Chap 99 Hospice Nursing

Front 1

(2) Describe the evolution of the hospice movement

Back 1

Hospice is based on the concept that most people want to die at home, free of pain, and among their loved ones. Physical and emotional comfort and quality of life are the primary concerns of hospice, not cure. Hospice programs care for terminally ill persons, while treating them with dignity. The goal of hospice care is to provide as much pain relief as possible, while helping the client to meet basic needs.

The term hospice derives from a medieval word meaning “to provide shelter for travelers on difficult journeys.” The hospice movement acknowledges that not all illnesses are curable and emphasizes the management of uncomfortable symptoms. The primary force behind the modern hospice movement was Dame Cicely Saunders, who founded St. Christopher’s Hospice in London in 1967. She felt that healthcare providers should do everything possible not only to help people die peacefully, but also to help them “to live until they die.

Front 2

(3) Name the four areas of human needs upon which the hospice concept focuses

Back 2

•Physical
•Psychological/emotional
•Social/cultural
•Spiritual

Front 3

(4) List at least six criteria a program must meet to be officiallty classified as a hospices

Back 3

•The hospice must be a centrally administered, autonomous program. Staff members primarily provide care in the home, with backup inpatient services.
•The goal should be symptom control (intensive palliative care), not curative measures. Clients should remain as alert and comfortable as possible.
•The major unit of care should be the client and his or her family. The term “family” refers to a client’s significant others, whether related by blood or not. The significant others are designated as primary caregivers.
•Team members should practice interdisciplinary care, under a qualified physician’s direction. Specially trained volunteers must be available to provide a multitude of services. Services are available on call 24 hours a day, 7 days a week.
•Support should be available for hospice staff, as well as for the client’s caregivers.
•Hospice services must be extended to the family during the time of bereavement (following the client’s death). (Medicare requires a 1-year follo

Front 4

(5) Explain the criteria for a person's admission to a hospice program

Back 4

•A diagnosis of progressive, terminal illness. The physician, client, and family agree that control of symptoms is the primary goal, after determining that no curative treatment is available or desirable.
•Life expectancy is usually no more than 6 months.
•A person (people) agrees to be primary caregiver(s)(responsible for care 24 hours a day).
•In most cases, the patient and family have agreed on DNR/DNI status.
•Hospice care can be discontinued with the agreement of the client, family, and attending physician.
•Admission can be directed primarily toward meeting the needs of the family.

Front 5

(6) Explain the purpose of respite care

Back 5

Respite care is to provide relief to the family members who care for a person who is terminally ill. An effort to maintain their psychosocial state of mind

Front 6

(7) Identify the major disciplines usually involved in interdisciplinary care.

Back 6

The interdisciplinary team or group (IDT or IDG) consists ofphysicians, nurses, medical social workers, therapists (occu-pational, physical, speech, respiratory), clergy, bereavement coordinators, dietitians, pharmacologists, home health aides, homemakers, and volunteers. The newest members of hospice teams are massage therapists.

Front 7

(8) Differentiate among the functions of the case manager, the hospice nurse, and other members of the healthcare team

Physician, Hospice Nurse, Home Care Services, Therapists, Bereavement Care, Volunteers, Social Services, Community Resources

Back 7

PHYSICIAN: The physician establishes the diagnosis and signs the initial certification of terminal illness. The physician or advance practice nurse performs the admission history and physical examination and orders required tests and medications.

RN: An RN does the initial admission and evaluation of the client and the home and is the case manager. A nationally certified RN is entitled to use the initials CRNH
(Certified RN, Hospice). LPN/LVNs and other caregivers are vital members of the team. All hospice workers observe the client’s ongoing condition and discuss findings with other team members. Nurses set up medications as ordered and evaluate the client’s compliance. Determining the effects of the medication regimen is essential. Questions such as the following must be answered: Are the medications effectively control-ling pain and other symptoms? Are they causing unwanted side effects?

Front 8

(8) Differentiate among the functions of the case manager, the hospice nurse, and other members of the healthcare team

Back 8

AIDE: Home health aides and homemakers assist primary caregivers to meet the daily needs of the client, such as cleanliness and nutrition.

The client and his or her family, along with hospice team members, decide what type of care is most appropriate. A specially trained nurse (usually an RN) makes an initial home visit to assess the home’s physical setup and the family dynamics. This assessment includes an evaluation of the willingness, ability, and motivation of primary caregivers and the client to participate. The client is particularly encouraged touse medications and other modalities for pain control. After the initial visit, other hospice team members make the most of the home visits. These team members assist family members to prepare for their loved one’s death. They help with matters such as funeral planning, as well as plans for the future.

Front 9

(9) Discuss the role of primary caregivers in hospice

Back 9

Primary caregivers are vital tothe client’s care. They can identify changes in the client’s condition that might not be noticeable to others. They can suggest approaches to care that meet with everyone’s approval. They provide a constant liaison between the client and the hospice team. Some functions of daily care are performed by the primary caregivers. For example, after medications are set up by the nurse, their administration is supervised by the client and the caregiver

Front 10

(10) Describe emotional and spiritual support for the client and family

Back 10

EMOTIONAL: The greatest fear of most clients is that they will be left alone to die. Caregivers need to be alert to this fear and provide more support as the illness progresses. Volunteers can assist by staying with clients to give respite to the family. The second greatest fear of most clients is that of having uncontrolled pain. This pain can usually be managed successfully. Empathic communication with hospice clients is essential. Many times, nonverbal communication is most helpful. It is important for the family to let the client know that they care and that they are sad about the situation.
SPIRITUAL: Most hospice teams have chaplains available for consultation if clients are interested. Various religious groups have differ-ent rituals and procedures related to illness, death, and care of the body after death. It is important to know the client's desire.

