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CH 46
end of life care
| Question | Answer |
|---|---|
| grief | process of moving from deep sorrow caused by loss toward healing and recovery |
| grief counselling | support for people coping with the difficulties associated with the loss of a loved one |
| postmortem care | care of the body after death |
| rigor mortis | stiffness or rigidity of skeletal muscles that occurs after death |
| support workers are required to help meet the physical, ________, emotional, _____________ and ______________ needs of those dying | emotional, social, spiritual |
| dying people must die in a facility t/f | f; can die in facility or home |
| PSWs provide support for the dying person only t/f | f; may need to provide support for family and loved one also |
| families are also involved in care of dying person t/f | f; families interact with death differently, some are very hands on, some are unable to due to distance or personal choice |
| end of life care can be ________ draining for loved ones and ______________ | emotionally, caregivers |
| witnessing and providing care may remind caregivers of their own eventual death or death of a loved ones t/f | t |
| having a dying client may cause feelings of helplessness since they are unable to make the client better t/f | t |
| health care members may be unsure of their feelings about death or may be uncomfortable with dying clients or the subject of death mentioned in convo with the client t/f | t |
| your ________and ________ about death and _______ may effect that care you give when caring for a dying client | feelings, beliefs, dying |
| its important to understand both _______ process and your own ________ towards death and dying | dying, attitudes |
| understanding death and dying will help you provide ________________ care | compassionate |
| life limiting illness have cures t/f | f; they have no cure |
| some injuries can become life limiting and cause body to stop functioning t/f | t |
| people dying of life limiting illness do not expect recovery and the illness or injury inevitably end in death t/f | t |
| Health care workers can predict the time of death t/f | f; they can not predict the exact time of death |
| No one can predict the length of _______ a client may have, as each client is _________ | time, unique |
| the fact that death is approaching is only difficult to the person that is dying t/f | f; difficult for family, friends, loved ones as well as client |
| everyone approaches death differently; some may solve unresolved issues, put financial affairs in order, decide on medical care t/f | t |
| the family of a dying person do not need to accept that this person will no longer be in their life because its a person choice t/f | f; the loved ones of the dying person must begin to realize that they will not always have this person in their lives and they must start the grieving of their loss |
| attitudes towards death are influenced by _________, personal beliefs, age, _________ ,experience | culture, religion |
| many people ________ death | fear |
| some people believe they will ____________ their health and not die | regain |
| some people _________ and look ___________ to death | accept, forward |
| a persons attitude towards death is fixed and permanent throughout life t/f | f; persons attitude toward death often changes with age and experience |
| until the _______ century, most _________ died in their own homes | 20th, Canadian |
| Canadian families often cared for the body of a loved who had died until the beginning of the 20th century t/f | t |
| most people still die at home today t/f | f; in facilities |
| death is not a frightening experience as most people have seen a dead body t/f | f; many people have never seen a dead body or dying person so death can be frightening |
| ___________ and ___________ about death differ among individuals, cultures and religions | practices, beliefs |
| a clients personal, cultural and religious beliefs also influence choices about end of life care and treatment of body after death t/f | t |
| goal is palliative care is to reduce suffering and pain as much as possible for that person using pain meds and soothing comfort measures t/f | t |
| some people believe that "________________" should include removing breathing machines, feeding tubes and other medical devices that only prolong life but do not cure | dying with dignity |
| assisted suicide | suicide that is aided by providing the client with the means to do it or the information on how to end their own life |
| euthanasia | act of putting another person painlessly to death |
| June 6, 2016 | assisted suicides became legal for any adult who is legally capable of making such a choice rationally |
| what two stipulations must be met for a person to legally be able to choose assisted suicide: | 1)the person clearly consents to termination of their life 2)person has an irreversible illness, disease or disability that is causing intolerable pain or sufferings and that cannot be reversed or acceptably reduced |
