Stress, Coping, Hospice, and End-of-Life Nursing Flashcards part 2

What should the nurse do before assessing a client’s stress?

Establish rapport and a trusting nurse–client relationship.

What environment supports an effective stress assessment?

A safe, private, quiet, confidential, and distraction-free setting.

What communication techniques help the nurse build trust?

Active listening, open-ended questions, clarification, and offering observations.

What is the Perceived Stress Scale (PSS)?

A self-report tool used to measure a client’s perceived stress level.

What does the PSS measure?

How unpredictable, uncontrollable, and overwhelming a person believes life has been during the past month.

What are the five steps of the nursing process?

Assessment, diagnosis, planning, implementation, and evaluation.

What information does the nurse collect during assessment?

Both subjective information and objective information.

What are examples of objective stress-assessment data?

Vital signs, appearance, behavior, and physical examination findings.

What are examples of subjective stress-assessment data?

Physical complaints, relationship or work situations, and the client’s view of current stressors.

What history should the nurse collect from a client experiencing stress?

Symptoms, health history, substance use, hospitalizations, mental health treatment, coping methods, and health beliefs.

What should the nurse do during the diagnosis or analysis step?

Use clinical judgment to identify the client’s actual or possible health problems.

What happens during the planning step?

The nurse, client, family, and health care team establish measurable short- and long-term goals.

What factors should be included in a stress plan of care?

Knowledge, support, access to care, beliefs, health habits, and cultural and spiritual preferences.

What is the nurse’s first safety priority for a highly stressed client?

Determine whether the client has thoughts of self-harm or suicide.

Why should the nurse validate the client’s feelings?

Validation helps build trust and a therapeutic relationship.

Why should the client participate in choosing coping strategies?

Participation gives the client more control and supports self-worth.

Why should the nurse help identify anxiety triggers?

Knowing triggers helps the client begin coping before anxiety becomes worse.

Why should the nurse evaluate the client’s past coping methods?

To identify which coping strategies were effective and which were ineffective.

What healthy coping skills can the nurse teach?

Deep breathing, progressive relaxation, positive self-affirmations, exercise, mindfulness, and journaling.

How can community resources help a client experiencing stress?

They can reduce situational stressors such as housing, food, financial, or child-care problems.

What happens during implementation?

The nurse performs, coordinates, or delegates interventions and documents the client’s response.

What happens during evaluation?

The nurse determines whether goals were met and changes the plan of care when needed.

What is trauma-informed care?

Care that recognizes how past trauma affects a client’s physical, emotional, and behavioral responses.

What should a trauma-informed nurse avoid?

Practices that could accidentally retraumatize the client.

What is precision nursing?

Personalized care based on how genetics, the environment, the body, health records, and social factors interact.

What is the nurse’s overall role when caring for clients experiencing stress?

Recognize stress responses, assess the client, provide individualized interventions, evaluate results, and teach healthy coping.

What is hospice care?

Medical, physical, spiritual, and psychosocial care for a person expected to live six months or less.

What is the main focus of hospice care?

Comfort, dignity, quality of life, and personal growth rather than curing the illness.

Where can hospice care be provided?

At home, in a family member’s home, hospital, extended-care facility, or inpatient hospice center.

Who usually serves as the hospice client’s primary caregiver?

A family member or close friend selected by the client.

What life-expectancy criterion is generally required for hospice?

The primary provider must determine that life expectancy is six months or less.

What must be certified before a client receives hospice services?

A hospice provider and primary care provider must certify that the client is terminally ill.

What type of care must a hospice client choose?

Palliative or comfort care instead of treatment intended to cure the illness.

What happens if a hospice client lives longer than six months?

An approved hospice provider can recertify that the client remains terminally ill.

Can a client stop hospice care?

Yes. Hospice services can be stopped at any time.

Who is part of the hospice interdisciplinary group?

Providers, nurses, social workers, and spiritual leaders.

What does the hospice team focus on when planning care?

The client’s individual needs, goals, and quality of life.

How can hospice volunteers help?

They may provide companionship, transportation, housekeeping help, or caregiver relief.

How long can hospice bereavement support continue after a client dies?

Up to 12 months for identified family members and the primary caregiver.

What is respite care?

Short-term care that gives the primary caregiver a break.

How long can inpatient hospice respite care generally last?

A maximum of five days.

What supplies may hospice provide?

Oxygen, hospital beds, wheelchairs, bedside commodes, nebulizers, wound supplies, and incontinence supplies.

What is palliative care?

Holistic care that relieves suffering and improves quality of life during serious illness.

When should palliative care begin?

It can begin early in a serious or life-threatening illness.

Can palliative care be given with curative treatment?

Yes. A client can receive palliative and curative treatment at the same time.

Is palliative care limited to clients expected to live six months or less?

No. It has no specific life-expectancy requirement.

What conditions may benefit from palliative care?

Advanced cancer, heart failure, kidney or respiratory failure, Alzheimer’s disease, and Parkinson’s disease.

What is the major difference between hospice and palliative care?

Hospice is for terminal illness when curative treatment stops; palliative care can occur at any stage and alongside curative treatment.

What does actively dying mean?

The terminal phase when death is imminent.

What respiratory changes commonly occur near death?

