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End of Life
Lewis ch. 11 End of Life and Palliative Care
| Question | Answer |
|---|---|
| According to the Institute of Medicine what is the definition of “End of Life”? | the period of time during which an individual copes with declining health from a terminal illness or from the frailties associated with advanced age even if death is not clearly imminent |
| What are the goals of end of life care? | 1) provide comfort and support, 2) improve the quality of remaining life, 3) help ensure a dignified death |
| What are the technical defining characteristics of death? | the irreversible cessation of circulatory and respiratory function or the irreversible cessation of all function of the entire brain including the brain stem |
| What condition exists if a person stops breathing, and their heart stops beating or if their brain does not work at all and we cannot do anything to fix it? | Death |
| What sense is believed to be the last to go? | hearing |
| In regards to the sensory system generally speaking what happens to the senses due to decreased oxygenation to the brain? | Overall senses decrease, vision may blur, decreased sense of touch and pain, decreased sense of taste and smell |
| What happens to the heart rate and circulation as person approaches death? | The heart rate slows and weakens, blood pressure falls progressively. |
| Why might a person’s body temperature be raised as they approach death? | Due to disease process or changes to hypothalamic function |
| What are respirations like as a person nears death? | Respirations may be slow, shallow, irregular, death rattle, or Cheyne-stokes respiration |
| Define Death Rattle. | Noisy wet sounding respirations due to mouth breathing and mucous in the airways |
| What is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing? | Cheyne-Stokes respirations |
| How does decreased circulation affect the character of the integument as a person is dying? | Extemities become pale, mottled and cyanotic. The skin feels cool first in extremities and then progressing to the torso. |
| How does the loss of muscle tone affect a person’s facial features and speech? | Facial muscle lose tone. The jaw sags. Speech becomes difficult. |
| How does the loss of muscle tone affect swallowing and the gag reflex? | Swallowing becomes increasingly difficult and eventually the gag reflex is lost. |
| What happens to the eyes as a person is dying? | Vision blurs. Eyes may sink and glaze. Blink reflex is lost. Eyelids remain half open. |
| How does loss of muscle tone affect the GI and its function? | Motility and transit diminish, leading to constipation, gas accumulation, distention, incontinence, and nausea. Pain medications may exacerbate dysfunctions. |
| What affect does the loss of muscle tone have on the urinary system? | Function and ability to produce urine diminish. Loss of sphincter control can lead to incontinence. |
| Define brain death. | Brain death is the irreversible loss of all brain function including the brain stem. |
| What condition exists if the cerebral cortex stops functioning or is irreversibly destroyed? | Brain death |
| What part of the brain is responsible for voluntary action and cognitive functioning? | Cerebral Cortex |
| What diagnostic criteria for brain death does the American Academy of Neurology recommend? | Coma or unresponsiveness, absence of brainstem reflexes, and apnea |
| What are the current legal and medical standards for the pronouncement of brain death and disconnection from life support? | All brain function must cease |
| What is an individual’s emotional response to the loss of a significant person? | Bereavement |
| What is the lived experience in reaction to loss that develops from bereavement? | Grief |
| How does grief affect a person? | Grief is one of the most powerful emotional states and affects all aspects of a person’s life. |
| How can we anticipate the course of a person’s grief? | We can’t. Grief and its expression are unique to each person. |
| What is pathologic grief? | Grief does not wane in intensity after the first year. |
| What is conflicted grief? | A person has ambivalent feeling toward the deceased. |
| What is absent grief? | when the bereaved person appears to be coping and carrying on as if nothing has happened |
| How would grief that is prolonged, unresolved, or disruptive be termed? | maladaptive or dysfunctional grief |
| What is grief that is helpful or assists the person in accepting the reality of death? | adaptive grief |
| The Omnibus Reconciliation Act of 1990 is also known as what? | the Patient Self-Determination Act |
| According to the Patient Self-Determination Act all institutions that participate in medicare must provide patients what? | Written information concerning their right to accept or refuse tx, including the right to initiate advance directives. |
| What are advance directives? | A person’s written wishes regarding medical care |
| Who can decide if organs may be donated? | competent patient’s before death, family members after death |
| Why does the surgeon need to be notified right away about organ donation? | because some organs must be used within hours after death. |
| A lay term for statements that give instructions about future treatment if a patient is unable to do so for himself. | living will |
| A term used to describe a document designating the person or persons who should make health care decisions if a patient cannot make informed decision for himself. | durable power of attorney for health care or medical power of attorney |
| A written document to a health care provider stating the patient’s wish to be allowed to die without heroic or extraordinary measures | Directive to health care provider |
| Specific state laws that include a variety of directives related to an individual’s wishes regarding medical treatment and prolongation of life | natural death acts |
| The federal law specifying that institutions participating in Medicare must provide written information to patients concerning their rights to accept or refuse treatment | Omnibus Reconciliation Act of 1990 or Patient Self-Determination Act |
| A general term used to describe all documents that give instructions about future medical care and treatments | Advanced directives |
| What are the signs of organ rejection? | oliguria, fever, increasing edema, hypertension and weight gain |
Created by:
Perseverandovercome
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