NUR 257 MIDTERM 4
- Living will
Answer
A legal document in which an individual gives written instructions expressing his or her wishes regarding health care in the event that person can no longer make those decisions.
- advanced directives
Answer
- types
living will
-health proxies -power of attorney
limited to hospital + Long term care facilities
3. POLST
Answer
a form that a physician fills out that determines if life saving resuscitation is desired or not in order for EMS to know what to do for a patient who is considered to be at risk for a life threatening event
including if the patient wants/does not want 1 / 4
-intubation -hydration -antibiotics -artificial nutrition
- impaired secretion in near death stage
Answer
buildup of saliva due to the loss of swallow ability
death rattle
xerostomia (Dry mouth) -exacerbated by oxygen + reliance on open mouth breathing use anticholinergic to decrease secretions oral care with swabs + moistened cloths
- Dyspnea in near death stage
Answer
changes in respiratory patterns (Shallow + peri- ods of apnea)
increased respiratory effort -retractions -accessory muscle use
-paradoxical abdominal breathing treatment 2 / 4
-bronchodilators -steroids -lorazepam for anxiety which can make dyspnea worse -O2 for comfort or hypoxemia -opiods to reduce air hunger discomfort
- dehydration in the near death stage
Answer
it is believed this can help with the release of endorphins which can provide a sense of well- being to a dying patient
not as many secretions, decreased risk of pulmonary congestion less urine output so there is no need for bed pan or urinal
- cachexia + anorexia
Answer
cachexia - lean muscle loss anorexia - inadequate nutritional intake
caused by disturbance in carbohydrate, protein, and fat metabolism, endocrine dysfunction and anemia
results in severe asthenia - loss of energy appetite stimulants are not effective not usually reversible Parenteral/enteral nutrition useful ONLY for pt with appetite who cannot swallow. ORAL CARE.
- impaired skin integrity
Answer
dusky , gray , cold , clammy , mottling which takes place days before death 3 / 4
do not massage non-blanch able redness/actual breakdown keep skin clean + moist incontinence - prevent further breakdown , changing the patient regularly.
- terminal + irreversible delirium
Answer
confusion , restlessness , agitation hallucinations (Auditory + visual) , sleep disturbances ,
common in patients with brain + liver metastases
use benzodiazepines + neuroleptics lorazepam + halloo
this is a different approach than traditional approach to treating delirium
- Neurotransmitter for parkinson
Answer
dopamine
- Nausea + Vomiting
Answer
identify cause + remove it
treatment
Answer
-anticholinergic -steroid
- / 4