/
VN057 gerontology 8 15, Chapter 15 VN057 gerontology 8 15, Chapter 15

VN057 gerontology 8 15, Chapter 15 - PowerPoint Presentation

roxanne
roxanne . @roxanne
Follow
342 views
Uploaded On 2022-06-18

VN057 gerontology 8 15, Chapter 15 - PPT Presentation

2 EndofLife Care The American Way of Dying Not seen as a natural progression Uncomfortable with death fragmented disorganized amp inadequate guidance forced to attempt to follow changing ID: 920738

life death care amp death life amp care person cont dying time loss pain people family die depression loved

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "VN057 gerontology 8 15, Chapter 15" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

VN057 gerontology 8

15,

Slide2

Chapter 15

2

End-of-Life Care

Slide3

Slide4

Slide5

The American Way of Dying

Not seen as a natural progression

Uncomfortable with death

fragmented, disorganized & inadequate guidanceforced to attempt to follow changing rules & regulations set up by multi bureaucraciesGvtinsurance

5

Slide6

Attitudes Toward Death and

End-of-Life Planning

6

Slide7

Attitudes

end-of-life

care and death

planningIdeally, discussions before a health crisis variety of options-end of life decisions difficulttoo many choicesvalues, cultural & spiritual beliefs, & life experiences all affect choices Most say that they do not fear death as much as they fear how they will die

7

Slide8

Slide9

Advance Directives

Specific end-of-life

decisions

Written- official documentsFewer issues-both providers & familyadvance directive living willdurable power of attorney for health careSpecify the type and amount of intervention desired by an individual

9

Slide10

Advance Directives (cont.)

Copies

to

PCP, hospital of choice, extended-care facility, power of attorney for health care, anyone else as appropriateA competent person retains the right to change his or her mind about treatment at any timeIntubation or feedingFull code to DNRDNR to full or chem codeComfort care to any of the above

10

Slide11

Advance Directives (cont.)

Not official or required-

Medic-alert bracelet or necklace with code status

Copy on refrigerator if person lives @ home

Slide12

Caregiver Attitudes Toward

End-of-Life Care

providers see

death as a professional failure rather than the inevitable end to the human experienceCaregivers need to be able to communicate effectively –deal with grief, loss & bereavement at the end of lifepatient,family significant others

12

Slide13

Death among older adults is typically caused by a(n):

acute illness.

accident.

chronic and debilitating conditions.sudden, unexpected condition.

13

Slide14

Values Clarification Related to Death and End-of-Life Care

14

Slide15

Slide16

Ethical Dilemmas

value systems

of

patient & caregiver are often very differentCaregivers benefit from spending time identifying their personal end of life values Understanding the value systems of others help the nurse provide quality end-of-life care, even when his or her values are not the same

16

Slide17

Values Clarification

Death, dying, and the end of life have different meanings for every person

Each individual must examine his or her own values

17

Slide18

Slide19

What Is a “Good Death”?

research

to identify

specific end-of-life outcomes most valued & desired by those nearing the end of life & by their familiesCommon theme: given their choice, most people wish to be treated with respect and dignity and to die quietly and peacefully, with loved ones nearby

19

Slide20

Patients’ Wishes Related to

End of Life

Most dying patients have similar desires

20

Slide21

Where People Die

90%

indicated

a wish to die at homeless than 25% actually occur there50% occur in hospitals25%in extended-care facilitiesHospice careThe focus is palliativeproviding comfortmeeting the needs of patients & their families

21

Slide22

Hospice care is usually available for the last __________ of life.

month.

6 months.

1 year.2 years.

22

Slide23

Medicare

covers hospice

when death is expected to occur within 6 months

Not always exact timing-some lee wayNot always cancerCHFDementiaCOPDetc

Slide24

Hospice Care

24

Slide25

Palliative Care

Focus-reduce

or

relieve symptoms without cureneither hastens nor postpones deathInterventions designed to make the best of the time left & live as active and complete a life as possible until death comes“Comfort Care”

25

Slide26

Palliative Care (cont.)

