End-of-Life Care and Palliative Nursing

-cardio: refractory hypotension, weak pulse, cool mottled skin
-resp: cheyne-stokes RR, death rattle
-neuro: confusion, restless, unresponsive

-GI and GU: decreased appetite, dysphagia, decreased urine
-senses: blurry vision, hearing last to go

-IV benzos (ativan) for anxiety, IV morphine for dyspnea and pain
-reposition, good hygiene, chaplain

-No. once CPR is started you cant stop until ROSC or death, even if a DNR is found

-what: comfort + seeking cure; relief of symptoms and pain at ANY stage of disease
-goal: improve quality of life

-what: patients in final stages of terminal illness (about 6mo)
-focus: comfort, dignity, quality of life (not cure)

-what: DH Form 1896; doesn't expire unless revoked (allowed at any time-verbal, physical, written); seperate from AD and living will
-form criteria: must be on a yellow paper, signed by patient or authorized surrogate or agent AND provider

-court appointed guardian-> spouse (even when seperated)-> children above 18 (majority vote)-> parents-> siblings (majority vote)-> adult relative (exhibited care and close contact)-> close friend-> court appointed clinical social worker (if no family)

-no

-not initiating

-what: discontinuation of life-sustaining therapy in a terminally ill patient
-terminal weaning: withdrawing ventilator (titrate pain meds and sedation during)
-process: given IV morphine and ativan before extubation-> all except comfort meds are discontinued-> tube feeds shut off

-1 of the following: terminal condition, end stage condition, persistent vegetative state
-supported by clear and convincing evidence aligning with patient's best interest
-2 physcians must do independent reviews of chart and conclude that patient has life-limiting illness
-1 places DNR order -> both write note attesting poor prognosis and withdrawal is appropriate

-autonomy: right to make decisions about own care
-beneficience: nurses and providers must act in patient's best interest
-nonmaleficence: 'do no harm', avoid prolonging suffering if treatment isn't beneficial
-justice: ensure fair and equitable care, respect patient values
-veracity and fidelity: be honest, keep promises, maintain trust

-what: full disclosure of dx, prupose of tx, risk and benefits, alternatives
-nurse role: witness signature and ensure patient understands the info
-implied: when immediate tx is needed to save life or prevent serious harm

-sustain life temporarily while condition is being treated or improved

-quantitative: likelihood of success extremely low
-qualitative: tx may work physically but wont result in meaningful quality of life or recovery