Chapter 40: Hospice Care Flashcards

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Questions and Answers

What is hospice?

A philosophy of care about providing support to patients with terminal illness and their families.

What is a terminal illness?

A disease in an advanced stage with no known cure and poor prognosis.

What is the philosophy of hospice?

To promote comfort and use compassion, interest, and genuine concern to allow the patient to live a better lifestyle during the dying process.

What are the goals of hospice?

<p>To maximize the quality of life and keep the patient as comfortable as possible in the home setting that he or she chooses.</p> Signup and view all the answers

Who renewed the idea of hospice in 1960 in London?

<p>Dame Cicely Saunders</p> Signup and view all the answers

Where and when did the first hospice program open in the United States?

<p>Connecticut in 1971</p> Signup and view all the answers

What is palliative care?

<p>The active, complete care of a patient whose disease has not responded to curative therapy.</p> Signup and view all the answers

What does palliative care emphasize?

<p>The control of pain, relief of symptoms, and provision of psychological, social, and spiritual assistance.</p> Signup and view all the answers

Is palliative care curative?

<p>Palliative care is not curative in nature but aims to relieve pain and distress and to control symptoms of the disease.</p> Signup and view all the answers

When is hospice care appropriate?

<p>When active, curative treatment is no longer effective and supportive measures are necessary to assist the terminally ill patient through the dying process.</p> Signup and view all the answers

What is the idea around palliative care?

<p>Palliative care is not giving up hope; it is full of hope of a good, fulfilling life.</p> Signup and view all the answers

What criteria must be met to be admitted into hospice?

<ol> <li>The attending physician has to certify that the patient's illness is terminal and the patient has a prognosis of 6 months or less to live. 2. For Medicare/Medicaid, 2 physicians are required to state the dying patient's prognosis. 3. It is mandatory that the patient desires the services. The patient has to be willing to forgo any further curative treatment and be willing to seek only palliative care. 4. Patient and caregiver are required to understand and agree that hospice staff will plan the care according to comfort and that they will not necessarily perform life support measures. 5. The patient and caregiver are required to understand the prognosis and be willing to participate in the planning of care.</li> </ol> Signup and view all the answers

Who are the core interdisciplinary hospice team members?

<ol> <li>Medical Director 2. Nurse Coordinator 3. Social Worker 4. Spiritual Coordinator.</li> </ol> Signup and view all the answers

What is the function of the Medical Director?

<p>Licensed Physician, mediator between the hospice team and attending physician, provides consultation relative to the medical aspect of care.</p> Signup and view all the answers

What is the function of the Nurse Coordinator?

<p>RN nurse, does initial assessment, manages the patient care, explains the service, admits the patients, assigns the primary team.</p> Signup and view all the answers

What is the function of the Social Worker?

<p>Bachelor's Degree, evaluates the psychosocial needs, resource for potential community services, assists with counseling in grief issues.</p> Signup and view all the answers

What is the function of the Spiritual Coordinator?

<p>Seminary Degree, liaison between the patient and spiritual community, coordinates spiritual support.</p> Signup and view all the answers

What is the function of the Volunteer Coordinator?

<p>Experience in volunteer work, recruits and trains the volunteers, coordinates assignments of volunteers.</p> Signup and view all the answers

What is the function of the Bereavement Coordinator?

<p>Professional with grief experience, assesses and supports the bereaved survivor, facilitates support groups.</p> Signup and view all the answers

What is the function of the Hospice Pharmacist?

<p>Licensed registered pharmacist, provides drug consultation.</p> Signup and view all the answers

What is the function of the Primary Physician?

<p>Licensed physician, responsible for the medical aspect of symptom control for the patient.</p> Signup and view all the answers

What is the function of the Primary Nurse?

<p>RN, liaison between patient and caregiver, physician, and interdisciplinary team, evaluates patient's response to treatment, educates the patient and family in disease process and care, assesses symptom management, provides emotional support to patient caregiver.</p> Signup and view all the answers

What is the function of the Primary Spiritual Leader?

