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Chapter 10
Concepts 3
| Question | Answer |
|---|---|
| Temporary cessation of breathing, often seen in end-of-life stages or during sleep disorders. | Apnea |
| Bluish discoloration around the mouth, typically indicating poor oxygenation | Circumoral cyanosis |
| The presence of two or more medical conditions occurring simultaneously in a patient (e.g., diabetes and heart disease). | Comorbidity |
| A legal directive instructing health care providers not to perform CPR or advanced life support if cardiac or respiratory arrest occurs. | Do-not-attempt-resuscitation (DNAR) order |
| A legal document granting a designated person the authority to make health care decisions on behalf of a patient who is unable to do so | Durable power of attorney |
| The intentional act of ending a person's life to relieve suffering; legality and ethics vary by region and context | Euthanasia |
| Deep emotional response to loss, commonly experienced after death, diagnosis, or major life change | Grief |
| Specialized care for patients nearing the end of life, focused on comfort and quality rather than curative treatments. | Hospice care |
| A legal document outlining a person’s wishes for medical treatment in case they become unable to communicate those decisions. | Living will |
| Supportive care aimed at relieving symptoms and improving comfort for patients with serious or chronic illnesses, regardless of prognosis. | Palliative care |
| The respectful preparation and handling of the body after death, in accordance with cultural or religious practices. | Postmortem care |
| Temporary relief for primary caregivers, allowing them rest or time away while maintaining patient safety and comfort. | Respite |
| A situation where traditional family roles shift—often when adult children care for aging parents or when illness alters responsibilities. | Role reversal |
| Alleviate pain and discomfort, not cure illness. Administer opioids, antiemetics, anxiolytics with ethical sensitivity. Monitor for side effects, reassess pain frequently. Support family understanding of comfort-focused care. | Nurse’s Role in Medicating Terminally Ill Patients |
| Aims to treat and heal illness Recovery or remission | Curative Care |
| Focuses on symptom relief, not cure Comfort, dignity, symptom control | Palliative Care |
| End-of-life care for terminal patients (usually <6 months) Peaceful transition and support | Hospice |
| Appoints a trusted person to make medical decisions if patient is incapacitated. | Durable Power of Attorney |
| Written document outlining specific treatment preferences (e.g., no feeding tube, no CPR). | Living Will |
| • Legal directive to withhold CPR or advanced resuscitative measures | Do-Not-Attempt-Resuscitation (DNAR) |
| Do-Not-Attempt-Resuscitation (DNAR): Nurse Role | Know status, honor wishes, educate family, document |
| Do-Not-Attempt-Resuscitation (DNAR): Provider Role | Establish medical appropriateness, discuss with patient/family, complete orders. |
| Five Stages of Grief (Kubler-Ross) | 1. Denial, 2. Anger, 3. Bargaining 4. Depression 5. Acceptance |
| "This isn’t happening." | Denial |
| "Why me?" | Anger |
| "If I do this, maybe..." | Bargaining |
| Sadness and withdrawal | Depression |
| Peace or readiness for what comes | Acceptance |
| Burial within 24 hours, no cremation, prayer rites | Islam |
| Cremation preferred, reincarnation beliefs | Hinduism |
| Mindfulness, peaceful environment, karma considerations | Buddhism |
| Burial rituals, care by designated persons | Judaism |
| Increased sleeping or unresponsiveness Cheyne-Stokes respirations Mottled or cool extremities Apnea or irregular breathing Circumoral cyanosis Decreased urinary output Terminal restlessness or withdrawal | Seven Common End-Stage Signs |
| Weakness, altered vitals, reduced appetite | Physical |
| Fear, anxiety, hope, sadness | Emotional |
| Acceptance, reflection, detachment, spiritual distress | Psychological |
| Provide comfort measures (e.g., repositioning, gentle hygiene) Offer presence and listening Facilitate spiritual care or rituals Support family with education and compassionate communication | Appropriate Nursing Care |
| Four Benefits of Dehydration at End of Life | Reduces respiratory secretions Minimizes gastric discomfort May reduce pain perception Promotes natural sleepiness and comfort |
| I’m tired of fighting.” “I wonder what happens after this.” “I just want peace.” “I wish I could talk to someone about what's next.” | Patient Comments That May Indicate Readiness |
| Use proper body mechanics for repositioning weak patients Monitor oxygen use and sedation effects Respect DNAR orders—do not initiate resuscitation without consent Document end-of-life discussions accurately | Safety Information |
