End of Life Care

in palliative care the patient can still receive

curative and palliative treatments

palliative care focuses on

reducing severity of disease symptoms

palliative care extends into

EOL care

in hospise care the patient is no longer receiving what

curative care

hospice care can be provided mainly in what three settings

home, hospital, long term care settings

hospice control focuses on what three things

symptom control, spiritual assessment, family needs

• provide comfort and supportive care

• improve quality of patient’s remaining life

• ensure a dignified death

• provide emotional support for the family

these are all what

goals of EOL care

• pain

• dyspnea

• difficulty managing secretions

• restlessness

• depression

• dementia

these are all

prominent symptoms of dying

what are the two S/S prior to dying (1-3 months)

withdraw, food/fluid intake decline

what are the six S/S prior to dying (1-2 weeks)

disorientation, BP, HR, temperature, perspiration, respiration

what are the seven S/S prior to dying (2 days - 2 hours)

earlier S/S more intense, energy surge, restlessness, congestion, GI/GU, extremities, nonresponsive

what is a kennedy terminal ulcer

rapidly developing skin wound that occurs during the final stages of life

• sacrococcygeal area

• heel, elbow, calf, arm

• pear, butterfly, horseshoe shape

• red, yellow, black, blue, purple

• irregular border

• sudden onset

these are all S/S of what

kennedy terminal ulcer

when is withdrawal of care considered

when life sustaining treatments are no longer helping

what is the goal of the healthcare team when withdrawing care from a patient

achieving a “good death”

will CRRT or telemetry be continued when withdrawing care

no

will enteral feeding tubes be continued when withdrawing care

no

will implanted defibrillators or pacemakers be used when withdrawing care

no

will respiratory assistive devices such as mechanical ventilators, CPAP, or BiPAP be used when withdrawing care on a patient

no

• delirium (can be reversible assess for causes)

• anxiety/fear

• life review

• vision like experiences

• withdrawal

• waiting for approval

• saying goodbye

these are all _________ factors in the dying process

psychological

• tachy then brady, irregular

• dyspnea

• weak pulse

• decreased BP

• delayed absorption of drugs given IM or SQ

• Cheyne Stokes

• terminal secretions, gurgling

these are all ________ factors of the dying process

CV and respiratory

• hearing

• sight > blurred vision, blink reflex absent, eyelids stay half open

• taste and smell > decreased

• touch > decreased

these are all _______ factors for the dying process

sensory

which sense is the last to go

hearing

• facial grimacing

• restless, tense

• attempts to sit up

• pulls at lines

• muscle rigidity or tension

• moaning

• crying and sobbing

these are all _______ indicators in the dying process

pain

• hypoactive/absent BS

• distention/constipation

• N/V

• bowel incontinence

these are all ________ factors in the dying process

GI

• oliguria

• anuria

• incontinence

these are all ______ factors in the dying process

GU

• cold

• clammy

• kennedy ulcer

these are all _____ factors in the dying process

skin

• loss of ability to move

• myoclonus (opioid related)

these are all __________ factors in the dying process

musculoskeletal

what should the nurse avoid saying as much as possible to a grieving family

I’m sorry

what should the nurse use instead of the phrase “I’m sorry”

I wish or I worry

what 6 organs can be donated after brain death

heart, lungs, kidneys, pancreas, liver, intestines

what 6 things can be donated after cardiac death

corneas, skin, heart valves, bone, blood vessels, connective tissue

what are the three critera to dx brain death

GCS < 8, absense of brainstem reflexes, apnea

what are three examples of absent brainstem reflexes that will be looked for when looking at possible brain death

cortical brain function, pupillary reflexes, gag reflex

what 4 things must be present in order to dx brain death (outside of 3 criteria)

normothermic, SBP WNL, no sedation/paralytics, metabolic issues excluded

what is the vestibulo-ocular reflex (positive)

when eyes move toward the side of the ice water injection

what is a negative vestibulo-ocular reflex

eyes stay fixed midline even during the ice water injection

what is another name for the oculocephalic reflex

doll’s eyes

what is a normal response when testing the oculocephalic reflex

eyes move to opposite of head movement

what is a negative oculocephalic reflex

eyes stay fixed midline

what is another way a HCP can establish brain death (think scans)

absense of intracerebral filling above carotids

what scan is the gold standard for cerebral blood flow documentation

4 vessel angiography