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25 Cards in this Set
- Front
- Back
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What is the aim of end of life care?
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to make life's last transition as easy and meaningful as possible for dying pt's and their families
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how should you break bad news to a pt? location, setting, manner?
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in a quiet, unhurried, comfortable setting. find out what the pt's know and what they want to know
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what are the goals of care at the end of life?
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maximize comfort and fcn and to minimize pain and suffering.
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how do you obtain these goals of end of life?
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discuss expectations and goals of care directly with pt's who are capable of making their own decisions
empowerthe pt to control their own treatment and resolve conflicts of care. discuss expectations and tx goals be sensitive to cultural differences in end-of-life care be available to the pt and family |
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what are the stages of dying?
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anger
denial depression bargaining acceptance |
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__ __ ultimately guide pt decision making.
-patient goals -cultural beliefs -personal values |
personal values
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__ are written or oral instructions that enable pt's to guide their future health care decisions in the event that they can't do so themselves.
-living will -advanced directives -DPOA -oral directives |
advanced directives
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what is the most common form of advanced directives?
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oral directives
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__ are legal documents that enable a pt to appoint another specific individual to make decisions for them, should they be unable to do so for themselves.
-advanced directive -living will -DPOA |
DPOA
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what are the 3 scenarios of a living will?
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-do everything medically possible to maintain life
-do no extraordinary life but maintain comfort and allow death to occur "naturally" -do no extraordinary intervention but continue nutrition and hydration in addition to comfort care |
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__ __ refers to the ability to make a rational decision about medical tx options.
-DPOA -medical decision making capacity -oral directives |
medical decision making capacity
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symptom and problem mgt should focus on __ and function, not on achieving a particular physiogic effect.
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comfort
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anxiety and agitation may be due to ?
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hypoxemia
pain specific fear |
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t/f
drug addiction issues must remain a topic of discussion thru out the end of life process. |
false; we do NOT care
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The goal of complete pain relief must be weighted against the competing goals of function and ___.
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alertness
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severe anxiety or agitation treatment options include?
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short acting benzos like lorazepam, alprazolam, amitriptyline, trazadone, haldol, risperidone, quetiapine (seroquel), olanzapine (zyprexa).
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what are commonly used meds to tx N/V?
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prochlorperazine (compazine)
metoclopramide (reglan) ondansetron (zofran) droperidol (inapsine) |
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what are some common causes of n/v at the end of life?
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constipation
gastritis excessive diet volume diet intolerances opiate pain medications |
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what is a major and life threatening s/e of inapsine (droperidol)?
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prolonged QT interval
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__ refers to the withholding of CPR in the event of a cardiac or pulmonary arrest.
-determination of futility -do not resusitate -ethics consultation |
DNR order
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what are the brain death criteria?
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-irreversible coma
-absence of motor fcn and reflexes -absence of brainstem fcn-established by apnea and the lack of pupillary and oculovestibular reflexes |
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when should you consult an ethics committee?
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whenever there are persistent disagreements or conflicts in pt care.
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what type of test is confirmatory but usually unnecessary to confirm brain death?
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EEG
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__ revers to the condition wherein pts have no obvious cortical fcn but do have residual brainstem activity that allows them to maintain circulatory and respiratory fcns and many neurologic reflexs.
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persistent vegetative state
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When should an autopsy be performed?
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-when pt or family requests it
-confirm clinical diagnosis -evaluate the level of response to a particular tx -reassurance that care was appropriate and death was unavoidable |
