed by administrator and DON

38
Q

Joint commission:National or. safety

A

Goals- identify pt. correctly
Use medicine safely
Prevent infection
Fall prevention
Prevent pressure injuries

39
Q

Palliative vs.curative care

A

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
Q

Criteria for hospice admissions

A

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
Q

Goals of hospice

A

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
Q

Interdisciplinary team

A

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
Q

Common symptoms of terminally ill

A

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
Q

Most feared symptom

A

Pain-priority for symptom management TREAT FIRST can be excruciating, constant , terrifying

45
Q

Types of pain

A

Somatic- muscluloskeletal
Visceral-organs
Neuronal-nerves

46
Q

Nursing interventions

A

*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
Q

Pt + caregiver teaching

A

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
Q

Signs and symptoms of approaching death

A

Mottled extremities- different colors of paleness
Irregular breathing-Cheyenne-stoke
Restlessness, less urine, incontinence, less appetite and thirst

49
Q

Bereavement period

A

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
Q

Ethical issues in hospice care

A

Withholding/withdrawing nutrition
Support right to refuse tx
DNR orders hopefully wishes known in advance
Nurse: be aware of facilities ethnic policy

51
Q

Miscellaneous

A

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

Lpn (16 decks)

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