Misc.
What are the 5 stages of Grief in order?
Denial/numbness
Anger/blame
Bargaining
Depression
Acceptance
What are the lifespan considerations of grief for infants?
death has least significance to infants younger than 6 months of age
after parent-child attachment and trust are established, the loss of a significant person is profound
prolonged separation or loss in thought to be more significant at this age than subsequent age
As the nurse: maintain normal environment, have a routine
What types of assessments would be used in Palliative Care and why?
Pain, H2T, cognitive (decreased LOC, lethargic, confused), respiratory, diet, elimination (foley), psychosocial
What 2 anticholinergics for palliative care are used to reduce secretions?
Scopolamine patch & atropine sulfate
What are the Emotional Signs of approaching death?
What is withdrawal, vision like experiences, letting go, saying goodbye
What are the lifespan considerations of grief for ADULTS?
reduced concentration
a sense of numbness
disrupted sleeping patterns
changed eating habits
roller coaster of emotional energy
loss of faith, trust, control
As the nurse: make sure they are getting their emotional, spiritual, and physical needs met
What are the lifespan consideration of grief for TODDLERS?
toddlers are egocentric (me, me, me), can only think about events in terms of their own frame of reference--LIVING
unable to comprehend the absence of life. may continue to act as though the person is still alive
As the Nurse: encourage the same routine, someone they can rely on, have the same person
What changes could the nurse anticipate to see on a head-to-toe assessment?
Vital signs, skin, appetite, LOC, energy/fatigue
What medication for palliative care is used for nausea and vomiting and can help a patient eat better?
Ondansetron
What are the Physical Signs of approaching death
What is cool extremities, increased sleeping, decreased oral intake, incontinence, congestion/gurgling, change in breathing pattern, disorientation, restlessness
What is Palliative care?
relief or management of symptoms without providing a cure
reduce the severity of a chronic debilitating illness
What are the lifespan considerations for grief for Preschool-age?
greatest concerns: separation form parents/loved ones
maintains some understanding of death but see it as a kind of sleep. They do not separate it from living abilities
death is temporary and gradual
death or illness as punishment or feel responsible
may regress in behavior, giggle, or deny pain
reverting back to toddler behavior (tantrums, sucking thumb, wetting the bed)
What changes to vital signs might the nurse expect to see and why?
Decreased BP, increased HR then eventually drops, respiratory changes, increased O2 needs, Cheyenne Stokes, body temperature drops
Why: Organs are starting to fail
What 2 opioid medications for palliative care help with pain, decrease O2 needs, and decrease anxiety?
Morphine sulfate (sublingual Roxanol) & hydromorphone
What are the signs of the Late Stage of dying?
What is unconsciousness, eyes half open, blink reflex absent, decreased response to stimuli, HR slows and BP decreases, heart rhythm irregular, skin cool and clammy, cyanosis/mottling, Cheyne-Stokes and Agonal respirations
What are the 3 goals of palliative care?
adjust meds, therapies, treatments, and interventions
reduce symptoms including pain, nausea, dyspnea, vomiting, constipation, diarrhea, anorexia and cachexia
alleviate symptoms including anxiety, panic, insomnia, fatigue, depression, despair and existential/spiritual crises
What are the lifespan considerations of grief for School-age?
younger school age: death is something to be feared and may see death as a monster or bogeyman
may identify death as punishment; may take responsibility for loved one's death
curious about post-mortem care of the body
by age 9/10, children may have adult view on death--might realize that death is final and irreversible; responds to logic
As the nurse: encourage them to share their feelings, honesty is important
What are some Non-Pharmacological Interventions for palliative care?
massage, music therapy, therapeutic touch, mouth swabs/sips of water, aromatherapy, foley catheter, positioning (q2h), calm quiet environment, cool cloth to forehead
What palliative care medication is a benzodiazepine that helps with anxiety and fear?
Lorazepam
What are the signs that death has occured?
What is the difference between grief and mourning?
grief= lasts for a long time
What are the lifespan considerations of grief for ADOLESCENTS?
have a mature understanding of death
have the most difficulty in coping with death
often feel alone in the struggle to accept death and deal with grief
have an idealistic view of the world and may be critical of the processes of grief including funerals
As the nurse: respect their needs and their privacy, treat them as adults
What is the role of the nurse in caring for patients and patient families who are experiencing grief?
support them, be honest, build that relationship with the client
What palliative bronchodilator medication is used to help with ease of breathing?
Albuterol
What role does the nurse have in the care of the patient's family and patient's body after death has occured?
Patient's Family: support, let them be present, allow them time
Patient's Body: position them flat*, clean them, incontinence pads under hips, dentures in mouth