NURS 443 Lecture Notes - Lecture 8: Duodenum, Chronic Pancreatitis, Endoscopic Retrograde Cholangiopancreatography
End of Life (EOL)
Book Notes
A. End of life in general
1. Definition
1. Term used for issues and services related to death and dying. It focuses on the
eeds for patiets ad the patiet’s faily
2. Lifetime risk of dying is always 100%:
i. Heart disease, cancer, alzheier’s, diaetes, parkiso’s i that order
2. Goal
1. (1) provide comfort and supportive care during dying process, (2) improve quality of
pt’s reaiig life, help esure a digified death, proide eotioal support
to family
3. Manifestations (table 10-2 pg. 143)
1. Fatigued, anorexic, decreased salivation
2. Metabolism reduces and body gradually slows down until function ends
3. Respiratory: rapid or slow, shallow, and irregular. Sounds may become wet and
noisy, both audibly and on auscultation also known as death rattle. Cheyne-Stokes is
a common breathing pattern, alternating periods of apnea and deep/ rapid
breathing.
4. Grieving process may also occur
4. Palliation/ Hospice Care
1. Palliative- covers all of the treatments for focus on care as opposed to cure. Key
point is comfort.
2. Hospice- type of palliative care. Need to have 6 months or less to live and everyone
has to agree to stop curative treatment
3. PPS (palliative performance scale) determines how soon you will die
5. Kubler-Ross’ Stages of grief & Erikso’s stages of deelopet
1. Shock and denial, anger, depression, bargaining, acceptance.
i. No right way, everyone goes through the stages in different steps
2. Ego Integrity vs. Despair (65- death)
i. Adjusts to life changes and losses. Finds order, meaning, and value in life as it
is and was. Positive resolution results in wisdom.
6. Spiritual needs
1. Defined as those beliefs, values, and practices that relate to the search for
existential meaning and purpose.
2. Assess the pt’s ad the faily preferees related to spiritual guidae or pastoral
care services and make appropriate referrals
7. Cultural competent Care
1. African Americans and Hispanics typically express their feelings and emotions
2. African Americans use hospice care less often because they value the idea of
toughess
3. Hispanics usually have spouses or daughters involved in decisions regarding
palliative and hospice care
4. Jewish believe that spirit should not be alone when it leaves the body therefore they
have someone with the body at all times. They also believe that all body tissues
must be buried w/ the individual
5. Puerto Ria’s ay at to hug ad kiss the ody to say goodye
8. Culture and burial needs
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1. Hiduis typially reate the ody’s
2. Judaism- all body parts must be returned if autopsy is performed in order for proper
burial
9. Legal and Ethics (Table 10-6 pg. 146)
1. Organ and tissue donation- the decision to donate organs or to provide anatomic
gifts may be made by a person before death or by immediate family after death.
Family permission must be obtained at the time of donation. Doctor must be
notified immediately that organ donation is intended.
2. Advanced directive- documents that give instruction about future medical care and
treatments and who should make the decisions in the event the person in unable to
communicate
3. Do not Resuscitate- ritte physiia’s order istrutig health are proiders ot
to attempt CPR
4. Durable/ medical power of attorney- term used by some states to describe a
document used for listing the person(s) to make health care decisions should a pt
become unable to make informed decisions for self
5. Living will- term used to describe any documents that give instruction about future
medical care and treatments or the wish to be allowed to die without heroic or
extraordinary measures should the pt. be unable to communicate
B. Senescence (aging)
1. People fear dying alone or in pain. Dying is harder for the young as opposed to elderly.
2. Spiritual attachment is important at this time.
C. Persistent vegetative state
1. Definition
1. Pts. Heart will still be beating and can still breathe w/ support
2. All brain function must cease for brain death to be pronounced and life support to
be disconnected
3. In some states or under specific circumstances, a registered nurse can legally permit
to pronounce death
2. Nursing considerations
1. Pt. does not recover. There is no chance of recovery and typically left alive with
artificial machines
D. Amyotrophic Lateral Sclerosis (ALS)
1. Patho: rare progressive neuro disorder and muscle atrophy characterized by loss of motor
neurons. The spread into all muscle groups is the defining characteristic of ALS
1. Typically die w/I 2-6 yrs of diagnosis due to respiratory tract infection/ failure
2. Typical in 40-70 yrs of age, more common in women, and also known as the Lou
Gehrig’s disease
2. Risks
1. Genetic defect (chromosome 21), typical in Guam, programmed cell death
3. S&S
1. Limb weakness, dysarthria, dysphagia, muscle wasting (atrophy/amyotrophy) ,
lateral sclerosis (demyelination followed by hardening of the spinal column), and
fasciculation of tongue (twitching) while at rest
2. Pain, sleep disorder, spasticity, slurred speech, drooling, fatigue, emotional lability,
depression, constipation, and esophageal reflux
3. As the disease progresses, it will move up the affected leg or arm until eventually all
muscle groups become involved. Arms and legs are typically first muscles affected
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Document Summary
Book notes: term used for issues and services related to death and dying. 143: fatigued, anorexic, decreased salivation, metabolism reduces and body gradually slows down until function ends, respiratory: rapid or slow, shallow, and irregular. Sounds may become wet and noisy, both audibly and on auscultation also known as death rattle. Cheyne-stokes is a common breathing pattern, alternating periods of apnea and deep/ rapid breathing: grieving process may also occur, palliation/ hospice care, palliative- covers all of the treatments for focus on care as opposed to cure. Key point is comfort: hospice- type of palliative care. Despair (65- death: adjusts to life changes and losses. Finds order, meaning, and value in life as it is and was. 146: organ and tissue donation- the decision to donate organs or to provide anatomic gifts may be made by a person before death or by immediate family after death. Family permission must be obtained at the time of donation.
