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NUR 1212C Session 1 Summary

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  • October 16, 2024
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1212C Session 1

MODULE 4
Exemplars: Death and Dying, Intercranial Regulation/Lumbar Puncture, Seizures

Death-Dying-End of Life Care
 Part of the normal life cycle
 Nurses can affect the dying process
 Preventing death without dignity
 Promoting a peaceful, meaningful death
 Helping patient remain free from distress
 Minimizing suffering for patients and families

Planning for End of Life and
Advance Directives
 Patient Self-Determination Act (PSDA)
 Documentation associated with PSDA
 Advance directive
o also known as living will, personal directive, advance directive, medical
directive or advance decision, is a legal document in which a person specifies what
actions should be taken for their health if they are no longer able to make decisions for
themselves
 Durable power of attorney for healthcare (DPOAHC)
 Living will
 Do not resuscitate (DNR)
 Allow for Natural Death (AND)
 Physician orders for life-sustaining treatment (POLST)

Compassion

 Is the ability to be with someone who is suffering.
 Is less like a feeling and more like a human capacity
 that is developed and sustained in relation to
 others.
 Needs to be shared and passed on
 Even brief and fleeting expressions of compassion
 nourish this quality in ourselves and in others.
 Truly hearing the suffering of others puts us
 in touch with our own needs and vulnerabilities,
 and we might want to turn away to protect ourselves.

Hospice Care
Multidisciplinary team is made up of the physician, nurse, chaplain, social worker, certified nursing aide,
volunteer, and bereavement counselor.

All medications and supplies related to a terminal diagnosis are covered by Medicare and reimbursed.

,Other insurance providers mimic Medicare benefits.

Hospice Care (Con’t)
 Most patients are cared for in the “home.”
 Short-term acute inpatient care is available.
 Respite periods for caregivers are available.
 Patients are perceived as living fully until they die.
 Choices and preferences are incorporated in care.
 Patient and family are considered the unit of care and both receive counseling and support in
anticipatory grief and mourning, as well as in spirituality and meaning making.
 Electing hospice care is appropriate when the patient leaves the hospital or physician’s office
with the understanding that a cure is no longer possible, but many sophisticated medical and
holistic interventions are still available for this phase of living.

Palliative Care

 Palliative care is an approach that improves the quality of life of patients (adults and children)
and their families who are facing problems associated with a life-threatening illness. It prevents
and relieves suffering through the early identification, correct assessment and treatment of pain
and other problems, whether physical, psychosocial, or spiritual.
 Palliative care is a crucial part of integrated, people-centered health services, at all levels of care:
it aims to relieve suffering, whether its cause is cancer, major organ failure, drug-resistant
tuberculosis, end-stage chronic illness, extreme birth prematurity or extreme frailty of old age
(WHO, 2021)
 Individual choices and decisions regarding care are paramount and must be followed.
 Is more common in hospitals and other medical or home health care settings “whenever
comfort, support, and quality of life are significant concerns for terminal illness.”


Therapeutic Presence
People going through intense life experiences report that they do not remember what others said to
them, but only what the others made them feel. The intentional presence of another person makes
people feel seen, valued, and important.

End of Life Care

Vocabulary

 Cachexia - weakness and wasting of the body due to severe chronic illness
 Death Rattle - are sounds often produced by someone who is near death as a result of fluids
such as saliva and bronchial secretions accumulating in the throat and upper chest.
 Cheyne-Stokes Respirations - cyclic breathing marked by a gradual increase in the rapidity
of respiration followed by a gradual decrease and total cessation for from 5 to 50 seconds



End of Life Care

,  Managing Weakness
 Aspiration precautions
 Provide mouth care; apply emollient to lips
 Altered routes of medication administration
 Choose least invasive route with the most effective treatment
 Managing Dyspnea
 Supplemental 02 for comfort
 Electric fan for air circulation
 Reposition

End of Life Care
 Managing Nausea and Vomiting
 Antiemetic agents
 Prochlorperazine (Compazine)
 Ondansetron (Zofran)
 Metoclopramide (Reglan, Maxeran)
 Anti-inflammatory agent
 Dexamethasone (Decadron, Deronil, Dexasone)
 Remove any source of odors
 Comfortable room temperature
 Aromatherapy
 Music Therapy

End of Life
Terminally ill patients in pain:
 Adequate pain management is the priority for those with chronic pain
 ****Many patients’ primary wish is to die without pain, and the best intervention to meet this
goal is the administration of pain medication around the clock (SCHEDULED) with extra doses for
breakthrough pain. ***Morphine sublingual is most appropriate for someone unable to
swallow, is utilized, and available more readily than a pill or tablet.
 Fentanyl (Sublimaze) [prescribed in mcg]
o Transdermal Fentanyl - *Change the patch every 72 hours*

End of Life Care
 Managing Agitation and Delirium
 Assess for pain, urinary retention, constipation
 Music therapy; aromatherapy
 Pharmacologic agents
o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines,
antipsychotic medication for end-of-life psychosis



End of Life

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