end life
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| What is end life? | When a disease or illness is deemed incurable by health care provider
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| What is the goal of end life? | -maintain comfort
-maintain quality of life
-provide all means for a dignified death (respect their wishes)
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| What does DNR stand for? | Do Not Resuscitate
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| Full code | aka code blue; do anything to resuscitate
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| Chemical code | no cpr, meds are administered
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| What are the two types of loss? | -actual loss
-anticipatory loss
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| What is actual loss? | -can be recognized by others (i.e. death, amputation, job loss)
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| What is anticipatory loss? | Loss that has yet to take place (i.e. hospice care, terminal illness)
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| Grief | emotional reaction to loss
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| Bereavement | state of grieving during which a person goes through the grief process (normal, essential for good health)
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| Mourning | acceptance of loss and grief during which a person learns to deal with the loss
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| What are Kubler-Ross' five stages of Grief? | 1) Denial & Isolation
2) Anger
3) Bargaining
4) Depression
5) Acceptance
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| Definitions of death | irreversible cessation of respiration & circulation, functions of entire brain, loss of all "higher" brain function
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| Clinical signs of impending death: Cardiovascular | -Hypotension
-Change in pulse (increase, decrease,irreg, weak)
-Poor circulation
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| Clinical signs of impending death: Respiratory | -Change in breathing patterns (agonal, cheyne stokes, irregular, -death rattle (accumulation of secretions)
-dyspnea
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| Clinical signs of impending death: Gastrointestinal | -decreased GI motility
-nausea, bloating, flatus, anorexia
-bowel incontinence
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| Clinical signs of impending death: Genitourinary | -decreased urinary output (oliguria-->anuria)
-Incontinence
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| Clinical signs of impending death: CNS | -confusion/delirium
-out of body experiences
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| Clinical signs of impending death: Sensory system | -decreased sensation
-pain
-glazed eyes
-eyelids remain half open
-hearing believed to be last sense to disappear
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| Clinical signs of impending death: Musculoskeletal | -difficulty speaking
-sagging of jaw from loss of facial muscle tone
-gradual loss of ability to move
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| Interventions for Dyspnea | -provide oxygen
-nebulized medications (morphine, bronchodilators
-place in comfortable position
-suction as needed
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| Interventions for pain | -meds (around the clock and breakthrough)
-massage, aromatherapy, music therapy, relaxation techniques
-minimize irritants (wetness, cold, pressure)
-do not deny pain relief measures
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| Interventions for nutrition/hydration | -ice chips, sips of fluids, mouth swabs, moist cloths to suck
-assess nausea: c/o, contributing causes
-provide frequent mouth care
-provide antiemetics before meals
-offer culturally appropriate foods
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| Restlessness | -assess for spiritual distress as a cause of restlessness and agitation
-do not restrain
-use soothing music, slow soft touch & voice
-limit persons at bs
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| Confusion/disorientation/delirium | -reorient
-keep personal and familiar items within reach
-clock
-comfort pt, speak in soft soothing voice
-family members at bs
-identify cause if possible (pain, discomfort, urinary retention)
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| Elimination | -keep skin clean from incontinence
-urinary catheters may be used
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| Therapeutic communication | -open environment for expression
-nonjudgmental
-just be there
-life review
-be yourself
-empathize
-show human kindness
-keep it simple
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| Advance directives | documents that state end of life wishes specifically or designate the person who will make those decisions
(i.e. living will, durable power of attorney)
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| Living will | this document states specific wishes regarding kinds of healthcare that should be delivered or withheld in certain situations
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| Durable power of Attorney | designates someone to make any decisions for you, when you are no longer to make those decisions for yourself
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| Hospice care | concept of care when disease is no longer curable ( less than 6 months to live)
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| Palliative care | symptom management (appropriate across lifespan of disease prognosis) no time frame, kind of like home health
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| End of life care | time frame is last few weeks of life
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