Foundations: End of Life Care

What is terminal illness?

A disease that has progressed to the point where treatment can no longer cure or control it and body systems progressively fail

What is the terminal phase called?

Actively dying or imminent death

What happens to the respiratory system at end of life?

Brainstem loses ability to regulate breathing causing Cheyne-Stokes respirations and pooling secretions causing death rattle

What happens to circulation at end of life?

Peripheral circulation fails causing mottling, cool extremities, pallor, cyanosis

What happens neurologically at end of life?

Decreased oxygen to the brain causes altered consciousness, hallucinations, confusion, and eventual unresponsiveness

What happens to urine output at end of life?

Urine output decreases and urine becomes dark and concentrated

What are key signs of active dying?

Mottling, death rattle, Cheyne-Stokes respirations, jaw relaxation, decreased responsiveness, unresponsiveness

What are common respiratory signs at end of life?

Dyspnea, Cheyne-Stokes respirations, apnea, death rattle

What are common skin findings at end of life?

Mottling, pallor, cyanosis, cool clammy skin

What are common urinary findings at end of life?

Oliguria, dark concentrated urine

What are common neurological findings at end of life?

Hallucinations, confusion, decreased responsiveness, unresponsiveness

What is the priority nursing assessment in end-of-life care?

Pain assessment even in nonverbal clients using behavioral cues

What should the nurse monitor for respiratory status?

Respiratory rate, pattern, apneic periods, dyspnea, oxygen saturation

What signs indicate decline in actively dying clients?

Worsening dyspnea, increased apnea, spreading mottling, cold extremities, jaw relaxation, unresponsiveness

What medication is most commonly used at end of life?

Morphine

Why is morphine used in end-of-life care?

Relieves pain and dyspnea or air hunger

What are adverse effects of morphine?

Respiratory depression, sedation, constipation, nausea

How does the nurse know morphine is working?

Client appears comfortable, pain relieved, dyspnea improved

What medications help reduce death rattle?

Scopolamine and glycopyrrolate

What medications help with anxiety and agitation at end of life?

Lorazepam or midazolam

What should the nurse monitor after giving opioids or benzodiazepines?

Respiratory rate, LOC, sedation level

What should the nurse assess first in end-of-life care?

Pain, respiratory status, advance directives, and code status

What physical comfort interventions should the nurse provide?

Elevate HOB, mouth care, skin care, gentle repositioning, manage secretions, calm environment

What psychosocial interventions should the nurse provide?

Allow family presence, offer chaplain or pastoral care, provide emotional support, maintain dignity

What is the NURSE technique?

Name, Understand, Respect, Support, Explore

What should the nurse do during postmortem care?

Wash body, position respectfully, remove invasive devices, account for belongings, place ID tags, prepare for viewing

How does the nurse know interventions were effective?

Client appears peaceful, relaxed facial expression, dyspnea relieved, family feels supported

What should the nurse NOT do in actively dying clients?

Do not force oral nutrition or hydration, do not ignore DNR/DNI, do not rush postmortem care, do not leave client alone if not desired

Can the nurse initiate discussion about organ donation?

No only trained requestors or authorized providers may initiate the discussion

What is the focus of care at end of life?

Comfort and dignity rather than curative treatment

What assessments are still important at end of life?

Pain scale, FLACC, vital signs, respiratory pattern, urine output, pulse oximetry

What is hospice care?

Comfort-focused care for terminal illness with life expectancy less than 6 months

What is palliative care?

Symptom relief and comfort care that can occur at any stage of serious illness alongside curative treatment

What is the difference between hospice and palliative care?

Hospice is comfort only with life expectancy under 6 months; palliative can be given with curative treatment at any stage

What should the nurse teach families to expect near death?

Cheyne-Stokes respirations, death rattle, mottling, hallucinations, decreased responsiveness

What should the nurse teach about comfort medications?

They relieve suffering and do not hasten death

What statements show correct understanding?

Hospice focuses on comfort, morphine helps breathing and pain, palliative care can occur with chemotherapy

What statements need follow-up teaching?

Palliative care is only for dying clients, morphine speeds up death, nurse can discuss organ donation