| reincarnation | the belief that the spirit or soul is reborn in another human body or in another life form |
| what four things can be impacted by the beliefs about the body's form after death? | 1)buried or cremated? 2)autopsy performed or not 3) organs donated or not 4)donation of body to science or not |
| peoples attitudes and responses to dying are highly ____________ | individual |
| two of the major influencers of peoples feelings and reactions to death are? | age and stage of life |
| infants and toddlers can understand death t/f | f; have no concept of death |
| between 3 and 5 children have some ideas about death and are curious t/f | t; however may not understand the permanence of death |
| children 5-7 understand death is permanent t/f | t; however may not think it will happen to them |
| adults have the same number of fears that children do t/f | f; may have more fears |
| older adults often have fewer fears about dying and death t/f | t |
| report any wishes made y your dying patient to the __________, who will forward them to the family | supervisor |
| younger adults and older adults often fear ____________ | dying alone |
| you _________ predict what a particular individuals response to death will be | cannot |
| Hindu death and dying rituals | 1)dying person may be laid on floor 2)thread around neck or wrist placed by priest must not be removed 3)priest may pour water in person mouth 4)family members may wash body |
| Sikhism death and drying rituals | body must have: 1)kesh (uncut hair) 2) kangra (wooden comb) 3)kara (wrist band) 4)kirpan (sword) 5)kach (shorts) |
| Buddhism death and dying rituals | 1)monk brought before death; performs last rites/ chants by bedside 2)burial or cremation of body ok |
| Shinto death and dying rituals | 1)jewelry removed 2)body washed 3)dressed in white kimono and straw shoes |
| Islam death and dying rituals | 1)confession of sins 2)body washed and wrapped in white cloth 3)head turned to right shoulder facing east towards mecca |
| Judaism death and dying rituals | 1)body washed by burial society 2)someone remains with body at all times (orthodox/ conservative Jews) 3)burial with 24hrs of death if possible |
| Christianity death and dying rituals | 1)vary greatly 2)last rites/ communion may happen many prefer burial |
| Christian Science death and drying rituals | 1)Females only handle females who have died 2)postmortem not allowed unless law requires |
| Indigenous groups death and dying rituals | Inuits= generally follow Christian practices Metis, First Nations and individual families= vary widely, some follow Christian practices, some incorporate traditional spiritual aspects, some combine |
| ___________ is one of life's most stressful events | loss |
| each person responds to ____________ in their own way | grief |
| Grief is also called ________________ | bereavement |
| each client and family will grieve differently based on ______ experiences, ________ strategies, cultural beliefs and spiritual beliefs | past, coping |
| coping with grief involves the process of _______ and ________ to the loss | mourning, adapting |
| grieving is a streamlined process through all the stages t/f | f; it is an individual experiences with the ability to move backward and forth through the stages |
| with enough time people can "get over " a loss t/f | f; no one really "gets over the loss", the individual can heal and adapt to the loss |
| people experience grief after any important loss that affects their life t/f | t |
| grief is complicated and the same for everyone t/f | f; complicated and different for everyone |
| _____________, thoughts, reactions and ___________ related to grief are very personal | feelings, challenges |
| thoughts and feelings during grief are constant in people t/f | f; they may be at odds |
| the ___________ of grief changes a lot over time | intensity |
| people work through grief at the their _____ and _______ | time, pace |
| factors that make grief more complicated inc sudden loss, frightening, an accident or disaster or result of crime, experience with mental illness, lack of personal/ social support, and difficult personal relationship t/f | t |
| members of the health care team do not experience grief because they are rained professionals t/f | f; caring for a dying person is a moving and emotional experience and supporting the family can be very difficult |
| advise the grieving person to connect with caring and ____ people | supportive |
| let the grieving person know they do not have a lot of time so its good to accept asap t/f | f; let them know it takes time, everyone reacts differently to loss |
| Advise a grieving person to allow themselves to feel uncomfortable with their emotions and find _________ ways to share | healthy |
