Respecting Patient's Wishes
Advance Directives
Advocacy
Hospice v. Palliative
Pediatric
100
The difference between autonomy and beneficence.
Autonomy is the ethical principle that the patient has the right to choose or refuse treatment. Beneficence is the principle that the healthcare professional should act in the best interest of the patient.
100
List 3 of the 7 decisions an advance directive can make.
What are CPR, tube feedings, artificial respirations, antibiotics, dialysis, surgery, and blood transfusions.
100
Speaking up for what you feel is right when you’re afraid or feel threatened
What is moral courage
100
Begins after treatment is stopped and when it is clear the person is not going to survive the illness.
What is Hospice Care
100
Group of pediatric patients that believe impending death is their fault.
What is school-aged children? The nurse should give repeated explanations to correct misconceptions and frequent reassurance to quell their developing fears.
200
Your patient voices to you that she wants to know her dog, Austin, is lying at the foot of her bed with his cold muzzle against her dry skin instead of more chemotherapy coursing through her veins. What do you do?
Respect patient's wish to d/c chemotherapy by speaking with provider and discussing hospice. We are respecting the patient's autonomy by accepting her right to refuse treatment
200
The 2 main directives
What are living will and designation of healthcare surrogate or durable power of attorney
200
The condition of knowing the morally right thing to do, but institutional, procedural or social constraints make doing the right thing nearly impossible, threatening core values and moral integrity
What is moral distress?
200
Can begin at any time during the disease process and occur at the same time at curative treatment.
What is palliative care.
200
True or False: Research has shown that direct conversation about death with children tends to make the situation bleak and overwhelming.
What is FALSE. While some may believe this to be true, avoiding conversation actually causes more anxiety and limits the child's willingness to discuss their developing questions and concerns.
300
Your patient has ALS and is finding it harder and harder to breathe but she wants to start smoking again. Not on some self-destructive, but to feel her lungs filled while she is still alive. What do you do?
Respect her wish to smoke as it increases HER quality of life.
300
Two things that must happen in order for a living will to be valid.
What is it must be signed when individual is competent and it must be witnessed by two adults that will not be benefited by it.
300
True or False: In an attempt to advocate for our patient during the end of life, nurses often find themselves in a position of challenging physicians and family members to consider changes the direction of care from curative to palliative.
What is TRUE
300
Focuses on provided comfort to patients facing serious illnesses by utilizing physical, social, psychological, and spiritual intervention to improve quality of life.
What are both palliative care and hospice care.
300
The best way to have a conversation with a dying adolescent.
Be direct, honest, and realistic but also provide time for introspection so they can process their own thoughts about death.
400
The distinction between disease-centered and patient-centered models of care.
Answers will vary. Creativity, play, psychosocial, spirituality, focusing on what is important to the patient (patient-value), providing care that is respectful of and responsive to individual preferences and values and ensuring all patient's values are considered when making clinical decisions. "let death be what takes us, not lack of imagination"
400
The five key documents that the term advance directive is used to cover.
What are durable health care power of attorney, durable mental health care power of attorney, living will, letter to my agent, pre-hospital medical directive (MOLST) (which must be on colored paper)
400
3 of the keys to moral courage (CODE).
What are Courage, Obligations, Danger management, Expression and action?
400
Name one local palliative care program.
Answers vary. What are Journeys McGuire Group, Hospice & Palliative Buffalo, Pathways Palliative Care, and Roswell Park Cancer Institute.
400
4 main responsibilities of the nurse when caring the terminal child's parents.
What are assess their understanding of the prognosis, their goals for treatment, teach them to communicate with their child in an open and trusted environment, refer them to social services or psychologists in order to cope with evolving prognosis, and involve them in as much care as possible.
500
A document that gives seriously ill patients a way to control the person they want to make decisions for them when they cannot, the kind of medical treatment they want, how comfortable they want to be, how they want people to treat them, and what they want their loved ones to know. Once it is filled out and properly signed it is valid under the laws of most states
What is The Five Wishes Documents developed by Aging with Dignity?
500
2 of the 4 responsibilities the power of attorney has
What are provide or withhold specific medical or surgical procedures, hiring/dismiss healthcare providers, spending/withhold funds for healthcare, access to medical records
500
Questions to ask a patient in order to assess a their quality of life and personal values
Answers vary. What are "What's having the greatest impact on your quality of life right now?", "What is most important to you?"
500
List five specific interventions palliative and hospice care implement to improve patient quality of life.
Answers may vary. What are pain control (medication, guided imagery, acupuncture, massage), spiritual care, animal therapy, music therapy, bereavement support, relief of associated symptoms (dyspnea, death rattle), and psychological support.
500
List 3 indirect signs that a child may be struggling with unacknowledged fears or concerns about his or her illness/death.
What are irritability, anger, tantrums, outbursts, the inability/refusal to cooperate, nightmares, and/or fear of separation from parents or caregivers. These acute changes in behavior, that we can recognize as nurses, so that reassurance and support can provided.
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