Loss, Grief, the Dying Patient, and Palliative Care Ch. 15

Terms in this set (59)

Anticipatory Guidance- Anticipating the death assists in preparing the family and patient by giving them guidance about physical changes, symptoms and complications that may arise. Also aids the patient and family in deciding about possible hospice care.
End-Stage Symptom Management- Expected symptoms such as pain, GI distress, dyspnea, fatigue, cough, death rattle, and delirium, that are related to metabolic changes at the end of life. Nurse must be able to alleviate them or help explain them to the patient and family.
Pain Control- Many terminally ill patients unnecessarily die with uncontrolled pain. It's the 1st fear of the patients regarding dying. The patient may fear becoming an addict, or tht the meds will not work when he needs them for minimal pain. Another fear nurses have is that the pain meds will result in hastening the patient's death by depressing respirations. A TRULY COMPATIONATE NURSE STUDIES AND LEARNS ABOUT PAIN MANAGEMENT AND APPLIES THOSE PRINCIPLES IN DAILY PRACTICE. REGULARLY SCHEDULED PAIN MEDS W/PRN BACKUP FOR BREAKTHROUGH PAIN IS 1 OF THE MOST EFFECTIVE METHODS OF CONTROLLING PAIN.
Constipation, Diarrhea- predictable for patients receiving opiates, experiencing decreased fluid intake & mobility, and hving certain abdominal diseases.
Anorexia, Nausea, Vomiting- Anorexia may be due to nausea, drug side effects, disease process, or slowing down that occurs naturally in dying process.
Dehydration- Patients spend more time sleeping. Researches show that dehydration results in less distress and pain, hydration doesn't improve comfort.
Dyspnea- Seen early in the dying process in certain lung and heart disorders, and shortly before death. Suctioning not effective in clearing airway but meds decrease secretion and ease breathing. Oxygen may provide comfort.
Death rattle- Noisy respirations are heard when patient can no longer clear throat.
Delirium- Patients may experience hallucinations and/or altered mental status.
Impaired Skin Integrity- Weight loss, decreased nutrition, incontinence, and inactivity all contribute to skin breakdown.
Weakness, fatigue, decreased ADL- The dying patient is not going to get stronger or better; he gets weaker and weaker, not because lying in bed, but because he is dying.
Anxiety, depression, Agitation- May be treated with appropriate drugs with good effects. Listen and use good therapeutic communication skills to allow patient to express fear, feelings and needs, and convey nonjudgmental acceptance.
Spiritual Distress, Fear of Meaninglessness- Each person needs to feel that his life had meaning, and this is the essence of the spiritual nature of the dying process.
Evaluation- is based on the specific expected outcomes written for the patient.