| Advise the grieving person to recognize their life has changed, disinterest is a natural part of loss t/f | t |
| suggest to the grieving person that they should reach out for help and support t/f | t |
| Advise the grieving person that they it may be helpful to plan ahead for ________ and think of new traditions as these times can be the most difficult | holidays |
| Advise the grieving person that their _________ health can be affected so take care and speak to a dr of any shifts happen | physical |
| A person that is grieving may find ____________ other is helpful to them during the process | helpful |
| advise grieving individuals to be honest with children about what is happening and engage them in conversations sharing emotions t/f | t |
| encourage a grieving person to work through ___________ emotions | difficult |
| suggest the grieving person make a new beginning, start old activities again and try to consider new ones t/f | t |
| suggest to the grieving person that any _________ life decisions should wait, ___________ changes may add more stress | major, sudden |
| Kubler Ross's Theory on Stages of Grief | identifies 5 stages that clients and family may undergo while grieving. not everyone who is grieving will go through every stage or experience them in specific order |
| Kubler Ross's Theory include what stages: | 1)denial 2)anger 3)bargaining 4)depression 5)acceptance |
| Bowlby's Phases of Mourning include what stages: | 1)numbing 2)yearning and searching 3)disorganization and despair 4)reorganization |
| Worden's Four Task of Mourning include what stages: | 1)acceptance of reality of loss 2)working through the pain of grief 3)adjusting to the environment without the deceased 4)emotionally relocation the deceased and moving on with life |
| Wordens four tasks of mourning imply that ______ who mourn can help themselves and be helped by people _______ them | people, around |
| it usually takes ______ to work through Wordens four tasks of mourning | 1 year |
| the World Health Organization defines palliative care as_____________________________________________________________ | an approach that improves quality of life for people/ families facing life threatening illness. prevention and early identification, assessment and treatment of pain and other problems associated with whole person (super paraphrase; pg 1064 for full) |
| the focus of palliative care is on _____________ symptoms and ___________ support to people when there is no response to treatment | controlling, providing |
| the idea for hospice care started in the __________________ in Europe | middle ages |
| in 1967, Dr. Cecily Saunders open the first __________ research and teaching hospice in ______________ | free standing, London |
| hospice care can mean the __________ the care is given | place |
| Palliative usually refers to ______________ | the care given |
| palliative and hospice can mean the same thing; _________________________________________________________________ | compassionate care of dying persons directed at comfort and pain management |
| the most common facility setting for palliative care is the palliative care unit in a home t/f | f; in a hospital |
| LTC facilities can also provide ____________________ | palliative care |
| a hospice program provides care for a client seeking rehabilitation t/f | f; provides care for a dying person |
| the goal of hospice is to provide a ___________, peaceful setting and to ensure comfort measures are ________ to client | comfortable, provided |
| some hospices provide palliative care to _________ client groups | special |
| hospice and palliative care is _____ intended to prolong life but to provide ______ quality of life | not, best |
| goal one of palliative care is to assist in controlling the pain and symptoms of illness t/f | t |
| goal two of palliative care is to ensure that death is a unnatural process t/f | f; make sure it is a natural process |
| goal three of palliative care is to provide quick and speedy care because people die fast t/f | f; provide compassionate care |
| most terminally ill clients fear _______ more than death itself | pain |
| medical interventions such as respirators and tube feeding are used to keep clients alive in hospice t/f | f; prolonging life is not a goal of palliative/end of life care |
| in palliative and end of life care the right to die with ________is strongly upheld | dignity |
| palliative care is demanding and there for requires a ___________ | team |
| the common goal or purpose behind all activities in palliative care is to assist the dying person and their family in best way possible t/f | t |
| clients and family unit are encouraged to help with client care t/f | t |
| mutual respect, communication, accurate charting and information among team members will ensure best possible care for the dying person and their family t/f | t |
| Client responsibilities inc: | 1)participate in decision making 2)be included in all discussions about care when possible |
