End of Life (Palliative Care)
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Questions and Answers

Which type of drugs are recommended for fast-acting relief of breakthrough pain?

  • Adjuvant analgesics
  • NSAIDs (correct)
  • Nonopioids
  • Long-acting opioids

    • What is the goal of titration in pain management?

  • To use the highest dosage of opioid
  • To use the lowest dosage of opioid with most side effects
  • To use nonopioids exclusively
  • To use the lowest dosage of opioid that provides effective pain control with fewest adverse effects (correct)

    • Which type of pain is Step 1 of the Analgesic Ladder designed to address?

  • Mild-moderate pain
  • Moderate-severe pain
  • Mild pain (correct)
  • Neuropathic pain

    • What is the recommended initial approach for relieving mild pain?

    <p>Nonopioids alone</p> Signup and view all the answers

    Which type of drugs are recommended for Step 2 of the Analgesic Ladder?

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

    What is the main concern with opioid use?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the recommended intervention to prevent constipation associated with opioid use?

    <p>Laxative + stool softener</p> Signup and view all the answers

    Which type of pain is Step 3 of the Analgesic Ladder designed to address?

    <p>Moderate-severe pain</p> Signup and view all the answers

    What is the role of adjuvant analgesic therapies in pain management?

    <p>To enhance the effects of opioids and nonopioids</p> Signup and view all the answers

    What is the recommended route for delivering opioids and other analgesic agents?

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

    When should pain be reassessed after administering an immediate release PO analgesic?

    <p>1 hour</p> Signup and view all the answers

    What is the priority planning approach in the collaborative management of end-of-life care?

    <p>Holistic approach focusing on patient and family needs</p> Signup and view all the answers

    What are some of the respiratory changes at the end of life?

    <p>Cheyne-Stokes respiration</p> Signup and view all the answers

    Which of the following is a musculoskeletal change at the end of life?

    <p>Gradual loss of movement</p> Signup and view all the answers

    What is an integumentary change near death?

    <p>Mottling on extremities</p> Signup and view all the answers

    What is a neurological change at the end of life?

    <p>Brain arrest</p> Signup and view all the answers

    What is a psychosocial manifestation at the end of life?

    <p>Saying goodbyes</p> Signup and view all the answers

    What is essential for effective pain management at the end of life?

    <p>The total pain model</p> Signup and view all the answers

    What does the total pain model encompass?

    <p>Social, psychological, spiritual, and physical pain</p> Signup and view all the answers

    What does palliative sedation aim to relieve?

    <p>Intractable symptoms in the last days of life</p> Signup and view all the answers

    Why is opioid use at the end of life often misunderstood?

    <p>Adequate medication is crucial to relieve physical and emotional suffering</p> Signup and view all the answers

    What is an option for competent individuals over 16 years old at the end of life?

    <p>Organ and tissue donation</p> Signup and view all the answers

    What does nursing management at end of life focus on?

    <p>Holistic care, respecting dignity, managing physical and psychosocial needs</p> Signup and view all the answers

    What does the palliative approach to pain management involve?

    <p>Determining goals of care, comprehensive pain assessment, identifying causes, and implementing interventions</p> Signup and view all the answers

    What is nociceptive pain caused by?

    <p>Tissue damage</p> Signup and view all the answers

    What is a key principle of pain treatment?

    <p>Routine assessment</p> Signup and view all the answers

    What is the standard basis for comparison in equianalgesic dosing?

    <p>10 mg parenteral morphine</p> Signup and view all the answers

    What is the focus of scheduling analgesics?

    <p>Prevention or control without waiting for severe pain</p> Signup and view all the answers

    What is the main focus of physical care in end-of-life care?

    <p>Symptom management and comfort</p> Signup and view all the answers

    What is a specific fear of dying clients mentioned in the text?

    <p>Loneliness and abandonment</p> Signup and view all the answers

    What does psychosocial care involve in end-of-life care?

    <p>Managing anxiety and depression</p> Signup and view all the answers

    What is the main focus of coordination of care in end-of-life care?

    <p>Client's needs, family and significant others' needs</p> Signup and view all the answers

    What is a key aspect of communication in end-of-life care?

    <p>Therapeutic communication</p> Signup and view all the answers

    What does high-quality nursing response involve in end-of-life care?

    <p>Providing comfort and support</p> Signup and view all the answers

    What is a key aspect of end-of-life care evaluation?

