Community Nursing – Week 15 – Palliative and End-of-Life Care

Please answer the question below:

The hospice nurse has a unique role in the provision of end of life services. 

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1. Mention important roles (at least 3) of the nurse while providing quality end -of-life care to seriously ill persons and their families. Explain your answer.

·      Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (7th ed.) ISBN: 978-1-4338-3216-1

·      Minimum of two references, not older than 2015.

Please provide plagiarism report

Chapter 24: Palliative and
End‐of‐Life Care

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1

Chapter Highlights
Social trends in aging and dying
Palliative and hospice care for persons across the life span
Caring for a person at the end of life
Strategies for managing pain and common symptoms

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Question #1
Is the following statement true or false?
Studies have documented that the American healthcare system has the best care in the world of seriously ill clients and their families.

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Answer to Question #1
False
Rationale: Studies have documented that the American healthcare system has substantial shortcomings in the care of seriously ill clients and their families.

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Nursing and Patients with Chronic Disease #1
Patient‐ and family‐centered care
Ethical behavior and consumer rights
Clinical excellence and safety
Inclusion and access
Organizational excellence

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Nursing and Patients with Chronic Disease #2
Workforce excellence
Standards
Compliance with laws and regulations
Stewardship and accountability
Performance measurement

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Death in the United States
Stages in the dying process
Specialized care at the end of life

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Nursing Care When Death Is Imminent
Decisions about level of care
Comfort measures only
Advance directives
Artificial nutrition and hydration
CPR
Euthanasia and physician‐assisted suicide

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Question #2
Is the following statement true or false?
It must be remembered that a dying patient will go through denial, anger, bargaining, and acceptance stages of dying.

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Answer to Question #2
False
Rationale: A dying person may not exhibit all of these stages, or may move quickly through a stage, only to return to it at a later time.

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Palliative Care
Interdisciplinary team‐based care that is focused on the relief of suffering for clients with serious illness
Best possible quality of life not only for clients but also for their families
Acute, serious, life‐threatening illness
Progressive chronic illness

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Focus of Palliative Care
Controlling symptoms
Coordinating care
Reducing unnecessary tests and futile interventions
Ongoing conversations with the client and family

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Hospice Care
Support and care for persons in the last phase of an incurable disease so that they may live as fully and comfortably as possible

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Hospice Care #1
Physician services
Nursing care
Physical therapy, occupational therapy, and speech‐language pathology services
Medical social services
Hospice aide services

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Hospice Care #2
Homemaker services
Medical supplies, including drugs and biologic and medical appliances
Counseling, including dietary counseling, counseling about care of the terminally ill client, and bereavement counseling
Short‐term inpatient care for respite care, pain control, and symptom management

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Caring for Patients at the End of Life #1
Death itself
Thoughts of a long or painful death
Facing death alone
Dying in a nursing home, hospital, or rest home
Loss of body control, such as bowel or bladder incontinence

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Caring for Patients at the End of Life #2
Not being able to make decisions concerning care
Loss of consciousness
Financial costs and becoming a burden on others
Dying before having a chance to put personal affairs in order

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Pain Management
Pain assessment
Types of pain in dying patients
Pain relief during the dying process

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Pain Medications
Nonopioid analgesics
Opioids
Adjuvant analgesics
Oral
Oral mucosa
Rectal
Transdermal
Topical
Parenteral
Intraspinal

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Question #3
Is the following statement true or false?
Short‐acting or immediate‐release agents are excellent prn medications, and their only use should be for control of breakthrough pain.

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Answer to Question #3
True
Rationale: Short‐acting or immediate‐release agents are excellent prn medications, and their only use should be for control of breakthrough pain. Breakthrough pain is defined as “intermittent episodes of moderate to severe pain that occur in spite of control of baseline continuous pain.”

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Preventing and Managing Adverse Effects
Constipation
Sedation
Respiratory depression
Nausea and vomiting
Myoclonus
Pruritus

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Management of Distressing Symptoms at the End of Life
Secretions
Anorexia and dehydration
Skin integrity
Incontinence
Terminal delirium

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Nursing Care of Clients Who Are Close to Death
Buildup of saliva and oropharyngeal secretions
Changes in respiratory patterns
Skin may appear dusky or gray and feel cold or clammy.
Eyes may appear discolored, deeper set, or bruised.

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Nursing Care After Death
Postmortem care
Grief—emotion felt after the loss
Mourning—recovery from the loss

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Grief
Numb shock
Emotional turmoil or depression
Reorganization or resolution

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Caring for the Caregiver
What have you done to meet your own needs today?
Have you laughed today?
Did you eat properly, rest enough, exercise, and play today?
What have you felt today?
Do you have something to look forward to?

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Complementary and Alternative Therapies
Acupuncture
Massage
Reiki
Chiropractic
Herbal medicine

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