Exam (elaborations)
Ch. 9 - Palliative Care at End of Life (Lewis)
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Ch. 9 - Palliative Care at End of Life (Lewis)
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Ch. 9 - Palliative Care at End ofLife (Lewis)
According to the World Health Organization, palliative care is an approach
that improves quality of life for patients and their families who face problems
associated with life-threatening illnesses. From the list below, identify the
specific goals of palliative care (select all that apply).
a. Regard dying as a normal process.
b. Minimize the financial burden on the family.
c. Provide relief from symptoms, including pain.
d. Affirm life and neither hasten nor postpone death.
e. Prolong the patient's life with aggressive new therapies.
f. Support holistic patient care and enhance quality of life.
g. Offer support to patients to live as actively as possible until death.
h. Assist the patient and family to identify and access pastoral care services.
i. Offer support to the family during the patient's illness and their own
bereavement. - - a, c, d, f, g, i. Table 10-1 lists the goals of palliative care.
Overall, goals of palliative care are to prevent and relieve suffering and to
improve the quality of life for the patient.
- Priority Decision: The husband and daughter of a Hispanic woman dying
from pancreatic cancer refuse to consider using hospice care. What is the
first thing the nurse should do?
a. Assess their understanding of what hospice care services are.
b. Ask them how they will care for the patient without hospice care.
c. Talk directly to the patient and family to see if she can change their minds.
d. Accept their decision since they are Hispanic and prefer to care for their
own. - - a. The family may not understand what hospice care is and may
need information. Some cultures and ethnic groups may underuse hospice
care because of a lack of awareness of the services offered, a desire to
continue with potentially curative therapies, and concerns about a lack of
minority hospice workers.
- List the two criteria for admission to a hospice program.
a.
b. - - a.
Patient must desire services and agree in writing that only hospice care can
be used to treat the terminal illness (palliative care)
b. Patient must meet eligibility, which is less than 6 months to live, certified
initially by two physicians
, - For each of the following body systems, identify three physical
manifestations that the nurse would expect to see in a patient approaching
death.
Respiratory
a.
b.
c.
Skin
a.
b.
c.
Gastrointestinal
a.
b.
c.
Musculoskeletal
a.
b.
c. - - Respiratory
a. Cheyne-Stokes respiration
b. Death rattle (inability to cough and clear secretions)
c. Increased, then slowing, respiratory rate
(Also: irregular breathing, terminal gasping)
Skin
a. Mottling on hands, feet, and legs that progresses to the
torso
b. Cold, clammy skin
c. Cyanosis on nose, nail beds, and knees
(Also: waxlike skin when very near death) Gastrointestinal
a. Slowing of the gastrointestinal tract with accumulation
of gas and abdominal distention
b. Loss of sphincter control with incontinence
c. Bowel movement before imminent death or at time of
death
Musculoskeletal
a. Loss of muscle tone with sagging jaw
b. Difficulty speaking
c. Difficulty swallowing
(Also: loss of ability to move or maintain body position, loss of gag reflex)
- Priority Decision: A terminally ill patient is unresponsive and has cold,
clammy skin with mottling on the extremities. The patient's husband and two
grown children are arguing at the bedside about where the patient's funeral
should be held. What should the nurse do first?
a. Ask the family members to leave the room if they are going to argue.
, b. Take the family members aside and explain that the patient may be able
to hear them.
c. Tell the family members that this decision is premature because the
patient has not yet died.
d. Remind the family that this should be the patient's decision and to ask her
if she regains consciousness. - - b. Hearing is often the last sense to
disappear with declining consciousness and conversations can distress
patients even when they appear unresponsive. Conversation around
unresponsive patients should never be other than that which one would
maintain if the patients were alert.
- A 20-year-old patient with a massive head injury is on life support,
including a ventilator to maintain respirations. What three criteria for brain
death are necessary to discontinue life support?
a.
b.
c. - - a. Coma
b. Absent brainstem reflexes
c. Apnea
- A patient with end-stage liver failure tells the nurse, "If I can just live to see
my first grandchild who is expected in
5 months, then I can die happy." The nurse recognizes that the patient is
demonstrating which of the following stages of grieving?
a. Prolonged grief disorder
b. Kübler-Ross's stage of bargaining
c. Kübler-Ross's stage of depression
d. The new normal stage of the Grief Wheel - - b. Bargaining is
demonstrated by "if-then" grief behavior that is described by Kübler-Ross.
Kübler-Ross's stage of depression is seen when the person says "yes me, and
I am sad." Prolonged grief disorder is seen when there is a dysfunctional
reaction to loss and the individual is unable to move forward after the death
of a loved one. In the Grief Wheel model, the new normal stage is when the
grief is resolved but the normal state, because of the loss, is not the same as
before.
- A terminally ill man tells the nurse, "I have never believed there is a God or
an afterlife, but now it is too terrible to imagine that I will not exist. Why was
I here in the first place?" What does this comment help the nurse recognize
about the patient's needs?
a. He is experiencing spiritual distress.
b. This man most likely will not have a peaceful death.
c. He needs to be reassured that his feelings are normal.
d. This patient should be referred to a clergyman for a discussion of his
beliefs. - - a. Spiritual distress may surface when an individual
is faced with a terminal illness and it is characterized
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