    <p>Evaluation of level of consciousness</p> Signup and view all the answers

    What is a key component of drug therapy for pain management?

    <p>Nonopioids, opioids, and co-analgesic or adjuvant drugs</p> Signup and view all the answers

    What is the purpose of advance care planning?

    <p>To help clients think about and communicate their future health and personal care wishes</p> Signup and view all the answers

    What are the two types of advance directives used in end-of-life care?

    <p>Healthcare proxy and power of attorney for personal care</p> Signup and view all the answers

    What is the purpose of the Palliative Performance Scale (PPS)?

    <p>To assess functional performance</p> Signup and view all the answers

    How is death defined in the context of end-of-life care?

    <p>The irreversible cessation of circulatory, respiratory, and brain functions</p> Signup and view all the answers

    What are some sensory changes at the end of life?

    <p>Blurring of vision and decreased sensation and perception of pain and touch</p> Signup and view all the answers

    What are some cardiovascular changes at the end of life?

    <p>Increase in heart rate, irregular rhythm, and delayed absorption of drugs administered intramuscularly or subcutaneously</p> Signup and view all the answers

    What is the sequence of the body's gradual shutdown at the end of life?

    <p>Respirations cease first, followed by the brain stopping</p> Signup and view all the answers

    What is the main focus of nursing care at end of life?

    <p>Disease management and physical care</p> Signup and view all the answers

    What is the purpose of the Edmonton Symptom Assessment System?

    <p>To assess symptom severity over time</p> Signup and view all the answers

    What is the role of nurses in end-of-life care assessment?

    <p>To complete comprehensive assessments covering various aspects including end-of-life care and loss/grief</p> Signup and view all the answers

    What is the primary purpose of advance directives in end-of-life care?

    <p>To help clients communicate their future health and personal care wishes</p> Signup and view all the answers

    What is the purpose of using validated tools in end-of-life care?

    <p>To identify individuals reaching end of life and consider signs and symptoms</p> Signup and view all the answers

    What is the recommended initial approach for relieving mild pain?

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

    What is the main concern with opioid use?

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

    When should pain be reassessed after administering an immediate release PO analgesic?

    <p>30 minutes</p> Signup and view all the answers

    What is the aim of palliative care in relation to death?

    <p>To neither hasten nor postpone death</p> Signup and view all the answers

    What is the main focus of hospice care?

    <p>Improving the quality of life in the last months of life</p> Signup and view all the answers

    What is the primary goal of palliative care?

    <p>Provide relief from symptoms, including pain</p> Signup and view all the answers

    Which of the following is a psychosocial manifestation at the end of life?

    <p>Altered decision making</p> Signup and view all the answers

    What is the palliative approach to pain management primarily involve?

    <p>Determining goals of care</p> Signup and view all the answers

    What is the main focus of nursing management at end of life?

    <p>Holistic care</p> Signup and view all the answers

    What are the two types of advance directives used in end-of-life care?

    <p>Instructional directives and proxy directives</p> Signup and view all the answers

    What is the purpose of the Palliative Performance Scale (PPS)?

    <p>Measuring functional performance</p> Signup and view all the answers

    What is the metabolic changes result in at the end of life?

    <p>The body gradually slowing down until all functions cease</p> Signup and view all the answers

    What is the main focus of coordination of care in end-of-life care?

    <p>Addressing the client's needs, family and significant others' needs, education, counseling, advocacy, and support</p> Signup and view all the answers

    What is nociceptive pain caused by?

    <p>Tissue damage</p> Signup and view all the answers

    What is the standard basis for comparison in equianalgesic dosing?

    <p>10 mg parenteral morphine</p> Signup and view all the answers

    What is the recommended intervention to prevent constipation associated with opioid use?

    <p>Encourage fiber intake and ambulation</p> Signup and view all the answers

    What is the primary intervention for dysphagia/anorexia/N&V?

    <p>Frequent oral care and identify least invasive routes of drug administration</p> Signup and view all the answers

    What is the recommended approach for managing restlessness?

    <p>Don’t restrain, provide soothing environment, and limit stimuli</p> Signup and view all the answers

    How should dehydration be managed?

    <p>Provide oral care and prevent drying mucous membranes</p> Signup and view all the answers

    What is the recommended approach for managing weakness and fatigue?

