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Death and Dying > Week 10: Hospice and Palliative Care - Dying as a Transition > Flashcards

Week 10: Hospice and Palliative Care - Dying as a Transition Flashcards

1
Q

What is the ultimate cause of death?

A

Lack of oxygen (cardiac and brain)

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2
Q

When is a person considered dead according to Harvard Criteria?

A
  • Unreceptive and unresponsive
  • No movements and/or breathing
  • No reflexes; pupils are fixed, dilated, not responsive to light, no blinking, no ocular movement
  • Flat EEG, no activity in the cerebrum (brain waves)
  • No circulation to, or within the brain
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3
Q

What is the definition of a brain death?

A

Irreversible cessation; entire brain including brain stem

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4
Q

What is the definition of a coma?

A

Profound unresponsiveness due to illness or injury. Won’t speak, open eyes, engage in purposeful behaviors

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5
Q

What is the definition of a vegetative state?

A

Depressed consciousness, brain stem function and breathing independently. Person may respond to pain or loud sounds, involuntary motions, etc.
- persons who are in a vegetative state of >1 year are in a permanent vegetative state

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6
Q

What are signs of brain death?

A
  • Pupils stay in mid-position and do not react to light
  • The eye does not blink when touched
  • The eyes do not rotate in the socket when the head is moved from side to side or up and down
  • The eyes do not move when ice water is placed in the ear canal
  • The patient does not cough or gag when a suction tube is placed deep into the breathing tube
  • The patient does not breathe when taken off the ventilator
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7
Q

What does Neocortical mean?

A

Least extreme form - upper part of the brain where thoughts, pleasure, pain and volition reside - no longer functions

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8
Q

What does cerebral death mean?

A

The next step - comes when only the cerebellum and the brainstem are active

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9
Q

What does Whole Brain Death mean?

A

Brainstem itself has stopped functioning - only type of brain death that is recognized in the US

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10
Q

What does UDDA mean?

A

Uniform Determination of Death Act - individual who has sustained either irreversible cessation of respiratory function or cessation of all functions of entire brain

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11
Q

What does agonal movement mean? and what types of movements happen before clinical death?

A
  • The body’s ultimate response to a lack of oxygen - the moment before the moment of death
  • Muscle spasms, gasps, and possibly a convulsion may occur
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12
Q

Define these 3 different mortis’
- Algor Mortis
- Livor Mortis
- Rigor Mortis

A
  • Algor Mortis: temperature of the body postmortem; normal circumstances (one degree per hr)
  • Livor Mortis: the color of death; RBCs settle to lowest part of body, postmortem stain (reddish-purple discoloration)
  • Rigor Mortis: the rigidity of death; face, trunk, limbs and organs; contraction of muscle (2-6 hours after death)
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13
Q

Within 24 hours of death, there are additional changes to the body… what are they?

A

Decomposition
- Autolysis : cell self-destruction; enzymes
- Putrefaction (rotting): 2-3 days after death; smell due to decaying RBCs and intestinal gas
- Breaking down of the body

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14
Q

What are the 5 stages of grief (of dying)

A
  1. Denial: No not me, it can’t be true
  2. Anger: Why me?
  3. Bargaining: Maybe if I ask nicely or pray
  4. Depression: Individual can no longer deny his or her illness (reactive, preparatory)
  5. Acceptance: Person is neither angry nor depressed - a quiet degree of expectation
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15
Q

What are some evaluation of the five stages?

A
  • Existence of stages has not been demonstrated
  • People may not move through stages 1 –> 5
  • Limitations of methods
  • Line is blurred between prescription and description
  • Totality of the person is neglected
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16
Q

How do the dying want to be treated?

A
  • Greatest fear of the dying: to be left alone
  • No single way to die
  • Appropriate death is based on the individual
  • Need to pull away
17
Q

How should someone communicate with the dying?

A
  • Get the setting right
  • Find out if he person wants to talk about it
  • Listen and show you’re listening
  • Encourage the patient to talk
  • Silence and non-verbal communication
  • Make sure you have understood what is said
  • Dont change subject
18
Q

What are some signs of an approaching death?

A
  • BP is very low 60/40
  • Heartbeat is weak, irregular, difficult to count and fast 120-140 beats/min
  • Breathing is congested and can be rapid and then very slow
  • Decreased urine output; although people may wet the bed
  • Hands, feet, and knees are cold and purplish
  • Person may be confused
  • May be non responsive
  • Sleeping with eyes partially open
  • Mouth probably open
19
Q

What happen when death has occurred?

A
  • Breathing/heartbeat ceases
  • Person cannot be aroused
  • Eyelids may be partially open
  • Mouth may fall open
  • May be a release of bowel and bladder contents
20
Q

What does a good death mean?

A
  • Don’t want to be in pain
  • Don’t want to suffer
  • Don’t want to be a burden
  • Don’t want to die alone
21
Q

What does Palliative care mean?

A
  • Relieving symptoms of the incurable illness - person is not necessarily dying
  • Improving quality of life
  • Making the best of the time that is remaining
22
Q

What does Curative care mean?

A

Eliminating a controllable disease

23
Q

Explain more facts about hospice care

A
  • Philosophy of care and a program for a persons with a life limiting illness (prognosis of 6 months or less to live)
  • Not necessarily a facility (80% is provided in the home)
  • Focus not on the disease but on patents comfort and family
  • Not 24 hours care but available on call
  • Hospice is covered by medicare
24
Q

How many hospice programs are in the US and what percentage is covered by Medicare

A
  • 4,840
  • 85.5%
25
Q

Name the 4 levels of hospice care

A
  1. Routine Hospice Care (RHC): provided at person’s residence
  2. Continuous Home Care (CHC): 8 to 24 hours/day of care for pain management and other symptoms of an acute nature (predominantly nursing)
  3. Inpatient Respite Care (IRC): respite refers to relief. This is provided to caregiver on a temporary basis. Provided at hospital, hospice facility, or LTC facility offering 24 hours personnel support
  4. General Inpatient Care (GIP): Pain and symptom management that cannot be provided elsewhere. Care provided in medicare certified hospital, hospice, inpatient facility on nursing facility with 24 hours nursing required
26
Q

Name some hospice stats

A
  • Number of patients: 1.55 mil
  • 56.2% female and 43.8% male
  • 70.6% of hospice patients are over 65 and 62.7% are 84+
  • 29.4% are under 65
  • <1% are pediatric (0.4%)
  • Typically white folks
27
Q

In 2018, what is the number of patients, total days, and average days of care?

A
  • 1.55 mil
  • 113.5 M
  • 89.6
28
Q

What is the most common days of care?

A

266 days or less

29
Q

What percentage of hospice admission were cancer patient?

A

29.6% are for cancer patients and 70.4% are non-cancer

30
Q

What was the mean survival for hospice compared to non-hospice?

A

Mean survival was 29 days longer for hospice than non-hospice patients

31
Q

What disease typically had the longest days of care?

A

Alzheimer’s disease average being 105.2

32
Q

When was hospice established in the US?

A

In 1974 - 3 demonstration projects were designed to evaluate the effectiveness of hospice (In New Haven, Boonton, NJ, and Tuscan, AZ)

33
Q

Which hospice care location gets the most people (choose between Private residence, Nursing facility, and assisted living facility)

A

Assisted living facility

34
Q

In 2018 where was the most common location of death with hospice patients?

A

51.5% at home

Death and Dying (13 decks)

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