Palliative Care questions and answers

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/F: Palliative care is same as hospice care - ANSWER False; palliative care is an ASPECT of hospice care The major difference between palliative care and hospice care is: - ANSWER Palliative care a... llows a person to simultaneously receive *curative and palliative treatments. * Hospice care is provided once a person decides to *forgo curative treatments.* Palliative Care includes: - ANSWER 1. Symptom management 2. Pain management 3. Comfort care 4. Emphasis on *quality of life* 5. Does *not* mean death is imminent 6. Requires coordination of care 7. Open discussion/patient choice/support/planning must consider _______ cases & what else? - ANSWER individual cases & other *co-morbid diseases* when do you implement palliative care? Early, middle, or late in the disease process? - ANSWER Speaker says: start it earlier in the disease process! think about..... - ANSWER illness trajectory Pts. Who live and die w/ chronic disease states (ex: CHF, COPD) experience ___________that lead towards poor prognosis - ANSWER exacerbations palliative care (actively or not actively dying?) - ANSWER *not actively dying* -addressive symptom management: dyspnea, fatigue, anxiety, depression -prevent exacerbations -promote activity -rehab Comfort care (actively or not actively dying?) - ANSWER *actively dying* -interventions for symptom management -provide reassurance -reduce physical functioning Supportive Care - ANSWER -use of lab analysis -blood transfusion -bone marow stimulation -specialy MD to manage pulmonary disease & S/S -lung cancer pt. undergoes oncology care End-of-life care - ANSWER -admit into hospice -DNR -*expect death will happen in 6 months* -no aggressive disease management -symptom management End-of-life care is most synonymous w/ which following types of care? a.Palliative care b.Hospice c.Supportive care d.Quality of life - ANSWER b. Hospice care What are the most important reasons for considering the use of palliative care in pt. care management? a. Patients live w/ multiple chronic diseases several years before dying b. Patients live with debilitating symptoms that interfere w/ quality of life c. Palliative care is reserved for those patients who are considered terminally ill d. Palliative care is used to reduce the symptoms associated w/ chronic disease - ANSWER a. Patients live w/ multiple chronic diseases several years before dying b. Patients live with debilitating symptoms that interfere w/ quality of life d. Palliative care is used to reduce the symptoms associated w/ chronic disease Palliative care is used to promote which of following items: (select all that apply) a. Physical functioning b. Reduction in disease exacerbations c. Improved quality of life d. Discussion on advanced directives - ANSWER ALL: a. Physical functioning b. Reduction in disease exacerbations c. Improved quality of life d. Discussion on advanced directives Hospice care focues on ________ care and forgoes _______ treatments? - ANSWER end- of- life curative Qualifications for Hospice Care: 4 - ANSWER 1. terminal within *6 mo* 2. pt. must accept tx an come to terms w/ it 3. financially eligable (medicare) 4. orders from *2* physicians POLST "Physician Ordered Life Sustaining Treatment" - ANSWER an approach to end-of -life planning based on conversations between patients, loved ones, and medical providers. The POLST Paradigm is designed to ensure that seriously ill patients can choose the treatments they want and that their wishes are honored by medical providers. End of life care: when _____ is not an option - ANSWER cure end of life care needs to be ______ - ANSWER holistic: psychosocial social spiritual what is said to be the last sense to go before death? - ANSWER hearing 5 types of grief - ANSWER •Anticipatory grief •Adaptive grief •Prolonged grief disorder or Complicated grief •Parental grief •Sibling grief anticipatory grief - ANSWER The grief experience for the caregiver of the patient with a chronic illness often begins long before the actual death event. Patients at the end of life can also experience this. Adaptive grief - ANSWER Grief that assists the person in accepting the reality of death; a healthy response. Prolonged grief disorder or complicated grief - ANSWER -describe prolonged and intense mourning. -can include symptoms such as: recurrent and severe distressing emotions and intrusive thoughts related to the loss of a loved one, self-neglect, and denial of the loss for longer than 6 months. -May feel "stuck" and unable to move forward after the death of a loved one. -At great risk for illness and have work and social impairments. Bereavement and grief counseling - ANSWER important aspect of palliative care. The goal is to provide support and to assist survivors in the transition to a life without the deceased person. Incorporate grief support into the plan of care for the family and significant others during the patient's illness and after the death. Stages of grief (Kubler-ross model of grief) - ANSWER denial anger/bargaining depression acceptance The grief wheel model (Lewis p. 144) - ANSWER 1. *shock* - numbness, denial, disbelief, hysteria, can't think straight 2. *Protest* - strong, powerful feelings of anger, guilt, sadness, fear, yearning, and searching 3. *Disorganization* - overwhelming bleakness, despair, apathy, anxiety, and confusion 4. *reorganization* - gradual return to normal funcitoning but feelings are different *grief resolves when "new normal" has been reached/accepted* Psychosocial manifestations at end of life - ANSWER •Altered decision making •Anxiety about unfinished business •Decreased socialization •Fear of loneliness •Fear of meaninglessness of one's life •Fear of pain •Helplessness •Life review •Peacefulness •Restlessness •Saying goodbyes •Unusual communication •Vision-like experiences -Withdrawal Nursing diagnoses (7) - ANSWER -Pain -Impaired skin integrity -Risk for Infection -Compromised human dignity -Impaired gas exchange r/t end stage COPD -Impaired Mobility -Impaired comfort Adequate pain relief is an important outcome for all patients but in particular for patients who are terminally ill. The principle of _____________. - ANSWER *Beneficience:* care is provided to benefit patients. The goal of adequate pain control in the terminally ill to alleviate suffering is based on the principle of ____________ - ANSWER *nonmaleficence:* preventing or reducing harm to the patient. The secondary effect of hastening the patient's death is ethically justified; this is known as the concept of double effect. What is the double effect? - ANSWER An action that has one good (intended) effect and one bad (unintended but foreseeable) effect is permissible if the following conditions are met: •The action itself must be good or indifferent. Only the good consequences of the action must be sincerely intended. •The good effect must not be produced by the bad effect. •There must be a compelling or proportionate reason for permitting the foreseeable bad effect to occur. [Show More]

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