Harkness2e chap24 ppt

Copyright © 2016 Wolters Kluwer • All Rights Reserved

Chapter 24: Palliative and

End-of-Life Care

Copyright © 2016 Wolters Kluwer • All Rights Reserved 2

Chapter Highlights• Social trends in aging and dying• Palliative and hospice care for persons

across the life span• Caring for a person at the end of life• Strategies for managing pain and

common symptoms


QuestionIs the following statement true or false?Studies have documented that the American healthcare system has the best care in the world of seriously ill clients and their families.


AnswerFalseRationale: Studies have documented that the American healthcare system has substantial shortcomings in the care of seriously ill clients and their families.


Nursing and Patients with Chronic Disease

• Patient- and family-centered care• Ethical behavior and consumer rights• Clinical excellence and safety• Inclusion and access• Organizational excellence


Nursing and Patients with Chronic Disease (cont.)

• Workforce excellence• Standards• Compliance with laws and regulations• Stewardship and accountability• Performance measurement


Medicare Hospice Benefits• Medicare Part A eligible• Less than 6 months or less to live• Sign for hospice care• Medicare-approved program


Hospice Care• Physician services• Nursing care• Physical therapy, occupational

therapy, and speech-language pathology services

• Medical social services• Hospice aide services


Hospice Care (cont.)• Homemaker services• Medical supplies, including drugs and

biological and medical appliances• Counseling, including dietary

counseling, counseling about care of the terminally ill client, and bereavement counseling

• Short-term inpatient care for respite care, pain control, and symptom management


Principles of Care• Care• Patient and family• Team• Address of loss, grief, and

bereavement• Anticipatory mourning


QuestionIs the following statement true or false?It must be remembered that a dying patient will go through denial, anger, bargaining, and acceptance stages of dying.


AnswerFalseRationale: A dying person may not exhibit all of these stages, or may move quickly through a stage, only to return to it at a later time.


Death in America• Stages in the dying process• Specialized care at the end of life


Nursing Care When Death Is Imminent

• Decisions about level of care• Comfort measures only• Advance directives• Artificial nutrition and hydration• CPR• Euthanasia and physician-assisted

suicide


Cultural and Religious Issues• Sensitivity and empathy are essential

when caring for a dying person from a different culture.

• Each person is a unique individual with cultural preferences that influence the specialized needs of the client, the family, and their caregivers.


Palliative Care• Interdisciplinary team-based care that

is focused on the relief of suffering for clients with serious illness

• Best possible quality of life not only for clients but also for their families

• Acute, serious, life-threatening illness• Progressive chronic illness


Focus of Palliative Care• Controlling symptoms• Coordinating care• Reducing unnecessary tests and futile

interventions• Ongoing conversations with the client

and family


Hospice Care• Support and care for persons in the

last phase of an incurable disease so that they may live as fully and comfortably as possible


Caring for Patients at the End of Life• Death itself• Thoughts of a long or painful death• Facing death alone• Dying in a nursing home, hospital, or

rest home• Loss of body control, such as bowel or

bladder incontinence


Caring for Patients at the End of Life (cont.)

• Not being able to make decisions concerning care

• Loss of consciousness• Financial costs and becoming a burden

on others• Dying before having a chance to put

personal affairs in order


Pain Management• Pain assessment• Types of pain in dying patients• Pain relief during the dying process


Pain Medications• Nonopioid analgesics• Opioids• Adjuvant analgesics• Oral• Oral mucosa• Rectal• Transdermal• Topical• Parenteral• Intraspinal


QuestionIs the following statement true or false?Short-acting or immediate-release agents are excellent prn medications, and their only use should be for control of breakthrough pain.


AnswerTrueRationale: Short-acting or immediate-release agents are excellent prn medications, and their only use should be for control of breakthrough pain. Breakthrough pain is defined as “intermittent episodes of moderate to severe pain that occur in spite of control of baseline continuous pain.”


Preventing and Managing Adverse Effects

• Constipation• Sedation• Respiratory depression• Nausea and vomiting• Myoclonus• Pruritus


Management of Distressing Symptoms at the End of Life

• Secretions• Anorexia and dehydration• Skin integrity• Incontinence• Terminal delirium


Nursing Care of Clients Who Are Close to Death

• Buildup of saliva and oropharyngeal secretions• Changes in respiratory patterns• Skin may appear dusky or gray and

feel cold or clammy.• Eyes may appear discolored, deeper

set, or bruised.


Nursing Care After Death• Postmortem care• Grief—emotion felt after the loss• Mourning—recovery from the loss


Grief• Numb shock• Emotional turmoil or depression• Reorganization or resolution


Caring for the Caregiver• What have you done to meet your own

needs today?• Have you laughed today?• Did you eat properly, rest enough,

exercise, and play today?• What have you felt today?• Do you have something to look

forward to?

Harkness2e chap24 ppt

Education

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