<p>Religious group, supports patient and caregiver to cope with fears and uncertainty of spiritual issues.</p> Signup and view all the answers

What is the function of the hospice volunteer?

<p>Volunteer training, provides companionship, available for short periods of respite care.</p> Signup and view all the answers

What is the function of the Hospice Aide?

<p>Home health aide, administers personal care and assistance with bathing.</p> Signup and view all the answers

What member is not part of the Hospice Team in any way?

<p>Mental Health provider</p> Signup and view all the answers

What is psychosocial?

<p>A combination of psychological and social factors.</p> Signup and view all the answers

What is respite care?

<p>A period of relief from responsibilities of caring for a patient.</p> Signup and view all the answers

What is bereavement?

<p>A common depressed reaction to the death of someone close.</p> Signup and view all the answers

How long does the bereavement coordinator follow the plan of care following the death?

<p>At least 1 year</p> Signup and view all the answers

What type of other services are available for a person on hospice?

<p>Physical therapist, speech language pathologist, occupational therapist.</p> Signup and view all the answers

What are types of medications for hospice care patients?

<p>Morphine sulfate (pain), fentanyl (pain), droperidol (antiemetic), prochlorperazine (antiemetic), senna (constipation), lorazepam (antianxiety).</p> Signup and view all the answers

What is the symptom most dreaded and feared in a dying patient?

<p>Pain</p> Signup and view all the answers

What is the priority for symptom management?

<p>Pain</p> Signup and view all the answers

What is pain assessment?

<p>Evaluation of the factors that alleviate or exacerbate a patient's pain.</p> Signup and view all the answers

What level of pain affects quality of life?

<p>Any pain over 5 on the 1-10 scale.</p> Signup and view all the answers

What are the 3 main types of pain?

<ol> <li>Somatic Pain 2. Visceral Pain 3. Neuropathic Pain.</li> </ol> Signup and view all the answers

What is somatic pain?

<p>Arises from the musculoskeletal system and is described as aching, stabbing, or throbbing.</p> Signup and view all the answers

What is visceral pain?

<p>Originates from the internal organs. Described as cramping, dull, or squeezing pain.</p> Signup and view all the answers

What is neuropathic pain?

<p>Arises from the nerves and the nervous system. Symptoms include tingling, burning, or shooting pains.</p> Signup and view all the answers

What is titrate?

<p>Slowly increase the amount of drug to find the therapeutic dose.</p> Signup and view all the answers

What is often the drug of choice for the hospice patient?

<p>Morphine</p> Signup and view all the answers

What is one of the most common problems of terminally ill patients?

<p>Constipation</p> Signup and view all the answers

What are factors that contribute to constipation?

<p>Poor dietary intake, poor fluid intake, hypercalcemia, hyponatremia, tumor compression of bowel, use of opioids for pain control, decrease in physical activity.</p> Signup and view all the answers

How do you educate patients and families regarding constipation?

<p>A decrease in oral intake will decrease the amount of stool expelled. A patient does not have oral intake; bowel movements will still be possible in some cases. Opioids pose a risk of constipation, so it is necessary to give laxatives. Comfort is the all-important factor.</p> Signup and view all the answers

What are major anxiety-producing symptoms of terminal illness?

<p>Anorexia and malnutrition.</p> Signup and view all the answers

What does poor appetite potentially arise from?

<p>Nausea and vomiting, constipation, dysphagia, stomatitis, tumor invasion, general deterioration of body, depression, or infections.</p> Signup and view all the answers

What is cachexia?

<p>Malnutrition marked by weakness and emaciation.</p> Signup and view all the answers

What does dyspnea arise from?

<p>A variety of possible conditions such as heart failure, dysrhythmias, infections, ascites, or tumor growth.</p> Signup and view all the answers

What is air hunger caused by?

