Palliative care→ aims to prevent and relieve suffering and support the best possible QOL for pt and their family; regardless of stage of disease..just must be symptomatic
­can be given with curative care
­introducing palliative care early ^ QOL
­interdisciplinary approach
CLOSED AWARENESS – PT. doesn’t know
SUSPECTED AWARENESS – they know something is wrong but no one tells them
MUTUAL PRETENSE AWARENESS – both the PT. & family knows but no one is talking about it
OPEN AWARENESS – everyone knows & is talking about it. *Best option*

Barriers to palliative care: pt/family concerns; denial; awareness of prognosis; understanding tx goals; cost; assisted suicide Hospice→ must have prognosis of 6 mo or less; includes palliative care; interdisciplinary(nurse, SW, chaplain, MD, aide, volunteer, PT/OT); pt/family=unit; bereavement services required
­medicare hospice benefit covers cost
­chronic, end stage diseases dont have 6 mo or less prognosis; based off labs
Barriers
to hospice: difficulty in making terminal prognosis; hospice associated with death; curative tx advancing; financial pressure; seen as giving up
Barriers
to communication: fear of mortality; lack of experience; avoiding emotions; insensitive; guilt; maintaining hope; fear of unknown; disagreement; lack of understanding culture/goals; roles; personal grief issues; ethical Approach to hospice/EOL→ interdisciplinary team is used to care for pt and family
Most distressing and feared by terminally ill→ difficulty breathing
EOL interventions the nurse must be prepared to perform→ allow family to verbalize fears/concerns; listen/acknowledge legitimacy of family’s plan; assist pt/family in reminiscing; determine spiritual needs
What intervention must nurse prepare for when pt is deteriorating→ determine pain, provide analgesics and make pt comfortable Most common tx for terminally ill→ opiods
Always ask family if they want time alone with the dead client
Pt forms pressure ulcer, family wants it treated, client says it doesn’t bother her what does the nurse do→ explain clients desire to the family; assure patient will be as comfortable as possible
What symptoms take highest priority with a dying pt→ pain, agitation and dyspnea
(other symptoms seen are delirium and anorexia/cachexia) EOL stages:
1.Decline­ drop in ADLS
2.Transitioning­ sleep more; limited eating
3.Actively dying­ comatose; breathing changes
Managing symptoms→ pt goals; NOT medical team goals
→ pharm: low dose morphine; steroids for dyspnea; benzos for anxiety
­­ nonopoids: acetaminophen(pain/fever; high dose can affect liver fuction; use cautiously with older adults)
NSAIDS[advil/celebrex/toradol](controversy w/ long term use; ^ in cardiovascular events; consider costs; toxicity)
­­opioids[morphine/hydromorphone/fentanyl/methadone/meperidine/codeine/hydrocodone/oxycodone](resp
depression; constipation; sedation; urinary retendion; n/v; pruritus) need bowel regimen in place
­­corticosteroids(can reduce pain; ^ appetite; proximal muscle wasting; admin in AM)
→ nonpharm: guided relac; reiki for anxiety r/t dyspnea; hypnotism; massage; music
Treating Dyspnea
→ sit upright; decrease anxiety; treat underlying pathology
(inhalers/nebulizers/corticosteroids/diuretics); alter perception of breathlessness(morphine/fan blowing across face/O2); conserve energy)

Treating Delirium
: causes[fullbladder/constipation/hypoxia/dyspnea/HF/pain/denial/PTSD] treat cause; antipsychotics(Haldol/Thorazine) Cachexia→ severe muscle wasting and irreversible
• Artificial Nutrition/Hydration
• Attempts at maintaining body weight are not reasonable or achievable goals.
• Hydration may have benefit w/ conscious, ambulatory PT.
• Fluid overload & aspiration is often caused at EOL by artificial nutrition/hydration.
• DO NOT force food or fluids.
• Anorexia may result in ketosis, leading to a peaceful state of mind & decreased pain
S/SX of ACTIVELY DYING
• Changes