PSYCHOsocial
While visiting a patient, you notice a new pressure ulcer to their buttocks. When you try to educate the daughter about repositioning, she breaks down and says that she is exhausted and can't wake up every 2 hours to do that. The house is a mess and the daughter herself is visibly disheveled. What can you do to help the situation?
1. Contact the social worker. They can provide resources for caregivers, etc.
2. Respite- social worker will help coordinate.
3. Offer a volunteer (*if appropriate).
All charting is due by...
9am the following day.
This medication is used to prevent the "death rattle."
Atropine
_____ is the most common level of hospice care. With this type of care, an individual receives hospice care at their residence (which could be a private residence, ALF, memory care, SNF, board & care, etc.
Routine.
National Hospice and Palliative Care Organization. (April 2018). NHPCO Facts and Figures: Hospice Care in America. Retrieved on May 31, 2019 from www.nhpco.org
Who creates the CHHA assignment?
The admitting RN!
*Not Jaci. Not Traci. Not the CHHA
What is the single most important thing you can do to please the family?
Communicate!
*This is our #1 complaint.
You are the nurse on call and NurseCom patches through a caller saying that her dad just somersaulted off the toilet. He is not injured and he is back in bed now. She does not want a visit but thought we should know. What do you need to document?
Fall event note.
Open fall care plan.Grimacing, wincing, restlessness, guarding, etc.
What are nonverbal signs of pain
_____ is available to provide temporary relief to the patient’s primary caregiver. This LOC can be provided in a hospital, hospice facility, or a long term care facility that has sufficient 24 hour nursing personnel present.
RESPITE.
National Hospice and Palliative Care Organization. (April 2018). NHPCO Facts and Figures: Hospice Care in America. Retrieved on May 31, 2019 from www.nhpco.org
What must you have visible at all times while visiting a patient?
Name badge
A family member is yelling at you on the phone because you are an hour late d/t an emergency with another patient.. what should you do?
A. Shut it down right away and tell them they can call back when they are calm.
B. Hang up since they are now using foul language.
C. Use empathetic listening.
D. Try to explain to them that you are late because you were helping another patient and you had to drive super far.
C. Use empathetic listening
Remember H.E.A.R.T.
H-hear their concerns
E-empathize for their situation
A-apologize
R-respond (try to resolve or notify admin)
T-thank them for their feedback and for allowing us to care for their loved one
You are admitting a patient with a diagnosis of Colon Cancer and a comorbidity of CHF. What scales MUST be documented every single visit?
KPS
PPS
ECOG
NYHA
How do you manage pain at home if patient cannot swallow?
Liquid morphine, methadone, fentanyl patch, CADD pump.
A patient might qualify for continuous care if they exhibit...
Unmanaged pain
Unmanaged dyspnea
Unmanaged agitation
Uncontrolled bleeding
Sanctuary policy states that in the event of a car accident (no matter how minor) while on the job, you MUST do these 3 things...
1. Get police report (mandatory).
2. Notify the office ASAP.
3. You MUST go to the clinic to be checked out and give a drug test (mandatory).
Daughter is insisting on IV hydration/nutrition for her mother who can no longer swallow, is minimally responsive, looks comfortable, and is dying from CHF. Is this patient appropriate for IVF? Provide your rationale.
No! Risks vs. Benefits
Educate: Gently remind them that the person’s body is beginning to shut down because of the disease and dying process, not because of the absence of food and liquid. Like any other medication, IV fluids can often have serious risks and cause more discomfort to the patient like shortness of breath, diarrhea, bloating and cramps. There are other ways to ensure a person’s comfort at the end of life like moist mouth swabs.
Reference:
National Hospice and Palliative Care Organization. (2015). Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life. Retrieved on May 31, 2019 from www.caringinfo.org
Who is responsible for getting consents signed for a readmission?
Admitting Nurse
What 2 medications work synergistically together to eliminate air hunger?
Morphine and Ativan
Reference:
Stanford School of Medicine. (2019). Dyspnea: How to Assess and Palliate Dyspnea (Air-Hunger). Retrieved on June 1, 2019 from https://palliative.standford.edu/dyspnea-how-to-assess-and-palliate-dyspnea-air-hunger
_____ is care provided for 8 hour blocks to manage pain or another acute medical crisis. These services must be predominately nursing care, supplemented with caregiver and hospice aide services and are intended to maintain the terminally ill patient at home during a pain or other symptom crisis.
Continuous Care (Crisis Care).
National Hospice and Palliative Care Organization. (April 2018). NHPCO Facts and Figures: Hospice Care in America. Retrieved on May 31, 2019 from www.nhpco.org
You are admitting a patient. You are doing their comprehensive pain assessment (mandatory) and they say that they have 5/10 pain but that they haven't taken their Norco yet. Their acceptable pain level is 3/10. Per policy, what needs to happen now?
-24 hour follow up visit to check on pain. If still above their acceptable level of pain, needs another 24 hour follow up visit. Please notify office to schedule.
-Open plan of care
-Document pain intervention and anything new added to regimen
Son is insisting on no morphine for his mother who is moaning and looks very distressed due to pain. He states that his friend told him that giving the Morphine could make his mom stop breathing and hasten death. Is this true? Provide explanation.
No. Morphine, when titrated appropriately, will not cause death in a hospice patient. In fact, research has shown that giving opioids to a patient near death may actually help them live a bit longer. The amount of energy used to fight pain and shortness of breath is exhausting and can tucker them out sooner. Morphine is the drug of choice for respiratory distress.
Reference:
Hospice of Southwest Ohio. (December 18, 2016). Does Morphine Make Death Come Sooner? Retrieved on June 4, 2018 from https://www.hswo.org/news/does-morphine-make-death-come-sooner
You've just completed a death visit. Family is not to the facility yet. You removed the patient's wedding ring and gave it to the nurse to give to the spouse. What should you do to cover yourself?
1. Document the name of the nurse you gave it to in our charting and if possible in the facility's chart.
2. Call the spouse immediately to let her know the name of the person you gave it to.
Most common side effect of opioids
Constipation
_____ is provided for pain control or other acute medical crisis. This LOC is provided in a Medicare certified hospital, hospice inpatient facility, or nursing facility that has a registered nurse available 24 hours a day to provide direct patient care.
GIP (General Inpatient).
National Hospice and Palliative Care Organization. (April 2018). NHPCO Facts and Figures: Hospice Care in America. Retrieved on May 31, 2019 from www.nhpco.org
When ordering a patient's medication from MedicationsCA you must include these 8 things for a complete order or Traci gets reeeeeaally mad...
(Be specific)
1. Patient's first and last name
2. Name of medication
3. Dosage
4. Route
5. Frequency
6. Reason (if ABX-must have duration)
7. Ordering doctor's first and last name
8. Delivery urgency (STAT vs. regular)