EOL Topic; AGING, PANCREATIC CANCER, ALS, Pediatric

Question	Answer
What is Palliative Care	--Any form of care or treatment that focuses on reducing severity of disease symptoms Rather than delaying or trying to reverse the progression of the disease
Who Should Receive Palliative Care	Ideally all patients receiving restorative healthcare should receive palliative care concurrently and it extends into EOL care and bereavement
What Are The Goals of Palliative Care	provide relief of symptoms, regard dying as a normal process, affirm life and neither hasten or postpone death, support holistic patient care and enhance quality of life, offer support to patients to live as actively as possible until death, offer support to family during pt illness and in their own bereavement
How Common is Pancreatic Cancer What Age Does It Occur In Most Where do the Majority of Tumors Occur	It is the Fourth Leading cause of death--- peak incidence is 65-80 years old---more than half occur in the head of the pancreas
What is a Complication of Pancreatic Cancer Located in the Head & How Can You Tell If the Cancer Starts in the Body or Tail When is it Diagnosed	As the tumor grows the common bile duct becomes obstructed you can tell because---Obstructive Jaundice Develops---it's often silent until advanced and is often metastasized at time of diagnsois
What is the Prognosis of Pancreatic Cancer What are General Clinical Manifestations	Patients usually die in 5-12 months of diagnosis survival past 3 years grim---abd pain (dull or aching) anorexia, rapid and progressive weight loss, nausea, and jaundice
What are the S/S of Cancer in Pancrease Head What Does it Mean if The Pain is Extreme and Unrelenting	Obstructive Jaundice--it's means the cancer has spread into the retroperitoneal tissues and nerve plexus
Where is Pancreatic Cancer Pain Frequently Located, what is it Commonly Related To, Might it Also Occur	Upper abdomen or left hypochondrium and often radiates to the back, related to eating, and may occur at night
What is Weight Loss with Pancreatic Cancer Due To What are Common Diagnostics Used	Weight loss is due to poor digestion and absorption caused by lack of digestive enzymes from the pancrease---Abd ultrasound or EUS, spiral CT scan, ERPC< MRI, and MRCP are the most commonly used
Run Down of What EUS Allow For When is CT Used Mostly & WHy What Does the ERCP Allow For How does a PET Scan Help	EUS is imaging of pancreas with endoscope in duodenum allowing fine needle aspiration of tumor--CT initial Study gives insight on metastasis and vascular involvement--ERCP allows collection of pancreatic secretion for tumor marker analysis--PET provides NO additional information
What is the Tumor Marker for Diagnosing and Monitoring Pancreatic Cancer	19-9 (CA 19-9) which is elevated in pancreatic cancer
How is Pancreated CA Treated	pancreaticoduodenectomy or whipple procedure where pancrease is resected adjoining duodenum, distal part of stomach, and distal common bile duct
What is Done When Tumor Compresses Bile Duct What Else Can Be Done for Pain Relief	cholecystojejunostomy for biliary obstruction or endoscopically placed biliary stent when tumors compress bile duct
What Measures Should the Nurse Take in Regards to Pt Nutrition What Does the Nurse Need to Watch For	Adequate nutrition and frequent and possible supplemental feedings as well measures should be taken to stimulate appetite---bleeding from body orifices and mucous membranes because bleeding can result from impaired vitamin K production
What Should the Nurse Watch for If Undergoing Radiation Therapy What is a Significant Component of Nursing Care	ADVERSE reactions such as Anorexia, Nausea, Vomiting, and Skin Irritation---helping pt and caregiver through grieving process
What is ALS Characterized By What Ages are Mostly Affected What Sex is Mostly Affected What is the Cause & Cure What is the Prognosis for ALS	Characterized by a Loss of MOTOR neurons---40-70y/o---Men by a 2:1 ratio--cause unknown, no known cure--death in 2-6 years after diagnosis few survive though past 10 years
What is the Effect on the Body vs Brain What Neurons are Affect and to what Extent	The body muscles waste away while the patient remains cognitively intact---MOTOR neurons in brain stem and spinal cord degenerate, dead motor neurons cannot produce or transport signals to muscles so they are either not made or are made and don't reach muscles.