Individuals

choosing

palliative care usually choose to decline procedures Invasive diagnostic tests cardiopulmonary resuscitation (CPR)artificial ventilationartificial feeding, prolong the dying process

26

Slide27

Slide28

Collaborative Assessments and Interventions for End-of-Life Care

Commitment & collaboration

of all caregivers

Disciplines must work together cooperatively & creatively positive attitude to solve any problems requires mutual respect & communication between all team members

28

Slide29

Communication at the End of Life

responsibility

for providing

& maintaining effective communicationnurses and assistive caregivers, who spend the most time with dying patientsNurses need to work to develop a climate that encourages open communication

29

Slide30

Communication at the End of Life (cont.)

demonstrate verbally and nonverbally you are

approachable

not detached or indifferentdemonstrate willingness to listen suggestions, requests, or criticisms made by the dying person or, more likely, by family

30

Slide31

Psychosocial Perspectives, Assessments, and Interventions

31

Slide32

Slide33

Cultural Perspectives

cultural

beliefs influence

people think, live & interact with other people-they also affect how a person approaches deathnurse’s responsibility to assess each person to find out their preferences & viewpoints Develops trust & can plan culturally sensitive care

33

Slide34

Communication About Death

The Western

perspective emphasizes patient’s

“right to know” diagnosis and prognosispatient can make informed decisionsAsians & Native Americans often believe speaking about death or other bad things decreases hope and produces bad outcomes

34

Slide35

Decision-Making Process

Amount and type of intervention that will be

accepted

Individual/culturalfocus on helping people cope with deathfocus on living and prolonging life

35

Slide36

Decision-Making Process (cont.)

Significance of pain and suffering

Western

perspective focuses on freedom from pain and sufferingNon-Western cultures often see pain as a test of faith or a preparation for the afterlifesomething that is to be endured rather than avoided

36

Slide37

Spiritual Considerations

Determine

if there are specific

religious beliefs or practices important to the patient or their family membersAssess whether they have a preferred spiritual counselorOffer choices when availableDetermine whether the person wishes any spiritual counselor to be notified

37

Slide38

Spiritual Considerations (cont.)

respect

for the patient’s religious and spiritual views

Avoid imposing your own beliefs Be present, be available, and listenAvoid moving beyond your role and level of expertise unless you have specific ministerial or pastoral training in death and dying

38

Slide39

Depression, Anxiety, and Fear

It is one thing to know that you will die eventually;

it’s another

to realize that you have lived most of your life and that death is likely to be a reality soonIndividuals must decide whether they will give up and let fear, anxiety, or depression overwhelm them or whether they will do something to remain in control of whatever time they have remaining

39

Slide40

One of the most important things caregivers can do for a dying person is to:

not talk about when they will die.

allow them to be alone as much as possible.

talk to them about a “do not resuscitate” status.

spend more time with them.

40

Slide41

Slide42

Physiologic Changes, Assessments,

and Interventions

42

Slide43

Pain

Biggest concern

of the dying person and

their significant othersCan interfere with the ability to maintain control, cope, and complete end-of-life tasksIncreases the likelihood of fatigue, depression, and loss of appetite

43

Slide44

Pain (cont.)

Interferes with the ability of the dying person to make thoughtful decisions

&

communicate effectively with loved ones at a critical timeRelief of pain begins with careful assessmentPerform assessment early & oftenpatient’s status can change dramatically in a relatively short period

44

Slide45

Pain (cont.)

Pain is what the patient says it

is,

but many older patients who have lived with multiple discomforts often underreport painDon’t want to be a botherAfraid of addiction to medication Medical personnelFamilypatientSelf-reported logs or journals are helpful patient and significant others more focused and attuned to subtle changes in the individual

45

Slide46

Fatigue and Sleepiness

May be caused by underlying disease processes, stress, anxiety, or medications

can interfere with

ability to carry out end-of-life tasks, including communicating with loved onesBecause of metabolic changes [& depression] patient may begin to sleep more and may be difficult to awaken as the end of life nears

46

Slide47

Cardiovascular Changes

Diminished peripheral

circulation

likely to worsen as death nearsresulting in dry, pale, or cyanotic extremitiesPeripheral pulses are often weakBlood pressure often decreased by 20 or more points from normal range and may be difficult to hearBody temperature may elevate significantly as death nears

47

Slide48

Respiratory Changes

Shortness of breath, difficulty breathing (dyspnea), and

Cheyne

-Stokes respirations during sleep are commonly observed in older adults as death nearsMild respiratory difficulty usually can be relieved by changing positioning, elevating the upper body, opening windows or using a fan to increase ventilation, or administering oxygen by nasal cannulaNarcotics often given for air hunger

48

Slide49

Gastrointestinal Changes

Loss of appetite (anorexia) and muscle wasting (cachexia) are commonly observed with advanced terminal conditions, particularly some forms of cancer

Dry mouth (xerostomia) and ulcerations of the mouth

Nausea and vomiting are not signs of impending death; rather, they are distressing symptoms of underlying problems

49

Slide50

Gastrointestinal Changes (cont.)