| caregivers responsibilities inc: | 1)may include family and friends 2)participate in decision making 3)included in discussions about care |
| Home care coordinator responsibilities inc: | 1)assesses clients needs 2)coordinates services at clients home |
| PSW responsibilities inc: | 1)assist with personal care/ household tasks 2)monitors situation, reports significant observations 3)provides emotional support to client and care givers |
| hospice volunteer responsibilities inc: | 1)provide emotional support/info bout services available |
| spiritual advisor responsibilities inc: | 1)provide spiritual/ emotional support to client/ care givers |
| occupational therapist responsibilities inc: | 1)teaches client/ caregivers to compete ADL's 2)emotional support to client/ caregivers |
| dr responsibilities inc: | 1)monitors clients health status 2)prescribes/ monitors meds for pain ad symptom management 3)educate/ provide emotional support for client/ caregivers |
| physiotherapist responsibilities inc: | 1)teach personal exercises to promote independence 2)recommend assistive devices to promote independence |
| social worker responsibilities inc: | 1)provide supportive counselling |
| nurses responsibilities inc: | 1)monitor meds and assist with pain/ symptom management 2)assist with personal care 3)educate/ provide emotional support to client/ caregivers |
| the health care team meets the _____________, sexual, spiritual, physical needs of the client | psycho social |
| clients who are dying do not need accurate information because they need peace and calm t/f | f; they need accurate information to make informed choices |
| what are three ways to meet the clients emotional, social, spiritual and intellectual needs? | 1)listening 2)touch 3)respect |
| as a dying person I have the right to be treated as a living human being until I die t/f | t |
| as a dying person I have the right to maintain a sense of hopefulness and to be cared by those who can maintain a sense of hopefulness, however changing its focus may be t/f | t |
| as a dying person I have the right to express my feelings and emotions about my approaching death in the manner that I am told t/f | f; I have the right to express my emotions and feelings about my approaching death in may own way |
| as a dying person I have the right to participate in decisions concerning my care and expect continuing medical/nursing attention even though acute goals must change to comfort goals t/f | t |
| as a dying person I have the right to die alone, be free of pain, to have my questions answered honestly, to not be deceived t/f | t |
| as a dying person I have the right to have help from and for my family in denying my death t/f | f; right to have help from and for my family in accepting my death |
| as a dying person I have the right to die in peace and with ______________ | dignity |
| as a dying person I have the right to retain my individuality and not be judged for my choices which may be contrary to belief of others t/f | t |
| as a dying person i have the right to discuss and enlarge my religious/ spiritual experiences regardless of what they may mean to others t/f | t |
| as a dying person I have the right to expect the sanctity of the ________ body will be respected after death | human |
| as a dying person I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to not understand my needs and will be able to gain dissatisfaction in helping me face my death t/f | f;I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain satisfaction in helping me face my death |
| ways to provide for physicals needs of a dying person inc: | 1)pain relief and omfort 2)comfort and posistioning 3)vison and sys care 4)hearing 5)speech 6)mouth care 7)nostril care 8)skin care 9)elimination 10)nutrition |
| pain relief and comfort can be provided through pain med, back massage, imagery, soft music and relaxation techniques t/f | t |
| when helping for pain relief and comfort good skin care, personal hygiene and proper _______ help promote comfort | alignment |
| ___________ position changes and _____________ devices also promote comfort | frequent, supportive |
| ___________position is best for easing breathing problems | fowlers |
| at the end of life vision remains strong t/f | f; vision becomes blurry, gradually fails so darkened rooms may be frightening |
| at the end of life rooms should be _____________, but avoid bright lights and glares | well lit |
| provide comfort to a dying persons eyes by applying moist pads or protective ointment t/f | t |
| hearing is the last function to be lost towards the end of life t/f | t |
| always assume a dying client can ________ | hear |
| some clients lose their ability to _____________ so ask simple yes or no questions, do not tire them out with questions that need long answers but still engage them | speak |
