NUR 445 Final Exam - Comprehensive SG
Quizlet 1, Quizlet 2
Kahoot 1, Kahoot 2
Other SG 1, SG 2, SG 3, SG 4
Notebook Resources
End of Life Concepts
- Ethical principles: Autonomy, beneficence, justice.
- Respiratory symptoms: Atropine for secretions, morphine for distress.
- Pain management: Benzodiazepines for agitation, massage/acupressure.
Palliative Care vs. Hospice
● Palliative Care:
- Focus: symptom management, quality of life, holistic support.
- Can occur at ANY stage of illness.
- Physical symptoms: pain, dyspnea, nausea.
- Psychosocial symptoms: anxiety, depression.
- Cultural considerations: communication, rituals, decision-making.
● Hospice Care:
- Prognosis < 6 months
- Comfort-focused, no curative intent
- Home or inpatient
- Family-centered; grief support provided.
● Philosophy: Comfort, dignity, holistic support (physical, psychological, social,
spiritual), family involvement.
Postmortem Care – Nursing Steps
● Verify death (per facility policy).
● Allow family time with the patient.
● Follow cultural/religious preferences.
, ● Remove tubes unless autopsy is needed.
● Bathe the body, place pads for incontinence.
● Close eyes/mouth, apply ID bands.
● Prepare the body for transport.
Stages of Dying
● Early Stage: Withdrawal, decreased appetite, more sleep.
● Middle Stage: Confusion, disorientation, low BP/temp, irregular pulse, labored
breathing.
● Late Stage: Surge of energy → coma, mottling, Cheyne-Stokes
respirations, inability to manage secretions (“death rattle”).
Symptom Management at End of Life
● Pain: Opioids (morphine), scheduled or PRN.
● Dyspnea: Opioids, fans, positioning, anticholinergics for secretions.
● Delirium: Reorient, familiar items, haloperidol/benzodiazepines.
● Secretions: Anticholinergics (atropine drops, glycopyrrolate).
● Nausea: Antiemetics.
● Agitation: lorazepam
Ethical Dilemmas in End of Life
● Conflict between curative vs. comfort care.
● Disagreements between family/patient/team.
● Futility of treatment.
● Moral distress in nurses.
Advanced Directives
● Early discussions encouraged.
● Includes wishes about CPR, ventilation, feeding tubes, etc.
● Should be revisited as the condition changes.
Quizlet 1, Quizlet 2
Kahoot 1, Kahoot 2
Other SG 1, SG 2, SG 3, SG 4
Notebook Resources
End of Life Concepts
- Ethical principles: Autonomy, beneficence, justice.
- Respiratory symptoms: Atropine for secretions, morphine for distress.
- Pain management: Benzodiazepines for agitation, massage/acupressure.
Palliative Care vs. Hospice
● Palliative Care:
- Focus: symptom management, quality of life, holistic support.
- Can occur at ANY stage of illness.
- Physical symptoms: pain, dyspnea, nausea.
- Psychosocial symptoms: anxiety, depression.
- Cultural considerations: communication, rituals, decision-making.
● Hospice Care:
- Prognosis < 6 months
- Comfort-focused, no curative intent
- Home or inpatient
- Family-centered; grief support provided.
● Philosophy: Comfort, dignity, holistic support (physical, psychological, social,
spiritual), family involvement.
Postmortem Care – Nursing Steps
● Verify death (per facility policy).
● Allow family time with the patient.
● Follow cultural/religious preferences.
, ● Remove tubes unless autopsy is needed.
● Bathe the body, place pads for incontinence.
● Close eyes/mouth, apply ID bands.
● Prepare the body for transport.
Stages of Dying
● Early Stage: Withdrawal, decreased appetite, more sleep.
● Middle Stage: Confusion, disorientation, low BP/temp, irregular pulse, labored
breathing.
● Late Stage: Surge of energy → coma, mottling, Cheyne-Stokes
respirations, inability to manage secretions (“death rattle”).
Symptom Management at End of Life
● Pain: Opioids (morphine), scheduled or PRN.
● Dyspnea: Opioids, fans, positioning, anticholinergics for secretions.
● Delirium: Reorient, familiar items, haloperidol/benzodiazepines.
● Secretions: Anticholinergics (atropine drops, glycopyrrolate).
● Nausea: Antiemetics.
● Agitation: lorazepam
Ethical Dilemmas in End of Life
● Conflict between curative vs. comfort care.
● Disagreements between family/patient/team.
● Futility of treatment.
● Moral distress in nurses.
Advanced Directives
● Early discussions encouraged.
● Includes wishes about CPR, ventilation, feeding tubes, etc.
● Should be revisited as the condition changes.