Constipation is a common and distressing problem for the terminal patient

Diarrhea is a less common problem at the end of life, but one that can have a profound effect on the quality of life

50

Slide51

Urinary Changes

Oliguria common-decreases in fluid intake, blood pressure, and kidney perfusion

Urinary incontinence common

Absorbent pads or indwelling catheterused to reduce need for bed changes that may disturb the dying person

51

Slide52

Integumentary Changes

Skin breakdown is a problem

malnourished

Lack of mobilityincontinence Interventions to prevent skin tears or pressure sores proper skin cleansing careful handling of skin frequent turning and positioning measures to reduce pressuresoft, nonconstricting, nonirritating clothing helps promote comfort and minimizes risk for skin dryness and rash

52

Slide53

Sensory Changes with end of life

Vision- diminishes and the visual field narrows

Hearing-acute until death

even if the person does not respondCalm, supportive, loving messages should be delivered, even when unresponsiveNegative or disturbing conversations should be avoided

,

53

Slide54

Changes in Cognition

Delirium-present in over 80% @ end of life

Causes

Hypotensionoxygen deprivation Apneahypoventilation, Feverneurologic changesmetabolic abnormalitiesHyperglycemia -uremia -dehydration other physiologic or emotional disturbances

54

Slide55

Death

55

Slide56

Slide57

Family Members and

Significant Others

Often wish to be present at the time of death

Some can spend only limited time wish to be called only when there is a significant change in the person’s statusOthers would rather be notified only after death has occurred

57

Slide58

Indicators of Imminent Death

Increased sleepiness

Decreased responsiveness

Confusion in a person who has been orientedHallucinations about people (sometimes deceased family members)Increased withdrawal from visitors or other social interaction

58

Slide59

Indicators of Imminent Death (cont.)

Loss of interest in food and fluids

Loss of control of bowel and bladder

Altered breathing patternsshallow breathingCheyne-Stokes respirationsrattling or gurglingInvoluntary muscle movements and diminished reflexes

59

Slide60

After Death

family members should be allowed to sit at the bedside and say farewells or grieve as long as they need

It is appropriate for the nurse to discreetly remove oxygen, IV lines, or other medical devices

Cultural practices regarding grieving and preparation of the body should be respected and accommodated whenever possible

60

Slide61

Postmortem Care

Removal of soiling and application of a clean sheet or shroud according to agency policies

In most cases, the head is elevated slightly to prevent discoloration

Eyes are gently closed, dentures are inserted, and a small towel is rolled and tucked under the jaw to close the mouthPersonal belongings should be identified, listed, and bagged for return to the family

61

Slide62

Funeral Arrangements

Most older people have given some thought to their final resting place, and many have made specific plans, issued specific directions regarding their wishes and, in some cases, even paid for their funeral

62

Slide63

Bereavement

Survivors often express having ambivalent feelings regarding the death

On one hand, they feel a sense of relief that the struggle is over and that the loved one is at rest

On the other hand, they seriously grieve and miss the loved one’s presenceEven when death is anticipated, the initial feeling of shock and numbness typically occurs

63

Slide64

Bereavement (cont.)

reality of the loss strikes

survivors often experience s/s of depression

loss of appetiteinability to sleepavoidance of social interactionuncontrolled bouts of cryingIn normal grieving, the frequency and severity of these signs of grieving gradually decrease over time, but the loss of a loved one never goes away completely

64

Slide65

Kübler

-Ross model-Five

Stages of

GriefDenial — "This can't be happening to me.“Anger — "Why me? It's not fair!""Who’s to blame?“Bargaining — "I'll do anything for a few more years."hope that the individual can delay death.Depression —"I'm going to die soon so what's the point?”Acceptance — "It's going to be okay."

Slide66