Week 15: End of Life Nursing Care

Palliative care

Program for delivering care to patients with life-limiting conditions: can receive curative treatments

Palliative care focuses on

-Minimizing physical, emotional, and spiritual burden

-Enhance quality of life

When can palliative care be delivered?

Any stage of life-limiting condition - acute, chronic, or terminal

Hospice care

Care of dying patients, not curing.

Hospice care focuses on

Care of dying patients through management of physical, psychosocial, and spiritual needs of patients and families

Goals of hospice care

1. provide holistic support

2. Improve quality of remaining life

3. Ensure dignified death

4. Emotional support to family

5. Provide physical, psychosocial, spiritual care

What are the 5 stages of grief?

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

*NOT LINEAR

Medicare hospice benefit eligibility requirements

-Enrolled in Medicare part A

-Doctor diagnoses terminal illness with 6 months or less to live

-Electing hospice (must sign electing for hospice over curative treatments)

-Certified agency through medicare

Advance directive

Written documentation that guides health care decisions when an individual is unable to do so (living will, durable power of attorney)

Health care directive

In Minnesota, the living will and durable power of attorney for heath care are combined and termed as this

Health care agent

One or more persons legally authorized to make health care decisions if the patient is unable to

Provider order for life-sustaining treatment (POLST)

Medical order based on the provider's understanding of the patient's wishes regarding LST

Nursing ethical obligations in end of life care

-Respect for autonomy

-Beneficience

-Non-maleficence

-Justice

-Dignity

Nursing legal obligations in end of life care

-Adhere to advanced directives

-Follow scope of practice

-Pain relief

-Avoiding assisted suicide or euthanasia (where prohib.)

Physician-assisted suicide / Medical aid in dying (MAID)

Doctor prescribes medication that the patient self-admin to end their life. The patient performs the final act.

Euthanasia

Physician directly administers a lethal substance to end the patients life (illegal in the U.S.)

Physical changes during the active phase of dying: cardiovascular

-Increased heart rate that then slows into a weakening pulse

-Decreased BP

Physical changes during the active phase of dying: GI system

-Slowing of GI function

-Anorexia, nausea, distention, gas accumulation

-Incontinence

Physical changes during the active phase of dying: skin

-Cold and clammy skin

-Mottling of hands, feet, arms, and legs

-Cyanosis of nose, nailbeds, knees

-Waxlike skin when near death

Physical changes during the active phase of dying: musculoskeletal

-Difficulty speaking/swallowing

-Loss of gag reflex

-Difficulty maintaining body position/alignment

-Jerking movements

Physical changes during the active phase of dying: respiratory system

-Inability to cough or clear secretions

-Oral secretions may increase/thicken

-Noisy breathing or death rattle

-Breathing pattern changes (cheyne-stokes)

-Bradypnea, gasps

Physical changes during the active phase of dying: sensory

-Blurring of vision

-Sinking and glazing of eyes

-Decreased sense of pain and touch

-Hearing is last sense to disappear

Physical changes during the active phase of dying: urinary system

-Incontinence

-Gradual decline in urine output

Emotional changes during the active phase of dying

-Emotional/physical withdrawal

-Decreased interest in activity

-Decreased alertness

-Periods of confusion and/or restlessness

-Talking about people who have died

-Saying goodbye, talking about journey

Methods to provide familial support

-Assess impact on family

-Assess cultural, spiritual, and religious beliefs

-Prepare for what to expect i dying process

-Ensure effective pain control, leaving alert enough

-Encourage families to take breaks, rest, and eat

-Discuss advance directive

Anticipatory grief

Coping mechanism that may be used when the death of a loved one is expected

Normal grief

Common, universal reaction characterized by emotional, cognitive, social, physical, and spiritual responses to loss and death

Bereavement

Refers to state or condition of having lost someone significant through death

Does medicare provide bereavement services?

Yes, for 13 months