Week 1 Flashcards
You can never delegate a take that the RN must EAT, what does EAT stand for?
Evaluate, assess, teach
what is a primary, independent nursing responsibility?
Health education
Tips for educating elderly patients:
Treat as they are capable of learning include in setting goals ID and accomodate any disability Gear rate of teaching to person's disability Break into small parts
Guideslines for developing patient education materials:
- visuals
- 3-5 grade level
- short and concise
- key points or must know bullets
- explain measurements
- clearly ID when to call doctor
- plan language
- teach back
- find advocate for someone with low literacy to ensure compliance
Chronic illness:
persistent and recurring health problems, non-self limiting, duration of months and years or forever
Trajectory model of chronic illness:
- pretrajectory
- trajectory onset
- stable
- unstable
- acute
- crisis
- comback
- downward
- dying
Palliative care
Relieve suffering; initiate at any time through patient care; encourage physical support
Hospice is the same BUT is only utilized when the patient is told they have less than 6 months to live
Goal setting in palliative care → comfort vs. aggressive disease focused treatment
hospice care
End of life
Focus: QOL
Eligibility criteria
Services covered by CMS
Pre-death what should patient expect and what should nurse do
The dying person needs to know what is happening and talked about its reality
be allowed to experience the pain of a feeling bad instead of hiding their feelings
participate in decision-making regarding how they will spend their final days
nurse primary responsibility is to develop a relationship with the dying person
Death
primary responsibility is to anticipate problems such as distressing symptoms or family disruptions before they interfere with a dying person’s wishes
Bereavement
Time after death, nurse should be in position to listen
Ethical decision making in end of life care
nurses must educate patients about possibilities and probabilities regarding their illness and live with the illness
Advanced directives
durable power of attorney for health care
Living Will
Symptom management for end-of-life care
physical, psychological, social, spiritual
Pain should be treated; even as death approaches those receiving pain medication should continue as the level of Consciousness changes. even if the patient is unresponsive pain medication should be continued
Anorexia is expected at the end of life; can use appetite stimulants; not important to make sure the dying person is eating if they do not want to eat. educate the family that this is a normal part of the dying process
Cachexia
muscle waisting
Measures to manage anorexia in dying patient
Utilize anti-emetics Encourage to each when effects of meds subside modify environment to eliminate odors remove items that may decrease appetite manage anxiety and depression position to enhace gastric emptying assess bowels oral care ensure dentures fit treat pain
Changes in consciousness and delirium in dying patient:
Hypo/hyper active; can treat with benzo’s like ativan; focus on cause
teach family, ensure safety, monitor medications, confusion May mask needs and fears about dying, acknowledge family concern
Dyspnea – end of life
treatment varies; subjective and objective should be treated, assess, intervene if needed
Secretions in end of life
Related to oropharyngeal relaxation and diminished awareness
suctioning generally does not help
repositioning is most helpful
Oral Care
Atropine (SL/IV/SQ/IM) reduces production of oral secretions
Glycopyrrolate (PO/rectal/SL)
Scopolamine patch
Palliative sedation at end of life
Used for people close to death who are not responding to conventional treatment
Goal: reduce symptoms
This is different from euthanasia or PAS as this is to cause death (nurses in iowa can not do this)
Nursing care of patients and families in final hours of life
Expected physiological changes
a. s/s of near death, focus on patient, pt. will sleep longer, encourage family to continue to speak to client
After death care
body becomes dusky, blood pools, skin waxy
Describe grief mourning and bereavement
Grief is a person’s feelings that accompany an anticipated or actual loss
mourning refers to expressions of grief
Bereavement is the period of time that the mourning takes place
Anatomy of skin: Epidermis
Keratin (live, continuously dividing cells)
Melanocytes (pigment)
Merkel cells (transmit stimuli to the axon through a chemical synapse
Langerhans cells (play a big role in cutaneous immune system reactions)
Rete ridges (hold epidermis and dermis together and permits the free exchange of essential nutrients between two layers)
Anatomy of skin: Dermis
Strength and structure in the form of collagen and elastic fibers
Anatomy of skin: hypodermis
subcutaneus
What are the 3 types of sweat glands
Eccrine: all areas of skin
Apocrine: larger glands and eccrine found in axilla, anus, scrotum and labia majora
Sebaceous glands: sebum on to the space between the hair follice and hair shaft
