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ATI Module
End of Life Care (Exam 2)
| Question | Answer |
|---|---|
| Cheyne-Stokes respirations | Breathing pattern of cycles that begin with rapid, shallow breaths; increase to deep breaths; and end with periods of apnea. |
| death rattle | Sound produced as a result of an accumulation of secretions in the lung and the throat leading to congestion; secretions become trapped as the client is unable to clear the secretions. |
| dyspnea | The sensation of difficult or labored breathing. |
| hallucinations | A sensation that something is there when it is not; includes all five of the senses. |
| hospice care | Care services for clients and families that focus on comfort and support; not curative when it is determined the client has less than 6 months to live. |
| mottling | Physical change of the skin marked by purple or reddish marbling caused by the heart's inability to pump blood effectively, leading to decreased blood perfusion throughout the body. |
| palliative care | An interprofessional care approach that is focused on the management of manifestations for chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client. |
| postmortem care | Physical care performed after the client has died; includes washing the body, accounting for the client's possessions, removing invasive devices, and placing identification tags on the body. |
| respite care | A service or agency that provides primary caregivers with a short-term break from the responsibilities of client care. |
| Admission criteria for hospice care include | a provider diagnosing of life expectancy of less than 6 months. Hospice care typically in home, but can also be delivered in the hospital, extended-care facility, or hospice inpatient facility. It also provides respite care for caregivers. |
| Palliative care is offered to | clients who may still be receiving curative care and is not regulated by time, meaning that services may be suitable and provided long before a client has been identified with a terminal illness. |
| The terminal phase of a client’s life is characteristically referred to as | “actively dying” or “imminent death” |
| end of life, physiological changes in the respiratory system commonly include | dyspnea, retention of secretions in the respiratory tract, also known as “death rattle”; and Cheyne-Stokes respirations |
| first choice in treating dyspnea | Opioids, such as morphine |
| used to relieve dyspnea and provides psychological comfort to the client’s family | Oxygen therapy |
| If death is imminent, comfort measures such as | positioning, using a fan to facilitate the movement of air, reducing exertion, and relaxation techniques should be the focus |
| used to help relieve anxiety associated with difficulty in breathing | Anxiolytics such as benzodiazepines |
| Death rattle is caused by | the accumulation of secretions in the lungs and throat, causing congestion and a “rattling” sound as the secretions become trapped, and the client is unable to clear these secretions. |
| Turning the client’s head to the side or rolling the client to the side can assist | with drainage of the secretions from the throat and lungs A moist washcloth and oral suctioning can be used to eliminate secretions from the mouth. |
| Death rattle Medications such as | oral atropine drops or scopolamine patches may also be used to reduce secretion production and lessen the audibility of secretions |
| Deep suctioning for Death rattle | Deep suctioning is ineffective in removing the accumulated secretions that are pooled in the lungs. |
| Cheyne-Stokes respirations provide relief by | positioning a fan to blow lightly in the direction of the client. The family should be educated that this type of breathing pattern is typical and expected. |
| Pharmacological treatment of pain includes | use of both nonopioids and opioids |
| Palliative care guidelines suggest | three-step ladder be used when administering these pain management medications |
| According to this three-step ladder, pain control begins | use of nonsteroidal anti-inflammatory drugs (NSAIDs), which are nonopioid medication pain is unrelieved or increases in intensity, codeine or tramadol When the client’s pain is rated as moderate to severe, morphine |
| Nurses are responsible for support in managing pain | use of psychological approaches, physical measures, integrative therapies, and interventional techniques. |
| Nurses are responsible for supporting nonpharmacological interventions in managing pain | Nonpharmacological interventions include diversion, relaxation exercises, or imagery; massage therapy; breathing exercises; music therapy; spiritual practices; repositioning; and the use of heat or cold therapy. |
| Physiological Changes | - Breathing and Respirations - Pain - Temperature - Vison and Hearing |
| nervous system’s ability to regulate body temperature | diminishes, causing the client to experience episodes of both increased and decreased temperature |
| The client’s body temperature can be managed with | cold or hot compresses, warm baths, hypothermia blankets, adjusting the air unit, using a fan, and antipyretic medications, including acetaminophen, ibuprofen, naproxen, or aspirin. |
| Mottling Interventions to keep the client comfortable include | providing blankets to keep the client warm. |
| When a client experiences a hallucination | provide a comforting and safe environment. |
| If the family is at the bedside When a client experiences a hallucination | provide support and reassurance, as they may become unsettled when the client experiences hallucinations. Interventions are aimed at ensuring client safety and preventing client injury. |
| Social isolation refers to | inadequate contact or relationships with people |
| Palliative care services have been designed to facilitate social support | services can be provided through home visits, the telephone, or the Internet. If possible, in-person face-to-face connections, social media platforms and texting to help the client who is actively dying stay in touch with friends and family. |
| As a nurse, assist in having visitors come at a time when the client’s | pain management and other adverse physical manifestations are controlled, which should enable the client to be more comfortable when interacting with others. |
| Nurses can support their clients’ dignity by | managing client manifestations, including pain and respiratory issues; advocating independence, privacy, and social assistance; providing care with an optimistic attitude; listening; providing correct information; empathy. |
| As a nurse, it is essential to involve clients in the decision-making process by | asking for their input about how they desire to be cared for and how they would like to die. Nurses should advocate for the client when the client is unable to handle matters themselves, which includes being truthful with family members and caregivers. |
| Religion is based on | specific beliefs and values that are shared within a community in the worship of a higher power |
| Spirituality speaks to a | person’s existence, centered on the significance and purpose of life. It is about relationships with others, nature, and a higher power |
| “good death” | pain management, planning for death, closure at the end of life, clear decision making, and contributing to others. Elements that influence clients’ perception of death include culture, religion, age, life events, illness, and financial concerns. |
| Spiritual services include | spending time listening to the client, performing religious ceremonies, and praying |
| Culture is a social structure that shapes a client’s views, behavior, and preferences, Some include | it is deemed improper and culturally insensitive to talk about impending death Many cultures do not agree with the use of opioids, which are routinely used in treating pain in medical settings |
| To evaluate the cultural needs of the client at the end of life, the nurse should engage in | open dialogue with clients and families regarding culturally specific beliefs, rituals, and family roles related to death and dying. |
| Cultural differences may influence how individuals | cope with death, how the body is handled after death, beliefs about the afterlife, and the roles family members assume during the dying process |
| Providing Postmortem Care Universal Interventions | - Provide Privacy - Comb hair of client - Cover client with a clean sheet - Place an absorbent pad under perineal area - Provide family with option to participate - Place client in a clean gown |
| Providing Postmortem Care Institutional policies | - Remove intravenous lines - Place foley catheter in place - Remove wound dressings |
| postmortem period in supporting a surrogate and family members who are considering organ donation consists of which of the following? | - Consult with interfaith - Referral to the organ procurement coordinator - Allow time for expression of family feelings |
| Strategies for a nurse to take to facilitate closure following the loss of a client include which of the following? | - Establish a bedtime routine - Discover a new hobby - Talk to an experience nurse about the loss - Journal your feelings |
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