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Ppt chapter 38

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  • 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 38 End-of-Life Care
  • 2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Is the following statement true or false? Acceptance occurs while clients deal with their losses and are completing unfinished business.
  • 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Acceptance occurs after clients have dealt with their losses and completed unfinished business.
  • 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care • Terminal illness: recovery from the condition is beyond reasonable expectations • Stages of dying – Denial: psychological defense mechanism; refusal to believe certain information; helps to cope with reality of death
  • 5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Stages of dying (cont’d) – Anger: emotional response to feeling victimized; occurs because there is no way to retaliate against fate – Bargaining: psychological mechanism to delay the inevitable – Depression: sad mood; realization that death will come sooner rather than later
  • 6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Stages of dying (cont’d) – Acceptance: attitude of complacency that occurs after clients have dealt with their losses • Promoting acceptance: nurses can help client to pass from one stage to another by providing emotional support and supporting client’s choice regarding terminal care
  • 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Dying
  • 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Promoting acceptance (cont’d) – Emotional support: part of missing nursing care; more necessary for dying clients – Arrangements for care: respecting the rights of dying clients
  • 9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Helping Dying Clients Cope
  • 10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Arrangements for care (cont’d) – Home care o Respite care: relief for the caregiver by a surrogate – Hospice care o Eligibility for hospice care: 6 months or less to live
  • 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins The Dying Person’s Bill of Rights
  • 12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Is the following statement true or false? In home care, the focus of support may shift back and forth from the client to the caregiver.
  • 13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. In home care, the focus of support may shift back and forth from the client to the caregiver.
  • 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Arrangements for care (cont’d) – Hospice care (cont’d) o Hospice services: clients receive care in their own homes; multidisciplinary team of hospice professionals and volunteer support are provided
  • 15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Medicare Home Hospice Benefits
  • 16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Arrangements for care (cont’d) – Terminating hospice care o Residential care: form of intermediate care o Acute care: sophisticated technology and labor-intensive treatment
  • 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Providing terminal care – Hydration: maintenance of adequate fluid volume – Nourishment: tube feeding and parenteral nutrition – Elimination: catheterization; enemas or suppositories; skin care
  • 18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Providing terminal care (cont’d) – Hygiene: clean, well groomed, and free of unpleasant odors – Positioning: promote comfort and circulation – Comfort: keep clients free from pain
  • 19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Family involvement: maintain family bonds to help coping with future grief • Approaching death: decrease and ultimate cessation of function – Multiple organ failure: two or more organs cease to function – Family notification: family should be aware of approaching death
  • 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Multiple Organ Failure
  • 21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Summoning the Family of a Dying Client
  • 22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question •Is the following statement true or false? Hospice services can be terminated if the client does not meet the Medicare criteria.
  • 23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Hospice services can be terminated if the client does not meet the Medicare criteria.
  • 24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Family notification (cont’d) – Meeting relatives to promote smooth transition – Discussing organ donation • Confirming death: determined on the basis that breathing and circulation have ceased
  • 25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Age Criteria for Organ Donation
  • 26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Confirming death (cont’d) – Brain death: irreversible loss of function of the brain – Death certificate – Permission for autopsy: examination of organs and tissues of human body after death
  • 27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Organ Procurement Form
  • 28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Terminal Illness and Care (cont’d) • Performing postmortem care: – Cleaning and preparing the body to enhance its appearance during viewing at the funeral home – Proper identification – Releasing the body to mortuary personnel
  • 29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Grieving • Process of feeling acute sorrow over a loss • Pathologic grief: dysfunctional grief; refusing to accept the client’s death • Resolution of grief: time taken for mourning; ability to talk about the dead person; controlling emotions
  • 30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications • Many nursing diagnoses: – Acute pain, fear, spiritual distress, social isolation, ineffective coping, decisional conflict, hopelessness, powerlessness, dysfunctional grieving, anticipatory grieving, caregiver role strain, death anxiety, and chronic sorrow
  • 31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations • Understand that the dying older client is a living person who may want to maintain the same interpersonal relationships as someone who is not dying • Encouraging older clients, who have experienced the death of a close friend or family member, to express feelings associated with grieving is important
  • 32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) • Reading obituaries can be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death

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