Front 11

(11) Identify measures used to help the hospice client meet basic needs. Specifically, discuss measures used to treat respiratory distress, anorexia, nausea and vomiting, constipation, diarrhea and skin breakdown, as well as measures used for odor management

Diarrhea: A low-residue diet lessens stimulation. Eliminate foods causing gas or cramps. (Clients often know what foods bother them.) Encourage clients to drink a variety of fluids.

Back 11

Hospice nurses usually do not provide a great deal of direct physical care. The focus is on identifying the needs of the client and family. The case manager coordinates the client’s care with other members of the team as well as the family.
RESPIRATORY: Many clients have lung involvement and dyspnea. Stress reduction and position changes help to provide maximum comfort. Using a fan to circulate air or an air conditioner tocool the room and elevating the head of the bed may help. Frequently evaluate the client’s vital signs and level of consciousness. Some clients need supplemental oxygen because of fever, anxiety, infection, or fluid collection. Oxygen concentrators, rather than tanks, are commonly used in the home.
ANOXERIA. Vitamins, tranquilizers, antidepressants,
antiemetics (anti-nausea medications), appetite stimulants, or small amounts of alcohol may help people to eat. Try to give the client frequent, small meals and snacks presented attractively. Consider food preferences. Offer soft foods

Front 12

(11) Identify measures used to help the hospice client meet basic needs. Specifically, discuss measures used to treat respiratory distress, anorexia, nausea and vomiting, constipation, diarrhea and skin breakdown, as well as measures used for odor management.

SKIN BREAKDOWN: Encourage and assist to change position as much as possible. The client’s nutritional status and hydration may be inadequate to maintain skin integrity. The disease process may have made the skin
friable. Stress the importance of frequent position changes and protecting pressure points when teaching caregivers. Caregivers should wear gloves when treating skin that is not intact. They should keep the client’s skin clean and dry.

Back 12

ANOXERIA. Consider food preferences. Offer soft foodsand a variety of fluids. (Often,
fluids are more easily tolerated than solids.) High-protein, high-calorie supplements, such as Ensure or Resource, are often ordered. Clients often enjoy colddrinks and clear liquids. Milk, creamed milk products, or very sweet drinks may cause problems. Offer clients ice pops, sherbet, and ice chips.
NAUSEA: Evaluate nausea for patterns and remove causes whenever possible. Nauseated clients should lie on their right side. Relaxation techniques are effective, as are companionship, music, meditation, backrubs, mouth breathing, and cool cloths on the forehead. Antiemetics and other medications are helpful; clients should receive them approximately one half hour before meals.
CONSTIPATION. Treatment for constipation includes a high-residue diet, as long as it can be tolerated by the client. Many hospice clients routinely receive laxatives. Suppositories also encourage peristalsis. If constipation is severe, cathartics and

Front 13

(12) Discuss threats to mental health, such as depression and anxiety, that are common in hospice clients and caregivers.

Back 13

DEPRESSION. You can intervene by listening with empathy and validating feelings. Clinical depression, with or without suicidal ideation (SI), may require antidepressant medication. It is normal to be sad, but continuing clinical depression is usually treated and should be prevented as much as possible. A referral to a psychologist or psychiatrist maybe necessary.
ANXIETY. Anxious clients sometimes become agitated or paranoid. Listen and offer reassurance. Sometimes clients need anti-anxiety medications.

Front 14

(13) Identify medications commonly used for pain management in hospice; for control of other symptoms.

Back 14

NSAID.
•fenoprofen calcium (Nalfon)
•ibuprofen (Advil, Motrin, Nuprin)
•indomethacin (Indocin)

Mild Opioids
•hydrocodone
•propoxyphene

Front 15

(14) List and briefly describe three psychosocial modalties, used in pain management.

Back 15

Psychosocial Modalities

Front 16

(15) List and describe at least two physical modalities used in pain management

Back 16

Physical Modalties

Front 17

(16) Discuss important considerations when caring for children in hospice programs

Back 17

x

Front 18

(17) Explain the nurse's role after the client dies.

Back 18

x

Front 19

Ablative surgery

Back 19

neurosurgery performed to sever or cut pain pathways

Front 20

adjuvant

Back 20

assisting or enhancing therapy given, especially in cancer, to prevent further growth or pain; therapy used which was originally intended for another purpose

Front 21

bereavement

Back 21

normal period of mourning or grieving following the death of a loved one

Front 22

debulking

Back 22

removing part of a tumor

Front 23

hospice

Back 23

facility or program of care that is specifically designed to provide emotional and physical support to end-of-life clients and their families.

Front 24

interdisciplinary care

Back 24

team of individuals from different disciplines acting together to care for a client under a physician's direction

Front 25

palliative care

Back 25

measures that give relief, but are not curative. EX chemotherapy

Front 26

primary caregivers

Back 26

a client's significant others, whether blood-related or not.

Front 27

respite

Back 27

means "time away"

Front 28

somnolent

Back 28

state in which a person is very difficult or impossible to rouse

Front 29

titration

Back 29

gradually increasing a medicine's dose

Front 30

BSC

Back 30

bedside commode

Front 31

CRNH

Back 31

certified registed nurse - hospice

Front 32

DME

Back 32

durable medical equipment

Front 33

DNI

Back 33

do not intubate

Front 34

DNR

Back 34

do not recussitate

Front 35

NAHC

Back 35

national association of home care

Front 36

PCA

Back 36

patient controlled analgesia

Front 37

(7) Describe the value of the Internet to a graduate.

Back 37

The Internet is an enormous source of information about medications, diseases, or new nursing procedures. Continuing education programs are offered, and applications for specialized credentials are also available. A certificate of completion can be printed at the end of many classes. Chat rooms and bulletin boards allow communication with experts who will answer questions.