| Assessing nonverbal signs of pain or spiritual distress Communicating with grieving families Performing postmortem care respectfully Using teach-back method to confirm understanding of directives | Skill Practice |
| Treat every patient as worthy of comfort, honor, and agency | Respect for human dignity |
| Honor patient decisions even if they differ from your own beliefs | Autonomy |
| Address body, mind, and spirit—not just symptoms | Holistic support |
| Dealing With the Terminal Patient: Nurse Responsibilities | Provide information, resources, and referrals for comfort and care. Understand your own beliefs around aging, treatment limitations, and death. Prepare for ethical dilemmas involving artificial nutrition, assisted suicide, and euthanasia |
| Addiction is not a concern in terminal illness. Preemptive pain control is more effective—don’t wait until pain is severe. There’s no moral obligation to “tough it out.” Patients have a right to die with dignity and comfort | Medicating the Dying Patient |
| The intentional act of ending a person’s life to relieve suffering Administered by another person (e.g., provider) | Euthanasia |
| Providing means for the patient to end their own life (e.g., prescription medication) Action is taken by the patient | Assisted Suicide |
| Euthanasia is generally illegal and ethically prohibited in U.S. nursing practice. Assisted suicide is legal in some states (e.g., Oregon) under strict conditions for mentally competent, terminal patients—but nurses are not authorized to participate. | Legal Status |
| A comfort-focused approach to care for patients with serious illness. Not meant to cure but to relieve symptoms like pain, dyspnea, nausea, and emotional distress. | palliative care |
| Can be initiated at any stage of illness—often alongside curative treatments. Delivered by an interdisciplinary team (nurses, physicians, chaplains, social workers, etc.). | palliative care |
| A patient with COPD receives medication and oxygen for symptom control while continuing pulmonary rehab | palliative care |
| Specialized end-of-life care for patients typically in the final 6 months of life. Focus is solely on comfort, not cure. | hospice care |
| Includes 24/7 support, emotional and spiritual care, grief counseling, and respite for families. Patient and family guide care decisions with dignity and autonomy | hospice care |
| A patient with terminal cancer chooses to receive home-based hospice services to be surrounded by loved ones. | hospice care |
| Treat, cure, stabilize illness Short-term, immediate interventions Task- and treatment-focused | Acute Care |
| Relieve suffering, support well-being Any stage of illness Holistic symptom management | Palliative Care |
| Provide comfort at life’s end Final months of life Patient advocacy & emotional care | Hospice Care |
| Temporary relief for primary caregivers so they can rest and rejuvenate. Can range from a few hours to several days. | respite care |
| Often provided by hospice teams or trained personnel. Reduces caregiver burnout and enhances support for both patient and family | respite care |
| Body image changes (e.g., scars, amputations) Lifestyle changes (e.g., insulin dependence) Identity shifts (e.g., cancer survivor mindset) Family role changes due to illness or caregiving | Types of Loss |
| Family Impact of Illness & Death | Loss of the patient’s role, not just the person Role reversal: Adult children become caregivers Grieving spouses may face emotional or financial insecurity Death of an encourager or emotional anchor creates deep emotional void |
| Grief = mental and emotional suffering from loss Everyone grieves differently—nurses must avoid judgment Fatigue and emotional depletion are normal Avoid saying “be strong”—it may discourage real emotional expression | Understanding Grief |
| Be honest and developmentally appropriate Use simple explanations; avoid euphemisms Encourage questions “Do you want to talk about what’s happening?” | Children and Grief |
| Expect regression Acting younger is common—don’t scold or correct harshly Offer reassurance: Let them know it’s not their fault | Children and Grief |
| “I’m no longer who I was before cancer.” | Loss of identity |
| Fear of recurrence or health fragility | Loss of security |
| Ongoing medical appointments, lifestyle changes | Loss of normalcy |
| Feeling betrayed by one’s own health | Loss of trust in the body |
| Temporary relief for primary caregivers so they can rest and rejuvenate. Can range from a few hours to several days. | respite care |
| Often provided by hospice teams or trained personnel. Reduces caregiver burnout and enhances support for both patient and family | respite care |
