End of Life Communication Collaboration .


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End of Life Correspondence and Coordinated effort. "Consideration of the Effectively Kicking the bucket" Cheryl Vahl MSN AOCN ACHPN Adjusted from Clinical Audit for the Hospice and Palliative Attendant. Program Goals. Depict palliative consideration, hospice care, and end of life consideration
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End of Life Communication & Collaboration "Care of the Actively Dying" Cheryl Vahl MSN AOCN ACHPN Adapted from Clinical Review for the Hospice and Palliative Nurse

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Program Objectives Describe palliative care, hospice care, and end of life care Identify end of life side effects and administration alternatives Identify administrative, institutional and individual hindrances affecting palliative care and end of life care Discuss the referral of patients to group palliative and end of life care and bolster administrations Describe the way toward working with patients and families to characterize objectives of care and utilization of cutting edge orders Examine approaches to team up with hospice mind suppliers inside long haul mind office settings Iowa Cancer Consortium & C-Change

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Identifying the Dying Patient Progressive, serious, interminable restorative condition Progressive sickness that no longer reacts to life-delaying medicines Heart disappointment or COPD Metastatic tumor Chronic yearning pneumonia Progressive decrease in useful capacity Psychological acknowledgment of impending passing CAPC: A Guide to Building a Hospital-based Palliative Care Program, 2004. Iowa Cancer Consortium & C-Change

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Identifying the Dying Patient Syndrome of Imminent Death Early Stage - bedbound, loss of intrigue/capacity to eat/drink; intellectual changes; either hypo/hyperactive wooziness, or sedation Mid Stage - additionally decrease in mental status (obtunded); \'final breath\' or powerlessness to oversee oral discharges; fever Late Stage - trance like state, cool furthest points, modified respiratory example; fever Time Course - shifts from under 24hrs to 14days; hard to foresee time course; family trouble as patient "waits." CAPC: A Guide to Building a Hospital-based Palliative Care Program, 2004. Iowa Cancer Consortium & C-Change

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Ensuring Good Care Make condition agreeable Attentiveness, empathy and concern Avoid oppressive care Respect values Working as a group Encourage family to be with, touch, address the patient; bolster them as expected to do this Iowa Cancer Consortium & C-Change

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Self-decided Needs & Goals Assist persistent in meeting end-of-life objectives Who? What? Where? Iowa Cancer Consortium & C-Change

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Cultural Influences Determine convictions and qualities Respect need to "bite the dust on his or her own terms" Never force claim convictions Avoid judging how relatives adapt Iowa Cancer Consortium & C-Change

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Family Needs Do patient\'s and family\'s objectives struggle? Is there incomplete business? Advance patient – family correspondence Reassess tolerant objectives and needs Iowa Cancer Consortium & C-Change

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Assist Patients & Family in "Reframing Hope" Hope may start with seek after a cure, however can develop into numerous things as patient and family objectives change There are numerous aspects to trust. It\'s the longing and the desire that something is reachable Caution to not to advance "false expectation" Iowa Cancer Consortium & C-Change

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Care Environment - Physical Environment "Hallowed space" Objects and perspectives Lighting Sound Family space Iowa Cancer Consortium & C-Change

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Care Environment - Staff practices and dispositions Privacy and bolster Sit, tune in, pass on sympathy, concern Importance of nearness Model conduct Iowa Cancer Consortium & C-Change

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Symptom Management Anticipate the patient\'s decrease Reduce polypharmacy Change medicine courses Plan to oversee "Expected Symptoms" Pain, dyspnea, incoherence, emissions Iowa Cancer Consortium & C-Change

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Plan to bolster Family Offer Spiritual, Cultural, Psychosocial Support Teach the signposts of Dying Process Provide Educational materials Iowa Cancer Consortium & C-Change

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Physical Comfort - Pain Patient\'s need; regularly biggest dread Handle tenderly with deference Signs of uneasiness in the non-verbal patient Iowa Cancer Consortium & C-Change

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Patient with huge agony, entering last days Assume torment will keep on being available until death Do not end torment meds as mental status decays Dose diminishment might be considered in liver & renal disappointment (particularly when there is no pee yield) Use nonverbal pointers of torment to judge pain relieving needs Iowa Cancer Consortium & C-Change

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Patient without noteworthy torment, entering last days New extreme torment because of kicking the bucket procedure is far-fetched Discomfort from stability can happen Trial of analgesics for suspected torment Iowa Cancer Consortium & C-Change

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Agitation - Delirium Types Reversible physical causes Emotional or otherworldly causes Non-verbal indications of inconvenience Provide quiet calm condition Minimize rest interferences Medications if upset Neuroleptics (haldol) Benzodiazepines (ativan) Iowa Cancer Consortium & C-Change