| towards the end of life the clients ____________ may feel dry, uncomfortable or sore and swallowing may be difficult | mouth |
| towards the end of life a clients nostrils may become crusted/ irritated usually because of nasal _______ , oxygen cannulas and ___________ tubes | secretions, nasogastric |
| towards the end of life circulation to the arms and legs increases as death approaches t/f | f; decreases |
| towards the end of life clients may not be _________ of the skin color changes, paleness, mottled look or coldness of their skin | aware |
| towards the end of life a client may __________ as circulation to the peripheral parts fail | sweat |
| towards the end of life do not add heavy blankets as this could cause over heating and restlessness. apply light covers only t/f | t |
| towards the end of life skin care, bathing, frequent position changes, fresh garments and linens keep client comfortable t/f | t |
| towards the end of life pressure ulcers are not a concern because the skin has less blood t/f | f; preventing pressure ulcers is a concern to the very end of life |
| towards the end of life a client could have urinary/ fecal incontinence or constipation or urinary retention t/f | t |
| towards the end of life nutritional needs decrease as the body can no longer deal with digesting foods t/f | t |
| if the family requests a spiritual advisor tell your supervisor when you can t/f | f; report immediately to the supervisor |
| show the family your feelings by being respectful, empathetic and supportive t/f | t |
| in facilities families are only permitted during visiting hours if death is imminent t/f | f; families are allowed 24/7 |
| clients that are dying are at high risk for ___________, choking and _____________ accidents | falls, other |
| advance directive is also called ______________ | living will |
| advance directive | a legal document in which a person states specific wishes about future health care, treatment(diagnostic, therapeutic, preventive, palliative) and personal care(clothing, shelter hygiene, safety, nutrition) |
| an advance directive is used when the person can no longer make decisions or express personal wishes t/f | t |
| advance directives allow people to ___________ their future health care | control |
| most advance directives have a dual function, these inc: | 1)allow a person to appoint a representative (proxy) to make medical care, treatment, personal care decisions 2)give written instructions bout medical care/ treatment/ personal care |
| the advance directive comes into effect ______ when a client can no longer make decisions about health care and personal care | only |
| dr's often write "_____________" (DNR) or "______" orders for clients who are not expected to recover | do not resuscitate, no code |
| if you are not comfortable with care and resuscitation decisions, discuss the matter with your ______________ | supervisor |
| signs of death always occur rapidly t/f | f; occur fast or slow |
| signs of death inc loss of muscle tone, movement and sensation t/f | t |
| signs of death include speeding up of peristalsis and other digestive functions t/f | f; these decrease |
| signs of death inc failure of circulation, and respiratory system t/f | t |
| sigs of death inc excessive alertness and wakefulness t/f | f; excessive fatigue and sleep |
| signs of death inc changes in eating patterns, social withdrawal and coolness in fingers and toes t/f | t |
| Cheyne- Stokes respiration | respiration gradually increase in rate and depth and then become shallow and slow and then stop for 30 secs. mucus collects in airway, causes wet/ gurgling sound as client breaths (death rattle) |
| the pulse being is fast and weak and irregular is a sign of death occurring t/f | t |
| nausea and vomiting may be present at the time of death t/f | t |
| the physiological signs of death inc absence of P, R or PB and fixed pupils t/f | t |
| autopsy | an examination of the body to determine the case of death |
| PSW may be asked to assist with post mortem care t/f | t |
| post mortem care is done to _____________ the body's appearance by helping prevent discoloration and skin damage | maintain |
| rigor mortis sets in within ____ to ______ hours after death | 2 to 3 |
| post mortem care involves ____________ the body in good alignment before_________ sets in | positioning, rigor mortis |
| if the client dies at home the ____________ usually provides post mortem care | funeral home |
| postmortem care may involve repositioning the body to clean soiled areas and put body in good alignment t/f | t |
| movement of the body can cause sounds to come from the body as _______ is expelled | air |
| PSWs have full responsibility of post mortem care so contact supervisor with questions t/f | f; they do not have full responsibility but may assist in procedure |
| wellness and preventative care focus on the ___________ of illness | prevention |