| Body image changes (e.g., scars, amputations) Lifestyle changes (e.g., insulin dependence) Identity shifts (e.g., cancer survivor mindset) Family role changes due to illness or caregiving | Types of Loss |
| Family Impact of Illness & Death | Loss of the patient’s role, not just the person Role reversal: Adult children become caregivers Grieving spouses may face emotional or financial insecurity Death of an encourager or emotional anchor creates deep emotional void |
| Grief = mental and emotional suffering from loss Everyone grieves differently—nurses must avoid judgment Fatigue and emotional depletion are normal Avoid saying “be strong”—it may discourage real emotional expression | Understanding Grief |
| Be honest and developmentally appropriate Use simple explanations; avoid euphemisms Encourage questions “Do you want to talk about what’s happening?” | Children and Grief |
| Expect regression Acting younger is common—don’t scold or correct harshly Offer reassurance: Let them know it’s not their fault | Children and Grief |
| “I’m no longer who I was before cancer.” | Loss of identity |
| Fear of recurrence or health fragility | Loss of security |
| Ongoing medical appointments, lifestyle changes | Loss of normalcy |
| Feeling betrayed by one’s own health | Loss of trust in the body |
| Body reduces energy intake; metabolic shift “Your body might not feel hungry—that’s part of the natural process.” | Anorexia |
| Muscle wasting from disease burden “This weight loss isn’t about diet—it’s the illness, not you.” | Cachexia |
| Changes in brain perfusion, medications, infection “If you feel confused, it’s okay. Let us help keep things calm.” | Confusion/delirium |
| Anticipatory grief, spiritual unrest “What worries you most right now? I’m here to listen.” | Anxiety/fear |
| GI changes from medications, immobility “We’ll keep monitoring bowel comfort—it’s part of comfort care.” | Constipation/diarrhea |
| Emotional grief, biochemical changes “This sadness is a valid part of the process—not something to fix.” | Sadness/depression |
| Medication side effects, GI slow-down “If you're nauseated, there are options to help.” | Nausea/vomiting |
| Tumor pressure, inflammation, systemic illness “You do not have to suffer—comfort is a priority.” | Pain |
| Cellular decline, anemia, poor intake “You might sleep more now—your body is working hard.” | Fatigue/weakness |
| Disease progression, anxiety, pulmonary function “Let’s find ways to ease your breathing, whether with meds or position.” | Dyspnea |
| Realization, withdrawal, spiritual searching Decreased interest, possible anorexia | 1–3 Months: Dying Process |
| Less talking, increased sleep, agitation Weakness, edema, anorexia, subtle vitals changes | 1–2 Weeks: Dying Process |
| Non responsiveness, glassy eyes, peaceful detachment Congestion/death rattle, mottling, decreased urine, shallow respirations | Last Days/Hours: Dying Process |
| Processing life events, preparing for death Support silent reflection, avoid overstimulation | Life review & introspection |
| Detaching from worldly relationships Educate family: this is normal, not rejection | Emotional withdrawal |
| Energy shifts inward Encourage gentle presence vs. active conversation | Reduced communication |
| Conserving physical energy; spiritual activity Provide quiet comfort, honor restfulness | Increased sleep & reduced activity |
| Body no longer needs fuel for life-sustaining functions Reassure family: nourishment is optional, not mandatory | Loss of appetite & thirst |
| • Use gentle touch and soft voice • Avoid painful assessments (e.g., sternal rubs) • Respect non-responsiveness—it's often spiritual, not medical • Refrain from reorientation attempts if the patient appears confused or speaks to deceased loved ones | Communicating with the Dying |
| ↓ BP, ↑ then ↓ HR; decreased perfusion Prioritize comfort over frequent monitoring | Vital Signs |
| Pallor, cyanosis, clamminess, mottling Reposition for skin integrity, minimize distress cues | Skin |
| Cheyne-Stokes pattern, apnea, “death rattle” Use meds (scopolamine, atropine), gentle repositioning | Respiratory |
| Effect of Dehydration ↑ Endorphin production ↓ Urine output ↓ Gastric secretions ↓ Pulmonary secretions ↓ Edema and ascites ↓ Pain perception | Comfort Benefit Provides natural pain relief and sense of well-being Less incontinence, fewer clean-up interventions Less nausea and vomiting Less death rattle, easier breathing Less abdominal and peripheral discomfort Supports overall comfort |
| Confirm death Notify provider Offer family participation Bathe and prepare body Position body Insert dentures (if policy allows) Support family | Steps after death |
Created by:
Whitwhit2025