    <p>Time care to conserve energy, frequent rest, and risk for falls</p> Signup and view all the answers

    What is involved in the pronouncement of death?

    <p>Confirming patient ID, assessing absence of vital signs, and documenting findings</p> Signup and view all the answers

    What does Medical Assistance in Dying (MAID) involve?

    <p>Administering medication to cause death at the client's request</p> Signup and view all the answers

    What is the role of Registered Nurses (RNs) in Medical Assistance in Dying (MAID)?

    <p>Participate by providing care and support but cannot administer the medication</p> Signup and view all the answers

    What does conscientious objection allow nurses to do in relation to MAID?

    <p>Refrain from participating in MAID based on personal beliefs</p> Signup and view all the answers

    What is the requirement for certifying death and completing the death certificate?

    <p>A physician or coroner</p> Signup and view all the answers

    What is a requirement for a client to be eligible for Medical Assistance in Dying (MAID) in Canada?

    <p>Having a grievous and irremediable medical condition causing intolerable suffering</p> Signup and view all the answers

    What is the waiting period between a client's request for MAID and the provision of MAID, unless death or loss of capacity is imminent?

    <p>10 days</p> Signup and view all the answers

    Who serves as the substitute decision-maker of last resort in the absence of other Substitute Decision Makers (SDMs) or in case of disagreement between equally ranked substitutes?

    <p>The Public Guardian and Trustee (PGT)</p> Signup and view all the answers

    What is required for any treatment except in emergency situations?

    <p>Written consent</p> Signup and view all the answers

    Who can make treatment decisions for incapable individuals in the absence of Substitute Decision Makers (SDMs) or in case of disagreement between equally ranked substitutes?

    <p>The Public Guardian and Trustee (PGT)</p> Signup and view all the answers

    Study Notes

    End-of-Life Care: Comprehensive Approach for Dying Clients

    • End-of-life care involves evaluation of level of consciousness, reflexes, pupil responses, circulation changes, vital signs, skin color, temperature, respiratory status, nutritional and fluid intake, urinary output, bowel functioning, skin condition, and fragility.
    • Coordination of care focuses on the client's needs, family and significant others' needs, education, counseling, advocacy, and support.
    • Psychosocial care involves managing anxiety and depression through pharmacological and nonpharmacological interventions.
    • Specific fears of dying clients include pain, shortness of breath, loneliness and abandonment, and meaninglessness, which can be addressed through encouragement, support, and education.
    • High-quality nursing responses involve providing comfort and support, such as holding hands, touching, and listening, to allow the dying person a sense of security.
    • Communication in end-of-life care involves therapeutic communication, empathy, active listening, and respecting rituals associated with the client's life review without judgment.
    • Physical care prioritizes symptom management and comfort, meeting physiological and safety needs, including oxygen, nutrition, pain relief, mobility, elimination, and skin care.
    • Pain treatment principles emphasize routine assessment, self-report of pain, and involving patients, families, and health professionals in pain management.
    • Nociceptive pain is caused by tissue damage, while neuropathic pain is caused by nerve cell damage or changes in spinal cord processing, and it is difficult to treat.
    • Drug therapy for pain management includes nonopioids, opioids, and co-analgesic or adjuvant drugs, with a focus on prevention or control without waiting for severe pain.
    • Equianalgesic doses are important for substituting one analgesic for another, and pain medications are generally divided into nonopioids, opioids, and co-analgesic or adjuvant drugs.
    • Scheduling analgesics should focus on prevention or control without waiting for severe pain, and 10 mg parenteral morphine is the standard basis for comparison in equianalgesic dosing.