<p>Tumor pressure, fluid and electrolyte imbalance, or anemia.</p> Signup and view all the answers

What do patients often experience 24 to 48 hours before death?

<p>Death Rattle</p> Signup and view all the answers

What is the death rattle?

<p>The result of accumulation of mucus and fluids in the posterior area of the pharynx.</p> Signup and view all the answers

When should you use suctioning?

<p>Only when a patient is choking and unable to recover.</p> Signup and view all the answers

What are examples of unmet spiritual needs?

<p>Depression, the need to suffer, bitterness, anger, hallucinations, dreams of fire.</p> Signup and view all the answers

What will lead to a decrease in soft tissues?

<p>Weight loss and dehydration.</p> Signup and view all the answers

What leads to an increased risk for skin impairment?

<p>Increased weakness.</p> Signup and view all the answers

What are signs and symptoms of approaching death?

<p>Arms and legs of body sometimes become cool to the touch, spends more time sleeping during the day and difficult to arouse, increasingly confused about time, place, and identity of close/familiar people, incontinence of urine and bowel movement, oral secretions more profuse and collect in the back of the throat, clarity of hearing and vision decrease slightly, restlessness, decrease need for food and drink, breathing patterns change, changes in vital signs occur.</p> Signup and view all the answers

What are ethical issues that are dealt with in hospice patients?

<p>Withholding nutritional support, right to refuse treatment, DNR.</p> Signup and view all the answers

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Study Notes

Hospice Care Overview

  • Hospice is a care philosophy focused on supporting terminally ill patients and their families.
  • A terminal illness is characterized by an advanced stage of disease with no known cure and a poor prognosis.

Philosophy and Goals of Hospice

  • The primary philosophy aims to promote comfort and enhance the quality of life during the dying process.
  • Goals include maximizing comfort and allowing patients to remain in chosen home settings.

Historical Context

  • Dame Cicely Saunders revitalized the concept of hospice care in 1960 in London.
  • The first hospice program in the United States opened in Connecticut in 1971.

Palliative Care

  • Defined by the World Health Organization as care for patients whose diseases are unresponsive to curative treatment.
  • Emphasizes pain control, symptom relief, and psychological, social, and spiritual support.

Admission Criteria for Hospice

  • Patients must have a terminal prognosis of 6 months or less, confirmed by attending physicians.
  • Admission requires patient consent to forgo curative treatments and pursue palliative care.
  • Care planning involves understanding the prognosis and comfort-focused strategies.

Team Composition and Roles

  • An interdisciplinary team approach includes Medical Directors, Nurse Coordinators, Social Workers, and Spiritual Coordinators.
  • Primary hospice team members also consist of Bereavement Coordinators, Hospice Pharmacists, Volunteers, and Aides.
  • Each team member has specific functions ranging from initial assessment to providing spiritual support and companionship.

Symptom Management Priorities

  • Pain management is prioritized, particularly when pain levels exceed 5 on a scale of 1-10.
  • Common types of pain include Somatic, Visceral, and Neuropathic, treated according to their origins.

Constipation and Other Issues

  • Constipation is a prevalent concern among terminally ill patients, often requiring laxatives due to opioid use.
  • Factors contributing to constipation include poor diet, fluid intake, and decreased physical activity.

Psychological and Spiritual Considerations

  • Major anxiety symptoms are associated with anorexia and malnutrition, motivating the need for addressing spiritual needs.
  • Unmet spiritual needs may manifest as depression or anger and require sensitive management.

Signs of Approaching Death

  • Signs include cool extremities, increased sleep, confusion, incontinence, and altered vital signs.
  • The "death rattle" indicates mucus accumulation, which requires careful monitoring and possible suctioning.

Ethical Concerns

  • Ethical issues in hospice care revolve around nutritional support, patient autonomy in treatment refusal, and DNR (Do Not Resuscitate) orders.

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