Time: 90 Minutes
Exam Covers
Palliative care and hospice care
Cheyne-Stokes respirations
Loss of gag reflex
Mottling
Cold/clammy skin
Cyanosis
Wax-like skin near death
Organ and tissue donation
End-of-life assessment and comfort care
Palliative Care - ANSWER-Care or treatment focusing on reducing the severity of
symptoms; curative treatment can be involved
Hospice Care - ANSWER-treatment of the terminally ill with the goal of helping
them to die comfortably, without pain; curative care is forgone
Physical manifestations of EOL - respiratory - ANSWER-Cheyne-Stokes respirations,
death rattle, terminal secretions, loss of gag reflex (risk for aspiration)
Physical manifestations of EOL - integumentary - ANSWER-Mottling, cyanosis in nail
beds, cold/clammy skin, and "waxlike" skin very near death
Decisional capacity - ANSWER-ability to consent to or refuse care
Tissue/Organ donation - ANSWER-Some used within hours, notify physician
immediately
What guides our care? - ANSWER-Code of Ethics - relieve suffering
, Principle of Beneficence - care is provided to benefit
Standard of Care - define nursing acts that are required for safe and competent
care
Assessments - last hours of life - ANSWER-limit to comfort measures, concerns
about pain and respiratory should be addressed, emotional/comfort support
Postmortem Care - ANSWER-close pt's eyes, replace dentures, wash/position body
- allow family privacy
Classic triad of DKA - ANSWER-hyperglycemia (>250)
ketones
acidosis
Other manifestations of DKA include - ANSWER-profound dehydration
tachycardia
fruity breath
(early signs) - weakness/lethargy
DKA treatment includes - ANSWER-IV fluids
regular insulin - 0.1 U/kg/hr
electrolytes (potassium esp.) - PRN
HHS occurs when - ANSWER-Blood glucose >600
HHS vs DKA - ANSWER-no ketones (has enough insulin to prevent this)
severe hyperglycemia (>600)
occurs gradually
Other HHS manifestations - ANSWER-increased serum osmolality (concentrated)
normal blood pH
fever/warm dry skin
Treatment for HHS - ANSWER-Same as DKA however fluids help as much as insulin
therapy because of the correction of the osmolarity issue
Addison's disease - ANSWER-insufficient corticosteroids (need to ADD)
Manifestations of Addison's disease - ANSWER-hyper-pigmented skin
hypoglycemia
muscle weakness
orthostatic hypotension
salt craving
hyperkalemia
Interprofessional care for Addison's - ANSWER-hormone therapy (hydrocortisone)
watch for s/s of Cushings
increase dietary salt intake
Exam Covers
Palliative care and hospice care
Cheyne-Stokes respirations
Loss of gag reflex
Mottling
Cold/clammy skin
Cyanosis
Wax-like skin near death
Organ and tissue donation
End-of-life assessment and comfort care
Palliative Care - ANSWER-Care or treatment focusing on reducing the severity of
symptoms; curative treatment can be involved
Hospice Care - ANSWER-treatment of the terminally ill with the goal of helping
them to die comfortably, without pain; curative care is forgone
Physical manifestations of EOL - respiratory - ANSWER-Cheyne-Stokes respirations,
death rattle, terminal secretions, loss of gag reflex (risk for aspiration)
Physical manifestations of EOL - integumentary - ANSWER-Mottling, cyanosis in nail
beds, cold/clammy skin, and "waxlike" skin very near death
Decisional capacity - ANSWER-ability to consent to or refuse care
Tissue/Organ donation - ANSWER-Some used within hours, notify physician
immediately
What guides our care? - ANSWER-Code of Ethics - relieve suffering
, Principle of Beneficence - care is provided to benefit
Standard of Care - define nursing acts that are required for safe and competent
care
Assessments - last hours of life - ANSWER-limit to comfort measures, concerns
about pain and respiratory should be addressed, emotional/comfort support
Postmortem Care - ANSWER-close pt's eyes, replace dentures, wash/position body
- allow family privacy
Classic triad of DKA - ANSWER-hyperglycemia (>250)
ketones
acidosis
Other manifestations of DKA include - ANSWER-profound dehydration
tachycardia
fruity breath
(early signs) - weakness/lethargy
DKA treatment includes - ANSWER-IV fluids
regular insulin - 0.1 U/kg/hr
electrolytes (potassium esp.) - PRN
HHS occurs when - ANSWER-Blood glucose >600
HHS vs DKA - ANSWER-no ketones (has enough insulin to prevent this)
severe hyperglycemia (>600)
occurs gradually
Other HHS manifestations - ANSWER-increased serum osmolality (concentrated)
normal blood pH
fever/warm dry skin
Treatment for HHS - ANSWER-Same as DKA however fluids help as much as insulin
therapy because of the correction of the osmolarity issue
Addison's disease - ANSWER-insufficient corticosteroids (need to ADD)
Manifestations of Addison's disease - ANSWER-hyper-pigmented skin
hypoglycemia
muscle weakness
orthostatic hypotension
salt craving
hyperkalemia
Interprofessional care for Addison's - ANSWER-hormone therapy (hydrocortisone)
watch for s/s of Cushings
increase dietary salt intake