    End-of-Life Care and Advance Care Planning

    • Advance care planning involves clients thinking about and sharing their wishes for future health and personal care.
    • Advance directives are legal documents used in end-of-life care, including instructional directives (living wills or treatment directives) and proxy directives (power of attorney for personal care).
    • Nursing care at end of life involves advocacy, recognizing when a person is reaching their last days, and managing the complex situation surrounding end-of-life care.
    • Nurses complete comprehensive assessments of patients and families, covering disease management, physical, psychological, spiritual, social, practical, end-of-life care, and loss/grief.
    • Nurses use clinical expertise and validated tools to identify individuals reaching end of life, considering signs and symptoms such as progressive weakness and changes in breathing pattern.
    • The Palliative Performance Scale (PPS) is a tool for measuring functional performance, and the Edmonton Symptom Assessment System assesses symptom severity over time.
    • Death is defined as the irreversible cessation of circulatory and respiratory function or the irreversible cessation of all functions of the entire brain, including the brainstem.
    • Physical manifestations at the end of life include alterations in interpretation of sensory input, loss of appetite, and gradual decrease in urine output.
    • Sensory changes at the end of life include blurring of vision, sinking and glazing of eyes, and decreased sensation and perception of pain and touch.
    • Cardiovascular changes at the end of life include an increase in heart rate, irregular rhythm, and a delayed absorption of drugs administered intramuscularly or subcutaneously.
    • The metabolic changes at the end of life result in the body gradually slowing down until all functions cease, with respirations ceasing first, followed by the heart stopping.
    • Trauma and disease can affect physical manifestations at the end of life, with gradual changes in various bodily systems and functions.

    End-of-Life Care: Comprehensive Approach for Dying Clients

    • End-of-life care involves evaluation of level of consciousness, reflexes, pupil responses, circulation changes, vital signs, skin color, temperature, respiratory status, nutritional and fluid intake, urinary output, bowel functioning, skin condition, and fragility.
    • Coordination of care focuses on the client's needs, family and significant others' needs, education, counseling, advocacy, and support.
    • Psychosocial care involves managing anxiety and depression through pharmacological and nonpharmacological interventions.
    • Specific fears of dying clients include pain, shortness of breath, loneliness and abandonment, and meaninglessness, which can be addressed through encouragement, support, and education.
    • High-quality nursing responses involve providing comfort and support, such as holding hands, touching, and listening, to allow the dying person a sense of security.
    • Communication in end-of-life care involves therapeutic communication, empathy, active listening, and respecting rituals associated with the client's life review without judgment.
    • Physical care prioritizes symptom management and comfort, meeting physiological and safety needs, including oxygen, nutrition, pain relief, mobility, elimination, and skin care.
    • Pain treatment principles emphasize routine assessment, self-report of pain, and involving patients, families, and health professionals in pain management.
    • Nociceptive pain is caused by tissue damage, while neuropathic pain is caused by nerve cell damage or changes in spinal cord processing, and it is difficult to treat.
    • Drug therapy for pain management includes nonopioids, opioids, and co-analgesic or adjuvant drugs, with a focus on prevention or control without waiting for severe pain.
    • Equianalgesic doses are important for substituting one analgesic for another, and pain medications are generally divided into nonopioids, opioids, and co-analgesic or adjuvant drugs.
    • Scheduling analgesics should focus on prevention or control without waiting for severe pain, and 10 mg parenteral morphine is the standard basis for comparison in equianalgesic dosing.

    Medical Assistance in Dying (MAID) in Canada: Eligibility, Safeguards, and Consent

    • Nurses who conscientiously object must transfer care to another nurse until a replacement caregiver is found
    • MAID eligibility criteria includes being 18 years or older, capable of decision-making, and having a grievous and irremediable medical condition causing intolerable suffering
    • Clients must provide informed consent for MAID, be eligible for government-funded health services, and can withdraw consent at any time
    • Safeguards for MAID include written requests witnessed by individuals not related to the patient and a second opinion from a non-involved NP or physician
    • There is a 10-day waiting period between the client's request and the provision of MAID, unless death or loss of capacity is imminent
    • Nurses' goal during MAID provision is to provide comfort
    • The client must have the opportunity to withdraw the request for MAID and express consent before receiving medication
    • Report to the coroner if MAID results in death, and to Health Canada if the request was made but death did not occur
    • Informed consent is required for any treatment unless it's an emergency, and must be voluntary, informed, and relate to the specific treatment
    • There is no minimum age for consent, and capacity is determined by healthcare providers based on the ability to understand and appreciate consequences
    • Substitute Decision Makers (SDMs) can make treatment decisions for incapable individuals and include guardians, attorneys for personal care, and relatives in a specific hierarchy
    • The Public Guardian and Trustee (PGT) serves as the substitute decision-maker of last resort in the absence of other SDMs or in case of disagreement between equally ranked substitutes

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    Test your knowledge on comprehensive end-of-life care, including physical, psychosocial, and communication aspects, as well as medical assistance in dying (MAID) in Canada, covering eligibility, safeguards, and consent requirements.

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