Common Signs&Symptoms of ALS What are Other Symptoms that May Present	Typical symp: linb weakness, dysarthria, and dysphagia. Other: pain, sleeping disorders, spasticity, drooling, emotional liablity, depression, constipation, and esophageal reflux (muscle wasting loss of message from brain reflex not available possible valve doesn't close causing esophageal refulx)
What Medication is Used in ALS	Riluzole (Rilutek) it slows the progression on ALS by decreasing glutamate (excitatory neurotransmitter) in brain
What Are Nursing Interventions for ALS	Facilitate communication, reduce risk of aspiration, facilitate early identification of RESPIRATORY INSUFFICIENCY, decreasing pain secondary to muscle weakness, decreasing risk of injury related to falls, providing diversional activities like reading and companionship
What Should Nursing Support Be Geared Towards with ALS What Needs to be Discussed with the Patient	Geared towards patient's cognitive and emotional functions, help patient and family manage grieving related to loss of function and ultimately death. Discuss artificial methods of ventilation and advanced directives
Identify the Cognitive State and Concept of Death in: Infancy & Toddlerhood Early Childhood Middle Childhood Adolescence	Inf&tod (0-2): Sensorimotor, Death as loss of caregiver, pain, and cold--Erly Childhd (2-7) Preoperational, death is reversible and temporary separation---Midd (7-12) Concrete operations death sad irreversible not really inevitable--Adoles (12+) Formal Operations death inevitable and irreversible distant event
How Do Infants & Toddlers Know the Severity of Their Disease Where Do the Toddlers Emotional Response Derive From What Are Typical Expressions	they know severity because caregivers/parents nonverbal communication--what's exhibited by toddler is conveyed from/by parent---reactions crying, attachment, separation anxiety
What Kind of Thinking do Preschoolers Have What does This Thinking Cause How do Preschoolers Typically View Their Illness	Magical and egocentric---guilt and shame as they think their thoughts cause/caused death--condition viewed as punishment for bad behaviors creating self imposed guilt then they think parents see them as bad feelings are internalized and they withdraw
What is Needed from the Nurse With Preschoolers What Provides a Feeling of Greater Security for these Children	much patience---when adults maintain discipline and suitable customary especially for dying children experiencing multiple changes
When do School Age Children Realize Death is not Only Inevitable for Adults	at age 10---coping with the dying process and use of other utilization and fear of dying may present as there are so many understandable unknowns at this age
What is a Near Death Awareness What May Happen With Dying Children	conversation weeks to hours before death where child gives specifics when they will die--heightened awareness as death nears and a need to complete a task or say goodbye
What Might Help the Nurse Better Understand and Participate in Patient Care What Should The Nurse Remind and Reassure the Dying Child Parents & Nurses Should Make Sure	Attending patient care conference---the illness and approaching death are NOT the result of any action or omission committed by the child---child KNOWS they will never be left alone, Literally, a family member or health care team member ALWAYS present
What Needs to Be Done With Family Members of Dying Child	They need time away from the child to express feelings so child doesn't feel responsible for let out anger, grief, and hostility
As Death Approaches What May Happen with Communication and How Can The Nurse Assist	Communication may decline nurse should communication strategies utilized at diagnosis or relapse and encourage these methods and evaluate each on an individual basis to assist them experience effective comfortable communication
As a Nurse How Should You Respond When Patient Asks About Approaching Death & What Should be Done Before Hand	Don't skirt any issues everything should be handled honestly so the nurse/pt relationship is not damaged. Parent should be informed you will NOT initiate conversation about death but intend to respond honestly so review and respect of wishes may be upheld
As a Nurse What do You Do if Patients Family wants to give Alternative Treatment and/or drugs Not Approved by FDA	allow them to because many will not cause physical harm, BUT if any unapproved meds or treatment is potentially harmful the health care team ma;y not allow their use and the decision and rational need to be explained compassionately
How Would You as A Nurse Advise a Parent What a DNR is What is Important to Communicate	CPR and other interventions to initiate heart beat are not done, DNR does not mean withholding treatment when alive but Refraining from performing treatment after child has died---they can change their mind at ANY time
