end of life

Death must be accepted, Patient’s total care best managed by interdisciplinary team whose members communicate regularly, Pain and other symptoms must be managed, Patient/family should be viewed as single unit of care, Bereavement care must be provided to family members, Common Diagnoses: Cancer, heart disease, lung disease, dementia, CVA

principles of hospice care

critical points of communication:

time of diagnosis, treatment failure, effectiveness of interventions, when to consider hospice

When we talk about ——, we are not —— that they will live but instead instilling  sense of meaning to their life. So we want to focus on spiritually or faith, their relationship with loved ones and happy memories. We don’t want to focus on abandonment, isolation, or pain

fostering hope

advanced care planning includes:

DNR, chemical code, healthcare POA, living will

Designates an individual to make decisions regarding care in the event the patient cannot make those decisions themself

healthcare POA

Legal document that provides instructions for medical care at the end of life in the event you cannot express your desires - type of advanced directive

living will

Provides instruction to your health care providers to treat you with medications only

chemical code

In the last stage of dying patients may experience impaired secretions which may be heard as noisy gurgling breathing, or moaning. —— medications can dry the secretions

anticholinergics

care should be limited to comfort measures, keep the environment peaceful and calm, dim the lights and transition your care to emotional support of the patient and family as death approaches and of course honor any wishes the patient has

final hours of care

occurs when all vital organs and body systems cease to function, irreversible cessation of respiratory, CV, and brain function

time of death

is the only person who can discuss organ donation with family

LOPA representative

when GCS is <5 call —-, upon death they will be contacted no matter the manner of death, but if GCS is <5 a rep will speak with family

LOPA

report less satisfaction with the quality of communication, including the extent to which providers listen and share information

African americans

are more likely to die in the hospital, are more likely to be hospitalized, and to receive intensive aggressive care in the last six months of life

minorities