Dyspnea, death rattle, and Cheyne-Stokes respirations.

What is dyspnea?

Shortness of breath.

What medication is the first choice for end-of-life dyspnea?

An opioid such as morphine.

How does morphine help dyspnea?

It decreases the feeling of breathing difficulty and reduces anxiety.

What comfort measures can relieve dyspnea?

Repositioning, a fan, oxygen, reduced exertion, and relaxation techniques.

What is a death rattle?

A rattling sound caused by secretions collecting in the lungs and throat.

Does a death rattle mean that the client is uncomfortable?

No. The sound may upset the family, but it does not show that the client is suffering.

What does a death rattle usually indicate?

Death may occur within hours or days.

How can the nurse reduce a death rattle?

Turn the head or body to the side and use atropine drops or a scopolamine patch as prescribed.

Should the nurse use deep suctioning for a death rattle?

No. Deep suctioning does not remove secretions pooled in the lungs.

What are Cheyne-Stokes respirations?

Quick breaths followed by periods of apnea in an irregular pattern.

When do Cheyne-Stokes respirations often occur?

Within about three days of death.

What should the nurse teach the family about Cheyne-Stokes breathing?

It is a common and expected change near death.

Why is pain management essential at the end of life?

It prevents unnecessary suffering and improves comfort.

What pain-control methods may be combined at the end of life?

Scheduled medication, PRN medication, and nonpharmacological methods.

What is the three-step medication ladder for pain?

NSAIDs first, then codeine or tramadol, and morphine for moderate-to-severe pain.

Can strong opioids be started earlier for severe pain?

Yes. Moderate-to-severe pain may require a strong opioid without completing every step.

What nonmedication methods can relieve end-of-life pain?

Relaxation, imagery, massage, breathing exercises, music, spiritual practices, repositioning, and heat or cold.

Why may body temperature change near death?

The nervous system loses the ability to regulate temperature normally.

How can temperature discomfort be managed?

Use warm or cool compresses, baths, blankets, a fan, room-temperature changes, or antipyretics.

What is mottling?

Purple, pale, gray, or reddish marbling of cool skin caused by decreased blood flow.

Where does mottling usually begin?

At the feet and then moves upward on the legs.

Does mottling cause pain?

No, but the client may feel cold and benefit from a blanket.

What sensory experience may occur near death?

The client may see or hear people or places that others do not perceive.

How should the nurse respond to end-of-life hallucinations?

Provide safety, reassurance, and comfort without arguing or repeatedly reorienting the client.

Can an unresponsive or comatose dying client still hear?

Yes. The nurse and family should continue speaking calmly and reassuringly.

What are major goals of end-of-life care?

Comfort, dignity, control, meaningful connection, spiritual support, and a peaceful death.

What is social isolation?

Having inadequate contact or relationships with other people.

How can social isolation affect a dying client?

It can cause loneliness and increase suffering.

How can the nurse reduce social isolation?

Support visits, calls, online communication, hospice volunteers, and support groups.

When should visits be planned for a dying client?

When pain and other uncomfortable symptoms are controlled.

How can the nurse protect a client’s dignity?

Manage symptoms, encourage independence and privacy, listen, give correct information, and show empathy.

How can the nurse support a client’s sense of control?

Include the client in decisions about care and their preferences for dying.

What is spirituality?

A person’s sense of meaning, purpose, relationships, nature, or connection to a higher power.

Is spirituality the same as religion?

No. Religion involves shared beliefs and worship, while spirituality is broader and concerns meaning and purpose.

What should the nurse do before offering spiritual care?

Ask whether the client wants spiritual care and allow the client to guide the discussion.

Who should provide in-depth spiritual counseling?

A qualified spiritual leader.

What may contribute to a “good death”?

Pain control, planning, closure, clear decisions, meaningful contribution, dignity, and individual preferences.

What factors influence a person’s idea of a “good death”?

Culture, religion, age, life events, illness, and financial concerns.

Should the nurse impose a personal idea of a “good death”?

No. The client’s individual values and preferences should guide care.

What is the nurse’s main role in end-of-life care?

Provide client-centered comfort care and support the client, family, and caregivers.

What does the hospice nurse teach family caregivers?

How to give medications, assist with daily care, recognize expected changes, and keep the client comfortable.

What should the nurse do when spiritual support is requested?

Collaborate with spiritual leaders and the hospice team to meet the client’s preferences.

How should culture guide end-of-life care?

The nurse should ask about beliefs, rituals, pain preferences, communication, family roles, and care of the body after death.

Who should interpret for a client with limited English proficiency?

A qualified medical interpreter provided at no cost.

Why should family members usually not serve as interpreters?

They may mistranslate information, add personal views, or reduce client privacy.

What should the nurse teach about common opioid myths?

Proper opioid use is not euthanasia, does not necessarily mean death is immediate, and can be safely adjusted for pain relief.

What is postmortem care?

Physical care of the body after death for viewing, autopsy, or release to a funeral home.

What universal actions are commonly included in postmortem care?

Wash the body, account for possessions, apply identification, and support the grieving family.

What determines whether tubes and invasive devices are removed after death?

The health care organization’s policy and circumstances such as autopsy or investigation.

Who should first discuss organ or tissue donation with the family?

A trained representative from the organ procurement organization.