EOL Student - End of Life notes PDF

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End of Life notes...

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End of Life Care-Key 1. What is hospice care? Pg 106 I and W Special kind of care that focuses on the quality of life for people and their caregivers who are experiencing an advance, lifelimiting illness.

2. What is the focus of hospice care? Focused on improving quality and comfort of remaining life

3. Where is hospice care provided? Provided at any place your loved one calls home

4. Does hospice care provide bereavement care to the family? yes

5. Hospice care  patients who require palliative care, symptom management, and pain relief at the end of life  Prognosis of 6 months  Care is provided when curative treatment such as chemotherapy has stopped  Ongoing care is provided by RNs, social worker, chaplains, and volunteers 6. Philosophy of Palliative Care  philosophy of care for people with life threatening diseases  Helps people identify their outcomes  Assists them with informed decision making 7. Palliation care is provided by (pg 106 I and W) Any care facility that is associated with palliative care

8. Palliative Care  Patients can be seen in any stage of serious illness  A consultation is provided that is concurrent with curative therapies or therapies that prolong life  Care is not limited by specific time periods

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End of Life Care-Key

The difference between hospice care and palliative care is important! Pg 107 I and W Table 7-2

9. EOL assessment  Assess comorbid conditions  Weakness  Sleeping more  Anorexia  Decreased peripheral circulation 2

Describe to the family the physical signs in detail to let them know what to expect; families often do not know what the normal death process is like. Pg 107 I and W

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Poor tissue perfusion, cool, mottled skin, and cyanotic extremities Pulse rate decreases Changes in breathing pattern (Cheyne-Stokes) periods of apnea LOC decreases: may not speak; hearing is last sense to go (explain to family)

10. Psychosocial Assessment  Ask where the patient would like to die  Discuss financial concerns  Assess cultural considerations, values, and religious beliefs of the patient and family (don't assume-ask about their wishes)  Assess the patient and family's coping mechanism (how have they dealt with stress in the past)

11. Fear and Anxiety about the dying process  People facing death may have fear and anxiety;  RN should appreciate pt's perspective  RN may have to clarify HCP information and say it another way. 12. What are the most common symptoms at the end of life? Weakness, decreased visual and auditory abilities, poor tissue perfusion, pulse rate decreases, changes in breathing pattern (CheyneStokes)

13. Assessing Pain in Unconscious Patients  look for agitation  facial grimacing  diaphoresis  change in breathing patterns 14. What is the most undertreated symptom in dying patients? Dyspnea 15. Pain Relief at EOL  pain relief is a priority  Nonopioid and opioid analgesics  Should be scheduled ATC not PRN  Long acting opioids cannot be crushed: rotate rectal, transdermal, IV of subcutaneous route  Short acting can be given SL  Do not hold medication from older adults (or anyone) at the end of their life 16. Fears of addiction 3

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obtain a detailed pain history to assess if pain control is adequate educate client and family that addiction is not a concern at EOL

17. Morphine: Managing breathlessness/Dyspnea  Morphine or another opioid  Alters the perception of dyspnea  Reduces anxiety and oxygen consumption  Reduces pulmonary congestion 18. Interventions: Managing breathlessness/Dyspnea  bronchodilators prn-Albuterol  Anticholinergics prn-Glycopyrrolate  oxygen not needed at EOL  use any interventions that will enhance comfort 19. Interventions: Managing Nausea and Vomiting  Antiemetics: Ondansetron  Dexamethasone  Prochlorperazine  Metoclopramide  Aromatherapy: camphor, peppermint, rose to relieve vomiting  Remove odors 20. Interventions: Meeting Psychosocial  Assess the patient and family understanding about the disease  clarify information and explain in a different way  Help the patient and family identify the desired outcomes for care  Explain to the family what to expect  Remove monitoring equipment from room; make room like home (allows more family in the room) 21. Meeting needs near the end of life  Allow as many family members in the room as desired  It may help the family to witness the death  use the words death and dying  Ask the family is they would like to spend time with the body alone after death 22. Spiritual needs  Support the patient's spirituality if this is important to the patient  don't share your views or personal experiences  DO NOT try to explain loss in philosophic of religious terms  don't share your experiences with EOL care 23. Life review  Life review is a structure process of reflection on what one has done through his or her life 4

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Storytelling Encourage reminiscence for both the patient and family

24. What would the nurse do if a family member wants all life saving measures in a patient who is brain dead? Call the Ethics Committee

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