What Should the Nurse Do if Conflict Arises Between Patient Practices and Their Beliefs	Try Coping Strategies or interventions if unsuccessful nurse should be given option not to participate in patients care
How Should The Nurse Address Parents Concern in Regards to Child Addicition to Pain Meds Risk	opiate addiction unlikely when given to patient for pain caused by illness. May be a decrease in pain relief as time passes increases or change in regime may be warranted, patient frequently monitored myths should be addressed upon first use
What is Hospice Care How Can The Nures Assist In Hospice Care Selection	care providing support and assistance to patients and their families during last phase of terminal illness that is the LAST 6 months of their life---referring them to Children's Hospice International CHI
How Should a Nurse Fix a Childs Room What is Important in the Childs Care What Changes May Occur in Sick Children	The room should be secluded, comfortable, and quiet---Privacy without interruption is important control of amount and frequency of visitors is necessary--child's endurance will be greatly diminished with increased need for daytime napping and extended nighttime sleep
What Changes may Occur in Fluid Intake What Interventions Must the Nurse Take	Fluid intake may Actually cause discomfort by increasing lung secretions necessitating suction---Nurse must prepare family days before death that ability to swallow will be compromised if lack of strength or coordination provide sippy cup, spoon, medicine dropper, or syringe
How Should A Nurse Provide Fluid for The Patient or Interventions for Dry Mouth When Would Fluid Intake be Restricted	If child has dry mouth or feels thirst small ice chips may be given---if terminally ill allow to drink favorite fluid DESPITE risk of aspiration that exists if ability to swallow is compromised---if kidney function declines the child will retain fluids and be uncomfortable so then!
How Can A Nurse Provide Oral Care to the Patient How Can Oral Medications Be Administered Can Family Be Involved in Care	Sponge Swabs to clean lips and mouth and moisture with use of artificial saliva preparations--anything to reduce pain or inflammation may be dipped in these swabs avoid---encourage family to decide type of care to provide and how much
If Responsiveness or Communication is Increased Right Before Death Is the Patient Getting Better?! What Does the Nurse Need to Teach The Family in These Regards	NO, a period of time may be experienced immediately before they die in which they are stronger, more alert, and show increased interest in family--to avoid unrealistic meaning or expectation nurse should prepare families about this possibility
What is The Last Sense to Go & What Should Be Encouraged Because of This	Hearing, so even if appearing unresponsive Encourage continuation of talking and maintaining physical contact like touching, holding their hand until death, or even after if desired
What Does the Nurse Recognize as Indicators of Iminent Death	Heart Rate Increases with concomitant decrease in strength and quality of peripheral pulses. Blood pressure decreases, and pulses and b/p may become difficult or impossible to palpate which can last hours. Cardiac changes occur before respiratory, respirations decline and may fluctuate with Cheyne Stokes
What are Cheyne Stokes What is the Term Agonal and Should the Nurse Use It	Cyclic slowing respirations with apnea followed by increased respiratory rate to a peak, then slowing and becoming apneic again. These is also known as "Agonal" but patient families misinterpret this as Painful do not use
What is the Death Rattle How Should the Nurse Treat The Death Rattle	Respirations become more audible and patient may let out respiratory sigh which resembles a moan that may alarm them because it's often interpreted as Painful--No treatment if child is otherwise without verbal or physical pain, suctioning may be done
If Hypoxic Agitation Occurs from Respiratory Changes What Does Nurse Administer	Oxygen and Morphine sublingual or IV
What Can The Nurse Administer to Decrease Secretions When Death Rattle Occurs & What Other Interventions May Be Done	Atropine or Diphenhydramine, nures may place client in side lying position and place towel under mouth child rarely aware of respiratory changes--final gasping noise may be heard family should be advised this is normal last air escaping
What Should The Nurse Have Informed the Family Prior to Holding the Deceased Child How can the Nurse Facilitate Family Comfort	Rapidly occuring changes such as cooling of body, cyanosis, or paleness and stiffness may occur---providing blankets nurse should provide privacy But remain close by

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EOL Topic; AGING, PANCREATIC CANCER, ALS, Pediatric

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	Created by Natashia Reyes about 9 years ago