End of Life (Palliative Care)

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