End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past...
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Transcript of End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past...
![Page 1: End of Life Care Let’s talk about it! Death and Dying in America What has changed over the past century?](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f1c5503460f94c31d41/html5/thumbnails/1.jpg)
End of Life Care
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Let’s talk about it!
•Death and Dying in America
•What has changed over the past century?
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End of Life Decisions
•What would you do?•What have you done?•What should you do?•Healthcare Surrogate decisions?
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Advanced Directives•Written instructions that guide health care decision making in accordance with a patient’s wishes, should they lose the ability to speak for self.
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Advance Directives•Common Forms
–Living Will–Health Care Surrogate Designation
–Do-Not-Resuscitate Order
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Advance Directives•Do not need lawyer to prepare
•Forms available–Health care facility–Physicians–Internet–Hospice
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Advance Directives
•WHY?•What if you don’t have Advance Directives?–Role of the nurse
•What care is covered?
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Death and Dying•Caring for a dying pt is: Opportunity Privilege•Natural part of life
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End of Life Care
Therapeutic PresenceCheerful - don’t overdoGentle and kindPromote comfortPt is team leader
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End of Life CareSupportiveEmpatheticAllow maintenance of self-esteem, dignity
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EOL: Symptom Management
Pain–WHO Analgesic Ladder
Resp. Sx.–Dyspnea, Cough
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EOL: Symptom Management
G.I. Sx.–Anorexia, Cachexia–Constipation–Diarrhea–Nausea / Vomiting
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EOL: Symptom Management
General Sx.–Fatigue / Weakness
Psych. Sx.–Depression–Anxiety–Delerium / Agitation / Confusion
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Care of the familyOK to cry in front ofAllow expressionAllow to stay and helpKeep on even keelOffer chaplain / clergy
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Care of the familyInvolve social services if necessary
Is healthiest: - be honest - allow to know
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Kubler-Ross Stages of Dying
1. Denial 2. Anger3. Bargaining4. Depression5. Acceptance6. Detachment
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HospicePhilosophy of CarePhysical and Emotional comfort
Quality of lifeTerminally ill cared for with dignity
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HospiceSymptom ControlPalliative CareNot curative measuresMost care given in home
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Hospice characteristics
AutonomousGoal of care is symptom control
Pt / Family is primary unitInterdisciplinary
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Hospice characteristics
Specially trainedOn-call servicesSupport for staffBereavement careBased on need, not $$
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Goal of HospiceDeath with dignityRelief of pain and other distressing sx.
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Hospice Admission Criteria
Confirmed, terminal dxAgree to goalLife expectancy < 6 mPrimary Caregiver - 24 hrs/day
Agree to DNR
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Signs of Approaching Death
Failing Circulation–Cold and Mottled Extremities
Decreased U/OV/S Changes
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Signs of Approaching Death
Resp. CongestionBreathing Pattern Changes
Failing Senses–Hearing last to go!
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Clinical deathWhen resp and heart beat stop
Note time of cessation
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Biologic DeathMaintain vital signs with mechanical means
Brain dead
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Death PronouncementCheck policiesDocument
–Pt. name–Date and time of death–Details of physical exam–Others notified
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Helping the Family
Prepare the bodyAllow to stay as long as needed
Asst. with phone callsOther notifications
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Organ DonationFamily MUST be askedEven if have signed driver’s license request
Family has custody of body at death
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DeathCan death be a good experience??
Fear of death shaped by culture and religion