| health care includes all medical treatments; diagnostic, therapeutic, preventative and palliative t/f | t |
| during the ___________ phase, people refuse to believe that anything is wrong | denial |
| during the __________ phase, people may strike at anything/ anyone | anger |
| during the ______________ phase, people try to postpone the loss and hope the loss can be prevented | bargaining |
| during the _____________ phase, people may feel overwhelmed and lonely and may withdraw from others | depression |
| during the ______________ phase, people move forward with their lives and appreciate their memories of the person | acceptance |
| do not ___________ the client if you feel uncomfortable or sad, try to understand how the clients is feeling | avoid |
| some of a _______persons fears and anxieties can be alleviated by providing good pain control | clients |
| DNR orders are written after ______________ with the client and family | consulting |
| post mortem care ___________ after the client is pronounced ______ and when no __________ is required | begins, dead, autopsy |
| complete the following tasks when assisting with a post mortem: | 1)bathe soiled areas in plain water. dry thoroughly. 2)place in supine position. straighten arms/ legs. pillow under head/ shoulders 3)close eyes, insert dentures, close mouth |
| when assisting with post mortem care check policy for placing a moist ___________ over eyes to keep them closed | cotton ball |
| if you do not insert dentures during assisting with post mortem care because of employer policy, place them in a _____________________ | labelled denture container |
| end of life care | care provided in last days and hours |
| hospice care | residential/ day service facility/ visiting program/ inpatient unit/ home care service providing holistic care by team to a person/ family when person expected to die within 6 months. care extended beyond death to bereaved |
| patterns of dying inc: | 1)stuttering decline 2)sudden decline 3)slow decline 4)steady decline |
| body map | is a outline of a body (front and back), it helps the team learn more about the persons pain and may also help people that struggle to tell about their pain |
| anorexia | persons appetite commonly decreases as their disease progresses. caused by disease progression and contributes to weight loss. may be in reaction to other symptoms(nausea, vomiting, sore mouth, dysphasia, dyspnea, constipation, depression, fatigue) |
| cachexia | involuntary weight loss of more than 5% of body weight in 6 months. triggered by body's inflammatory processes, occurs regardless of intake |
| delirium | physical state in which the brain cannot send a receive information correctly. person is confused , easily distracted, unable to focus on tasks/ convos, hallucinate, alert, agitated drowsy, incorrectly interpret info, unable to communicate thoughts/need |
| the state of delirium can be ___________ or ____________, lasting a few hours or days, occurring repeatedly as disease progresses or signal imminent death | reversible, irreversible |
| cultural humility | involves reflecting on your cultural biases, acknowledging the biases and keeping this info present so that you can learn about another's persons culture and develop relationships based on trust and respect |
| culturally safe care | advocating for and providing a culturally safe environment for the dying person and family that is free of discrimination and racism where power imbalances are addressed and all people shar in decision making, feel safe, respected and heard |
| cultural sensitivity | develops when you recognize differences and similarities between your cultures and other cultures and acknowledge that you culture is no better or worse than any other culture |
| cultural awareness | acknowledging you cultural values, beliefs, perceptions, and recognizing your view/ experiences of other cultures are thru a lens of our won culture |
| cultural competence | bring together skills of cultural humility/ sensitivity/ awareness |
| MAID | Medical Assistance in Dying |
| compassionate fatigue | describes the emotional/ physical exhaustion that can occur when a caregiver is unable to refuel/ regenerate quickly enough to meet the emotional/ physical demands at work |
| what are the three best practices groupings? | 1)expanding world view 2)building skills in connecting and communicating 3) developing best practice ways of being |
| expanding your world view includes: | 1)considering every person as valuable and worthy of honour and respect 2)supporting every person dignity 3) asking the dignity question |
| the dignity question is ;__________________________? | what do i need to know about you as a person to give you the best care possible? |
| you can build skills in connecting and communication by: | 1)listening 2)pausing 3)asking open ended questions 4)being silent 5)responding with curiosity 6)avoiding roadblocks to communication |