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Dyspnea "I can\'t get my breath" Different from Tachypnea (quick breathing) or Apnea (delays in breathing) Medications for view of windedness Morphine Lorazepam (Ativan ® ) Environment Change position Fan Iowa Cancer Consortium & C-Change

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Noisy Respirations "Final breath" Caused by unwinding of throat muscles and pooling of discharges Environment Reposition Minimize liquids Medications Scopolamine fix; Atropine drops; Glycopyrrolate Avoid profound suctioning Iowa Cancer Consortium & C-Change

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Nutrition/Hydration Provide family bolster when patients stop or can\'t eat by mouth Small tastes for cognizant patients who express Hunger or Thirst Avoid liquid over-burden Tube feedings – don\'t start or proceed with Dehydration may give comfort Mouth mind Iowa Cancer Consortium & C-Change

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IV Fluids Increased distress because of Repeated venipunctures Iatrogenic contaminations Worsening of edema Increasing respiratory emissions Iowa Cancer Consortium & C-Change

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Elimination Management Absorbent cushion/grown-up assurance Moisture hindrance Indwelling catheter Assess for hidden reasons for fecal incontinence Iowa Cancer Consortium & C-Change

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Skin Integrity & Loss of Mobility Reposition as often as possible Medicate preceding development Special beddings before decay Iowa Cancer Consortium & C-Change

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Terminal, Palliative, or Respite Sedation? What is the "purpose"? Utilization of narcotic to give help of hard-headed and deplorable manifestations toward the finish of life "Time restricted trial" Not killing Indicated in <2% of patients Iowa Cancer Consortium & C-Change

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Psychosocial Support for Patient Allow control Maintain pride Fears of obscure, relinquishment, troubling Communication Iowa Cancer Consortium & C-Change

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Psychosocial Support for Family Listen Allow control Determine who is the leader Respect inclinations Address concerns Iowa Cancer Consortium & C-Change

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Grieving Emotional reactions to misfortune Types Anticipatory Disenfranchised Public Normal versus Confused Iowa Cancer Consortium & C-Change

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Risk Factors for Complicated Grieving Enmeshed connections Multiple misfortunes Child\'s loss of a parent Death of a kid Substance manhandle Iowa Cancer Consortium & C-Change

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Grief Interventions Education and arrangement Keep family educated Provide data Prepare family for death Allow family to take an interest in caregiving Permission to take breaks or leave Iowa Cancer Consortium & C-Change

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Grief Coaching Encourage correspondence with patient Saying farewell Provide assets for deprivation bolster A "decent passing" is miserable, yet ideally will facilitate their misery Iowa Cancer Consortium & C-Change

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Spiritual Needs Suffering, which means, and expectation Cultural impacts Clergy bolster Patient-family strife of qualities/convictions Unresolved issues/connections Iowa Cancer Consortium & C-Change

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Spiritual Needs Intervention Chaplain/Clergy Goal fulfillment Forgiveness Permission to bite the dust Iowa Cancer Consortium & C-Change

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Request to Hasten Death Origin of anguish Physical or existential Who is enduring? Sympathetic, non-judgmental reaction Elicit group for bolster Iowa Cancer Consortium & C-Change

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Other Issues of Dying Final rally Symbolic dialect Visions Dying alone Iowa Cancer Consortium & C-Change

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Signs of Imminent Death Changes in mentation Loss of eyelash reflex Changes in breathing examples Decreased urinary yield Cooling and mottling of furthest points Iowa Cancer Consortium & C-Change

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The Death Event Signs of death Rituals and family bolster Post-mortem mind Iowa Cancer Consortium & C-Change

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Professional Coping Importance of self care View of passing on Personal feeling about patients who pass on Recognize limits Iowa Cancer Consortium & C-Change

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Conclusion Assist patient to meet objectives Individualize nature Anticipate side effect administration Anticipate otherworldly care needs Facilitate lamenting Recognize significance of self care Iowa Cancer Consortium & C-Change

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References Bednash G, Ferrell B. End-of-life Nursing Education Consortium (ELNEC) . Washington, DC: Association of Colleges of Nursing; 2005. Wagner B, Ersek M, Riddell S. Counterfeit Nutrition and Hydration Position Statement . Pittsburgh, PA: Hospice and Palliative Nurses Association; 2003. Corless IB. Mourning. In: Ferrell BR, Coyle N, eds. Course book of Palliative Nursing . second ed. New York, NY: Oxford University Press, 2006:531-544. Emanual L, von Gunten CF, Ferris FD, eds. The Education for Physicians on End-of-Life Care (EPEC) Curriculum . The EPEC Project, The Robert Wood Johnson, Foundation, 1999. Berry P, Griffie J. Getting ready for the real passing. In: Ferrel

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