NUR 2462C Chapter Notes - Chapter 1: Ageism, Advance Healthcare Directive, Unit

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Published on 8 Jun 2020
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SPC THREATS TO SELF-EXPRESSION
NUR2731/SELF-EXPRESSION 1 Fall, 2016
NUR 2731C - NURSING IV
UNIT I: THREATS TO SELF EXPRESSION
KEY TERMS
Advanced Directives- document that gives instructions about future medical care, tx. Gives power to a designated
person to make decisions on their behalf if they are unable to.
Ageism
Bereavement- period following the death of a loved one during which grief is experienced and mourning occurs.
End-of-Life- final phase of illness and death is imminent
Grief- normal reaction to loss. There are 5 stages (denial, anger, bargaining, depression and acceptance)
Health Care Surrogate- person designated to make health related decisions for the patient in the event they are
unable to.
Homebound Status- can leave home as needed for md visit but mainly is confined to the home
Home Health Care- cost effective alternative for homebound needs that are acute or imminent
Hospice- concept of care that provides compassion, concern and support for the dying.
Living Will- Document that allows a patient to decide what measures they want taken for their end of life care in the
event they r unable to communicate for themself
Loss
Medicare- federal funded health insurance for people 65 or older or 65 and younger with certain disabilities and
people with end stage kidney dz requiring dialysis or kidney transplant
Medicaid- state administered, need based program to assist eligible low income people
Mourning
Palliative Care- any form of care or tx that focuses on reducing the severity of dz symptoms, rather trying to delay
or reverse the progression of the disease itself or provide a cure
Patient Advocate
Power of Attorney
UNIT OBJECTIVES
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SPC THREATS TO SELF-EXPRESSION
NUR2731/SELF-EXPRESSION 2 Fall, 2016
1. Review governmental resources available for elder services.
2. Describe the factors influencing change in the healthcare system which have contributed to the shift from
hospital based care to home health care.
Health care reform, Skilled Nursing Care, Technology, Qualification for Home Care
3. Identify the types of services provided in home health care
IV antibiotics, new “Ostomy”, Wound Care, Home Chemo, Medication Management,
PICC Line Management, Foley, Rehab
4. Identify the eligibility requirements for home health services.
Must be homebound, approved by physician, requires skill of RN or RPT, skill is appro-
priate to diagnosis
5. Contrast the responsibilities between the members of the home health team.
RN coordinates care of team members like PT, ST and OT
6. Describe the meaning of the different types of advanced directives.
LIVING WILL- give instructions about care prior to pt being unable to communicate
HEALTH CARE POA- a designated person that will make healthcare related decisions on
a persons behalf in the event they cannot make informed decisions for their self
MEDICAL POA- a designated person that will make healthcare decisions in the event the
patient is unable to do so.
ADVANCE DIRECTIVE- patient wish to die without heroic or extraordinary measures
DNR- an order that states that if a person “codes” use of CPR or defibrillator will not be
used. Must be signed by a physician for it to be valid.
7. Differentiate between palliative care and end of life/hospice care.
PALLIATIVE- reduces severity of disease. Focus is aimed at relieving/preventing suffer-
ing
HOSPICE/EOL CARE- disease is not responsive to tx. Focus is to control pain and
symptoms. Reduce stress from family/patient.
8. Discuss the unique characteristics of end of life/hospice care for the dying and their significant others.
Focuses on the physical and psychosocial aspects of the family
9. Identify criteria for admission to Hospice care.
Requires MD order and has to have less than 6months to live
10. Describe the scope of services available to patients at Hospice.
Patient has the final say in all matters
11. Discuss barriers regarding hospice care.
Choices for organ and tissue donations, advance directives, resuscitation, mechanical
ventilation and feeding tube placement
12. Summarize the physical and psychosocial manifestations of approaching death.
Physical Care- Delirium, Dehydration, Dyspnea, Dysphagia, Pain and Symptom Control,
Restlessness
Psychosocial- Withdrawal, Peacefulness, Saying Goodbyes, Unusual Communication,
Fear of loneliness, Anxiety, Altered Decision Making
13. Identify ways the nurse can assist the client in managing physical symptoms at end of life.
Assessing respiratory changes, integumentary changes. Gi/gu changesand cardiovascu-
lar changes administration of pain to relieve discomfort
14. Analyze the spiritual needs of the dying patient and their families.
Many turn to religion because it may provide order to the world in presence of a physical
decline, social loss, siuffering and impending death. Spirtuality gives the patient possible
beliefs about a higher power, their journey through life, and an afterlife.
15. Explain the stages of grief and bereavement at the end of life.
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SPC THREATS TO SELF-EXPRESSION
NUR2731/SELF-EXPRESSION 3 Fall, 2016
i) Stages of Grief:
ii) Denial- denies loss has taken place and may withdraw
iii) , Anger- may be angry at self for not being able to prevent death or at person for leaving them
iv) Bargaining- may try to bargain with god
v) , Depression- feels numb, although anger and sadness may remain underneath
vi) , Acceptance- anger, mourning and sadness may have tapered off. Accepts reality of loss
vii) Bereavement is an individual’s response to the loss of a significant person
16. Analyze ways the RN can assist the client and family in coping with suffering, grief, loss, dying, and be-
reavement.
Being a constant support person for the patient and family by offering self.
17. Assess the importance of client culture/ethnicity when planning/providing/evaluating care.
Many patients from different cultural backgrounds have religious beliefs. Ask the
patient and family their wishes prior to providing care.
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