| roadblocks to communication are: | 1)minimizing problem 2)offering false reassurance 3)offering excessive praise 4)offering platitudes |
| you can develop best practice ways of being by: | 1)focusing on strengths and not judging 2)maintaining hope 3)being empathetic and compassionate |
| fear and misunderstanding about opioids inc: | 1)symbolism 2)developing tolerance 3)becoming dependent 4)developing substance use disorder 5)fear of being judged 6)developing R depression |
| common side effects of opioids inc: | 1)constipation 2)nausea vomiting 3)confusion/ delirium 4)drowsiness 5)opioid toxicity 6)other (dry mouth, itchiness, U retention, sweating, twitching) |
| common symptoms a person living with a life limiting may experience inc: | 1)anorexia/ cachexia 2)changes in bladder/bowel function 3)dehydration 4)Delirium 5)Depression 6)difficult breathing 7)fatigue 8)mouth discomfort 9)nausea/vomiting 10)pain |
| principles for using opioids to manage pain inc: | 1)adjust the opioid does to meet the persons needs 2)maintain symptom relief with reg doses of opioids 3)admin breakthrough doses when reg doses do not manage pain 4)change route of opioid admin when necessary |
| support physical comfort with complementary and alternative therapies such as: | 1)guided relaxation/ meditation 2)healing touch/ therapeutic touch/ reiki 4)massage 5) reflexology 6)music |
| therapeutic touch treatment, reiki treatment, healing touch treatment | based on moving/ transferring energy in the person recieving the therapy and reported to reduce pain, anxiety, stress and increase relaxation (healing touch=no touching person, therapeutic touch= touching person, reiki- laying hands ) |
| 10% of the population die from _____________ death | .sudden decline |
| 20% of the population die from ______________ death | steady decline |
| 70 % of population die from ___________________ or ______________________ death | stuttering decline, slow decline |
| PSWs provide excellent care by : | 1)integrating the palliative care approach 2)starting the discussion early 3)supporting through death/ grief |
| Edmonton Symptom Assessment Scale (ESAS) | self assessment about specific symptoms the person may be experiencing their severity. when person can no longer self assess/ communicate this tool is no longer effective. |
| Palliative Performance Scale (version 2) (PPSv2) | uses caregiver observations to id persons level of functioning. PSW usually not expected to conduct assessment, however need to understand how changes in PPS effect changes in care |
| Canadian study of Health and Aging (CSHA) Clinical Frailty Scale | uses caregivers observations to id a persons level of frailty and risk of dying in coming months or years |
| Symptom Framework for PSWs | uses standardized questions prompts to gather symptom specific info from person |
| Pain Assessment in Advanced Dementia (PAINAD) | uses caregiver observations to id behaviours in a person that may indicate untreated pain. cannot id severity of pain |
| Pain Assessment Checklist for seniors with Limited Ability to Communicate (PACSLAC-II) | guides caregivers to observe a person for bahaviours (from the check list) that may indicate untreated pain |
| Psychosocial Assessment Tool | gathers info about person, family, support system, goals of care, preferences of care when dying and after death |
| between the PPS scores of ____%-_____%, PSWs often start assisting the person who is facing a life limiting illness | 40-60 |
| the difference between 30% to 20% is often clarified by the fluid intake of the person t/f | t |
| the speed at which people move thorough the PPS percentages is referred to as the _______________ | the disease trajectory |
| baggage is the opinions, _____________, and values we carry everywhere we go | beliefs |
| if you are unaware of your baggage you may bring that into your practice; expectations or pressure of what good or bad deaths looks like, how families should grieve or care for loved ones or what traditions different cultures practice around death t/f | t |
| emotional resilience | having clarity about role and setting good boundaries, ability to remain confident and grounded, remaining clear/ centered about responsibilities/ limitations at work, ability to maintain balance between care deeply and healthy distance |
| stress of over involvement with patients and family's manifests as what 4 emotions? | 1)anxiety 2)fear 3)exhaustion 4)resentment |
| principles of palliative care inc: | 1)life affirming 2)holistic 3)dying person/ family are a unit 4)prevention/ early detection 5)may pos influence course of illness 6)provided by team 7)begin anytime/in all care settings 8)provide w/disease modifying therapy 9)culturaly sensitive |
| dyspnea is a _________ experience and is hard to measure | subjective |
| principles for opioids for pain management with frail and elderly inc; | 1)start low, go slow 2)find the right dose 3)give regularly 4)break thru doses when needed 5)treat side effects 6)change routes if necessary |
