study guide #2 (brief)

1. Discuss the legal implications of death and dying. (End-of-Life Lecture)
-Dying Person’s Bill of Rights
-Advanced Directives
-DNR Status
-Durable Power of Attorney/Living Will

2. Discuss therapeutic communication when caring for the dying patient. (End-of-Life Lecture)
-be direct and avoid false reassurances
-Hospice says, “Do you know you are dying?”

3. Discuss the types of grief and grief responses. (P/P: Ch. 30, pp. 463, 465-467)
-normal grief
-complicated grief: prolonged and difficult time moving forward
-anticipatory grief: “letting go” before death even occurs
-disenfranchised grief: unsupported grief which is not openly acknowledged
*grief responses vary depending on:
-developmental stage
-personal relationship
-nature of loss
-coping strategies
-socioeconomic status
-culture/ethnicity
-spiritual/religious beliefs
-hope

4. Discuss the concerns of the dying patient. (End-of-Life Lecture)
-arrange a variety of affairs
-cope with loss of loved ones and own death
-future medical needs
-plan for future

5. Discuss the interventions needed to assist the patients to die with dignity. (P/P, Ch. 30, pg. 475)
-treat patient as a whole being rather than a patient will an illness
-encourage conversation about patient’s life experience
-maintain personal hygiene and appearance
-be respectful: address by title

6. Explain the purpose of Hospice care. (P/P: Ch. 30, pp. 478-479)
-provides end-of-life support for patient and familiy
-priority to managing pain and symptoms, comfort, quality of life, and other needs for the patient with less than 6 months to live

7. Discuss the concepts of pain and pain management. (Pain Lecture)
-follow assessment principles
-patient centered
-drug and non-drug therapies
-collaborative care

8. Discuss ethical considerations for the terminal patient. (End-of-Life Lecture)
-Euthanasia/Assissted Suicide
-Organ Donations

9. Discuss the nursing interventions for the patient receiving chemotherapy or radiation treatment. (Cancer Lecture)
-adequate moisturizing
-ambulate/turn
-cough/deep breathe or incentive spirometer
-alternate resting and active periods
-make sure antiemetics are ordered
-therapeutic communication
-protective isolation: avoid crowds
-be aware of food preferences

10. Discuss the relevant assessment data needed for the terminal patient on pain medication. (P/P: Ch. 30, pp. 1078, 1080)
-monitor breakthrough pain

11. Differentiate between the assessment needed for the patient in acute and chronic pain. (Pain Management Lecture)
-based on cause, course, manifestation, and treatment

12. Describe the different types of pain. (P/P: Ch. 43, pp. 1055-1056)
-acute/transient pain: can identify cause, short term, limited tissue damage and emotional response
-chronic/persistent pain: lasts longer than anticipated, not always an identifiable cause, great personal suffering
-chronic episodic pain: sporadic pain over an extended period of time
-cancer pain: usually related to tumor progression or treatment of cancer
-pain by inferred pathological process: musculoskeletal, internal organ, or neuropathic pain
-idiopathic pain: no identifiable physical or psychological cause for chronic pain

13. Discuss the education needed for the patient on opioid medication. (Pain Management Lecture)
-low risk of addiction when treating pain

14. Discuss the nursing diagnoses relevant to grief. (P/P, Ch. 30, pg. 470)
-death anxiety
-compromised family coping
-ineffective denial
-complicated grieving
-hopelessness
-spiritual distress

15. Discuss goals/outcomes for patients in chronic pain. (Pain Management Lecture)
-sometimes the best thing is to decrease pain level
-describe experience in order to treat
-identify goal for therapy and resources for self-management
-prevent pain whenever possible
-will require only oral analgesics for pain
-reports pain of <3 on a scale of 1-10 after PCA use

16. Discuss the safety precaution education needed for patients receiving chemotherapy. (Cancer Lecture)
-radiation source being used
-method of administration
-start of treatment
-length of treatment
-prescribed nursing precautions: protective gear and isolation
-avoid crowds
-do not allow small children to sit on lap
-cough and deep breathe
-moisturize
-ambulate/turn
-alternate resting and active periods

17. Discuss the use of the pain diary in pain management. (Pain Management Lecture)
-helps both nurse and patient identify pain patterns and causative factors

18. Discuss titration in pain management. (Pain Management Lecture)
*adjusting dose or using the smallest dose possible:
-based on assessment of analgesic effect
-to provide effective pain control
-working with patient to decide the optimal analgesic dosage required
**to minimize side effects

19. Discuss the nursing care for the patient using PCA or continuous opioid analgesia. (P/P: Ch. 30, pg. 1076)
-monitor dosing and dosage rate
-teach patient how to use PCA and instruct visitors not to tamper with it
-monitor vital signs

20. Discuss nursing diagnoses relevant for patients with terminal disease. (P/P: Ch. 30, pg. 470)
-death anxiety
-caregiver role strain
-compromised family coping
-readiness for enhanced comfort
-disturbed personal identity
-ineffective denial
-fear
-hopelessness
-spiritual distress
-readiness for enhanced spiritual well-being

21. Discuss risk factors for cancer and the education needed. (Cancer Lecture)
-diet, health history
-ethnicity
-lifestyle
-genetics
-environment
*encourage diet high in fiber, low in fat
*note and report (as they may be early signs of cancer):
C-changes in bowels or bladder
A-a lesion that does not heal
U-unusual bleeding or discharge
I-indigestion or difficulty swallowing
O-obvious changes in wart of mole
N-nagging cough or persistant hoarseness

22. Dosage and Calculations:
-microdrops: 60 gtt/ml
-macrodrops: 10, 15, or 20 gtt/ml