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Chronicity - 3

End of Life Care

Loss When a valued person, object or situation is made inaccessible.
Actual Loss A visible loss (loss of a limb, a person)
Perceived Loss A loss that is felt by the person only. The loss of fertility, the loss of youth.
Physical Loss The loss of something physical, a house, a spouse, a body part
Psychological Loss Loss involving the psyche, the loss of self-image, the loss of a body image.
Anticipatory Loss Displaying grief for something that has yet to take place, a pending divorce, a terminal illness, and impending death.
Grief The emotional response to loss
Bereavement When you have a grief reaction. You may neglect your health, stop taking medication, not take care of yourself.
Mourning The period of acceptance after a loss. Get back into a routine, focus on yourself and proper care of yourself.
Kubler-Ross's 5 Stages of Grief or Death and Dying Denial/Isolation, Anger, Bargaining, Depression, Acceptance
Cardiovascular Changes at the End of Life Decreased CO, decreased perfusion, decreased BP, decreased urine output, cyanosis, coll, mottled extremities, tachycardia.
Respiratory Changes at the End of Life Change in respiratory pattern. Cheyne-Stokes respirations (alternating periods of apnea and deep, rapid breathing), decreased ability to mobilize secretions, O sign.
GI System Changes at the End of Life Decreased oral intake, fluid and electrolyte imbalance, constipation, diarrhea, incontinence
Neurological System Changes at the End of Life Change in level of consciousness, agitation, confusion, pain.
Nursing Implications at the End of Life Supplemental O2, Analgesics, Mouth care, Antiemetics, Managing the environment.
Dysfunctional Grief An abnormal or distorted grieving process.
Unresolved Grief The person has trouble expressing their feelings or they deny their feelings and stay in the bereavement stage.
Inhibited Grief Staying in denial Grief is not dealt with at all.
Death An irreversible cessation of circulatory or respiratory function or irreversible cessation of all function of the entire brain, including the brain stem.
Palliative Care Taking care of the whole self. Views dying as natural and personal. Goal is to have the best quality of life for the time they have left. No pain or suffering and wishes are addressed.
Advance Directives When the patient states in advance what their choices are for healthcare should certain circumstances develop. Must be physically on the chart for wishes to be honored.
Living Will When you describe certain situations, and what you would like done in those situations.
Power of Attorney Appoints someone to make decisions for you if you become unable to make decisions for yourself.
Euthanasia The act of willfully ending the life of an individual with an incurable disease
Comfort Care Pain medications, taking the patient outside if they wish, giving ice chips if they can't eat, keeping them comfortable.
Value Belief about the worth of something
Value System Organization of values; lead to a personal code of conduct.
Values Clarification Process by which people come to understand their own values and value system.
How We Form a Value Choosing from alternatives, Prizing our decision, Repeatedly acting on that value.
Professional Values described by AACN in 1998 Altruism, Autonomy, Human Dignity, Integrity, Social Justice
Altruism Showing concern for the welfare and well-being of others
Autonomy The right to self-determination.
Human Dignity Respect for the inherent worth and uniqueness of an individual or population. Demonstrated by respecting and protecting the patients privacy.
Integrity Acting in accordance with codes of ethics and standards of practice. Demonstrated by proper documentation.
Social Justice Upholding moral, legal, and humanistic principles. Demonstrated by promoting universal access to healthcare.
Ethics A systematic inquiry into principles of right and wrong as they relate to conduct. Usually measures general conduct (that of people overall).
Ethics vs Morals Morals usually refer to personal standards of right and wrong.
Utilitarian Theory of Ethics The right or wrong of an action depends on the consequences. The end justifies the means. (Abortion is acceptable in cases of rape)
Deontological Theory of Ethics The right or wrong of an action is independent of its consequences. (Believe all abortions are wrong)
Nursing Ethics A division of bioethics. The study of ethical issues as they arise in nursing.
Key Principles of Nursing Ethics Autonomy, Non-maleficence, Beneficence, Fidelity, Justice, Veracity
Code of Ethics Provides a framework for making ethical decisions. Provides a standard and sets expectations. ANA sets the standards of practice for nurses. International Council of Nurses.
Ethical Dilemma When two or more courses of action, each of which is right or wrong, and no matter which you choose, something of value will be compromised. There is no right answer.
Ethical Decision Making Model Used to solve an ethical dilemma. State the dilemma in a way that clearly reflects the alternatives, Collect, Analyze, and Interpret the Data, Consider the Choices of Action without considering consequences, Analyze Advan and Disadv of each, make decision
Criteria for Admission to Hospice The patient must desire the services, and a physician must certify that the patient has 6 months or less to live.
Bereavement Programs Provide support and assist survivors in the transition to a life without the deceased person.
Engel's Six Stages of Grief (1964) Shock and Disbelief (denial, stunned, numb), Developing Awareness (anger, emptiness, crying), Restitution (funeral), Resolving the Loss, Idealization (exag of good qualities person had), Outcome (dealing with death as common life experience)
Created by: rjsnowrn