| changes in the way people have started dying inc: | 1)much older 2)with multiple chronic illnesses 3)declining over many years |
| a steady decline death often occurs over ______ months | 6 |
| the most common cause of steady decline death is _____________ | cancer |
| in a sow decline death periods of decline and recovery are more _____________ | subtle |
| palliative care is care that is provided by the _____________ team when possible and can begin anytime and continues through ______ and __________________ | interdisciplinary, death, bereavement |
| Palliative care is a ______________ of care not a person | type |
| palliative care and acute care ( or disease modifying care) can occur ______________ | together |
| only _____% of people receive palliative care in their homes | 15 |
| only ____% of people in LTC receive palliative care | 6 |
| a person with cancer is _______ more likely to receive palliative care even though it accounts for less than 20% of deaths | 3 times |
| barriers to accessing/ receiving palliative care include: | 1)lack of resources/ funding 2)remote/ rural locations 3)lack of awareness 4)being a member of an underserved population |
| PSW integrate a palliative approach by: | 1)gathering info 2)considering needs of whole person 3)providing physical/ psychosocial support 4)communicating/ advocating 5)collaborating with team |
| the surprise question asks: | "would I be surprised if this person died in the next 12 months?" |
| preparing to care means: | 1)consciously acknowledging your beliefs, values and experiences 2)consciously working to provide care that aligns with the beliefs, values, experiences of the person |
| cultural safety is made up of 4 components, they are? | 1)sensitivity 2)humility 3)awareness 4)competence |
| strategies for building a professional and ethical practice inc: | 1)maintaining therapeutic boundaries 2)collaborating with team 3)committing to advocacy 4)committing to learning 5)committing to leadership |
| how to maintain boundaries inc: | 1)acknowledge their importance 2)know scope of practice 3)take time to reflect on situations where you experienced strong emotions 4)engage in self care regularly |
| on the edge of the dance floor in the family dance analogy you can: | 1)observe/ learn about fam interactions 2)explore to understand what to ask 3)normalize what a healing response looks like 4)preserve the integrity of the fam dance |
| what is an advocate? | someone who speaks up for or on behalf of another person |
| ways that PSWs advocate inc: | 1)clarify info to clear up miscommunications 2)connect the person with assistance 3)id people/ resources needed when people advocate for themselves |
| strategies for advocating inc: | 1)confidence 2)professionalism 3)preparedness 4)clarity 5)descriptiveness 6)positivity 7)gratitude for assistance |
| PSWs often provide the _________ of direct care for a dying person | majority |
| standardized tools inc: | 1)PPSv2 2)CHSA clinical frailty scale 3_ESAS 4)symptom framework for PSWs 5)PAINAD 6)PASCLAC II 7)Psychosocial assessment tool |
| Palliative Performance Scale looks at: | 1)ambulation 2)activity level/ evidence of disease 3)self care 4)intake 5)conscious level |
| opioids are commonly used for: | 1)moderate to severe pain 2)difficulty breathing 3)coughing |
| 4 things PSWs know about opioids for pain management inc: | 1)that pain relief threshold is different for every person 2)regular doses of opioids provide consistent pain relief 3)that breakthrough doses may be needed 4)that meds routes may change |
| opioids ate the number one med for dyspnea t/f | t; decrease sensation of breathlessness and sensitivity to C02 |
| for clients experiencing dyspnea oxygen may be helpful ____ the persons blood oxygen is low but many people with difficult breathing have normal blood oxygen levels | if |
| indicators of pain that can be observed inc: | 1)facial expressions 2)verbalizations/ vocalizations 3)body movements 4)changes in interpersonal interactions 5)changes in activity routine 6)mental status changes |
| preventive comfort measures inc: | 1)relaxed environment 2)plan caregiving for hen pain meds most effective 3)position for comfort 4)use mobility aids for safety |
| comfort measures in the moment inc: | 1)distraction (chat, reminisce, activity) 2)relaxation (massage, imagery, music) 3)stimulation (heated blankets, cold cloths, lotions, massage, position changes) |
| analgesics ________ pain; non opioids, acetaminophen, opioids, morphine, ibuprofen, codeine | treat |
| adjuvants _______ another symptom, secondary effect is reducing pain; steroids, NSAIDS, antibiotics | treat |
| indicators for dying from dementia inc: | 1)repeated infections 2)unhealed skin ulcers 3)significant intake decline 4)inability to swallow 5)increased sleep/withdrawal |
Created by:
Wil.Wilson
Popular Health & Social Care sets