NUR 2790 Nursing 3 – Final Exam Guide
EOL
Manifestations of Death
• breathing cessation (no breath sounds auscultated for 1 full minute- verified by 2 RNs)
• cardiac arrest (no apical heart sounds auscultated for 1 full minute verified by 2 RNs)
• pupils become fixed and dilated
• body color becomes pale and waxen
• body temp drops
• muscles and sphincters relax
• urine, stool, and air may be released
• eyes remain open, and there is no blinking
• the jaw may fall open
• observers may hear trickling of fluids internally
Advanced Directives
• Patient self-determination act
-requires that a rep in every health care agency ask patients when admitted if they have written
advance directives
-patients who do not should be provided written information
• Durable power of attorney
-aka health care proxy/heath surrogate
-doesn’t make decisions until patient lacks capacity
-to have decision-making ability, a person must be able to perform 3 tasks
• receive information
• evaluate, deliberate, and mentally manipulate information
• communicate a treatment preference
• Living will
-identifies what life saving measures one would (or would not) want if he/she were near death
(CPR, Mechanical ventilation, artificial nutrition)
• DNR (Do not resuscitate)
Comfort for Death and Dying
• Pain management:
-nonopioid and opioid analgesics
-continued scheduled doses to prevent recurrence of pain
-risk for delirium d/t kidney failure; consider fentanyl
• Dyspnea management:
-pharmacologic interventions should begin early in the course of dyspnea (only time pharm
comes 1st)
-bronchodilators, steroids, diuretics
-atropine for wet “death rattle”
-morphine sulfate standard treatment for dyspnea near death
• works by alternating perception of air hunger, reducing anxiety and associated oxygen
concentrations
-oxygen therapy not established as a standard of care for all patients
, • if lack of response to other drugs oxygen (2-6L NC) may be placed to assess effects
• patients often feel more comfortable when their O2 sat >90&
• avoid masks= frightening
• if oxygen not effective, discontinue
Agonal Breathing Response
• don’t really know what she wants put here.. if a patient has agonal breathing they are dead… no
intervention
Family Education Regarding Death and Dying
• Know what to educate
• Families of people near death often manifest fear, anxiety, and knowledge deficits regarding the process
of death
-provide information about the physiologic process of dying
-emphasize symptoms of distress do not always occur, and if they occur, they can be treated
and controlled (pain and dyspnea)
-ask them if they want to talk to a counselor or want guidance from clergy
-explain the common emotional signs of approaching death
• Common emotional signs of impending death
-withdrawal -vision-like experiences
-letting go -saying goodbye
• Physical s/s of approaching death
-coolness of extremities (circulation decreased; skin b/c mottled or discolored)
-increased sleepiness (metabolism decreased)
-fluid and food decreased
-incontinence (perineal muscles relax)
-breathing pattern changes (Cheyne Stokes respirations – apnea alternating w/ rapid breathing)
-disorientation
-congestion & gurgling
-restlessness
Cancer
Effects of Morphine on Patient
•
Primary, Secondary, Tertiary Cancer Prevention
•Primary (Avoidance)
-removing “at risk factors ”
-vaccines
• Hep B Virus (Liver CA)
• HPV (throat CA)
-health counseling
• environmental factors 2/3 cancer cause
• tobacco behavior (single best strategy for reduction)
• sunscreen
• ETOH
• diet (low fat, ↑ fiber)
, • exercise
• safe sexual practice
• Secondary (Screening):
-screening and early CA recognition
-Warning signs of CA
• Change in bowel/bladder habits
• A sore that doesn’t heal
• Unusual bleeding/discharge, anybody orifice
• Thickening or presence of lump
• Ingestion or difficulty swallowing
• Obvious change in wart or mole (color, size, texture)
• Nagging cough or hoarseness that is prolonged
• Tertiary (Preventing Recurrence):
-tamoxifen prescribed to reduce risk of recurrence of breast CA after breast CA surgery
-aspirin and NSAIDs chemoprevention R/T decreasing risk of colon CA
-teach importance of tertiary prevention in the avoidance of future disease
Oncological Emergencies
• Tumor Lysis Syndrome:
-results from massive breakdown of tumor cells; may occur spontaneously or result from chemo
or radiation therapy
-leakage of extracellular contents
• causes electrolyte imbalances (hyperkalemia, hyperphosphatemia, hypocalcemia, and
hyperuricemia)
-treatment: aggressive IV hydration
• Disseminated Intravascular Coagulation (DIC):
-disorder that involves simultaneous clotting and hemorrhaging
-triggers:
• sepsis or other infection, shock, severe trauma, neoplasm, and obstetric complications
-treatment:
• oxygen
• IV fluids
• transfusion of FFP, PRBCs, cryoprecipitate, and platelets
• use of heparin is controversial
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH):
-occurs when tumors release ADH; increase of ADH leads to water intoxication with dilutional
hyponatremia
-neurological effects common
-as hyponatremia becomes severe s/s progress to seizures, papilledema, coma and death
-treatment:
• fluid restriction
• hypertonic sodium chloride infusion
• diuretic administrations
• seizure precautions
• patient monitoring
• Superior Vena Cava Syndrome:
EOL
Manifestations of Death
• breathing cessation (no breath sounds auscultated for 1 full minute- verified by 2 RNs)
• cardiac arrest (no apical heart sounds auscultated for 1 full minute verified by 2 RNs)
• pupils become fixed and dilated
• body color becomes pale and waxen
• body temp drops
• muscles and sphincters relax
• urine, stool, and air may be released
• eyes remain open, and there is no blinking
• the jaw may fall open
• observers may hear trickling of fluids internally
Advanced Directives
• Patient self-determination act
-requires that a rep in every health care agency ask patients when admitted if they have written
advance directives
-patients who do not should be provided written information
• Durable power of attorney
-aka health care proxy/heath surrogate
-doesn’t make decisions until patient lacks capacity
-to have decision-making ability, a person must be able to perform 3 tasks
• receive information
• evaluate, deliberate, and mentally manipulate information
• communicate a treatment preference
• Living will
-identifies what life saving measures one would (or would not) want if he/she were near death
(CPR, Mechanical ventilation, artificial nutrition)
• DNR (Do not resuscitate)
Comfort for Death and Dying
• Pain management:
-nonopioid and opioid analgesics
-continued scheduled doses to prevent recurrence of pain
-risk for delirium d/t kidney failure; consider fentanyl
• Dyspnea management:
-pharmacologic interventions should begin early in the course of dyspnea (only time pharm
comes 1st)
-bronchodilators, steroids, diuretics
-atropine for wet “death rattle”
-morphine sulfate standard treatment for dyspnea near death
• works by alternating perception of air hunger, reducing anxiety and associated oxygen
concentrations
-oxygen therapy not established as a standard of care for all patients
, • if lack of response to other drugs oxygen (2-6L NC) may be placed to assess effects
• patients often feel more comfortable when their O2 sat >90&
• avoid masks= frightening
• if oxygen not effective, discontinue
Agonal Breathing Response
• don’t really know what she wants put here.. if a patient has agonal breathing they are dead… no
intervention
Family Education Regarding Death and Dying
• Know what to educate
• Families of people near death often manifest fear, anxiety, and knowledge deficits regarding the process
of death
-provide information about the physiologic process of dying
-emphasize symptoms of distress do not always occur, and if they occur, they can be treated
and controlled (pain and dyspnea)
-ask them if they want to talk to a counselor or want guidance from clergy
-explain the common emotional signs of approaching death
• Common emotional signs of impending death
-withdrawal -vision-like experiences
-letting go -saying goodbye
• Physical s/s of approaching death
-coolness of extremities (circulation decreased; skin b/c mottled or discolored)
-increased sleepiness (metabolism decreased)
-fluid and food decreased
-incontinence (perineal muscles relax)
-breathing pattern changes (Cheyne Stokes respirations – apnea alternating w/ rapid breathing)
-disorientation
-congestion & gurgling
-restlessness
Cancer
Effects of Morphine on Patient
•
Primary, Secondary, Tertiary Cancer Prevention
•Primary (Avoidance)
-removing “at risk factors ”
-vaccines
• Hep B Virus (Liver CA)
• HPV (throat CA)
-health counseling
• environmental factors 2/3 cancer cause
• tobacco behavior (single best strategy for reduction)
• sunscreen
• ETOH
• diet (low fat, ↑ fiber)
, • exercise
• safe sexual practice
• Secondary (Screening):
-screening and early CA recognition
-Warning signs of CA
• Change in bowel/bladder habits
• A sore that doesn’t heal
• Unusual bleeding/discharge, anybody orifice
• Thickening or presence of lump
• Ingestion or difficulty swallowing
• Obvious change in wart or mole (color, size, texture)
• Nagging cough or hoarseness that is prolonged
• Tertiary (Preventing Recurrence):
-tamoxifen prescribed to reduce risk of recurrence of breast CA after breast CA surgery
-aspirin and NSAIDs chemoprevention R/T decreasing risk of colon CA
-teach importance of tertiary prevention in the avoidance of future disease
Oncological Emergencies
• Tumor Lysis Syndrome:
-results from massive breakdown of tumor cells; may occur spontaneously or result from chemo
or radiation therapy
-leakage of extracellular contents
• causes electrolyte imbalances (hyperkalemia, hyperphosphatemia, hypocalcemia, and
hyperuricemia)
-treatment: aggressive IV hydration
• Disseminated Intravascular Coagulation (DIC):
-disorder that involves simultaneous clotting and hemorrhaging
-triggers:
• sepsis or other infection, shock, severe trauma, neoplasm, and obstetric complications
-treatment:
• oxygen
• IV fluids
• transfusion of FFP, PRBCs, cryoprecipitate, and platelets
• use of heparin is controversial
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH):
-occurs when tumors release ADH; increase of ADH leads to water intoxication with dilutional
hyponatremia
-neurological effects common
-as hyponatremia becomes severe s/s progress to seizures, papilledema, coma and death
-treatment:
• fluid restriction
• hypertonic sodium chloride infusion
• diuretic administrations
• seizure precautions
• patient monitoring
• Superior Vena Cava Syndrome:
