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Sherpath: Diabetes Mellitus Chapter 21 Test Case Study 4 (Short
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Practice questions for this set
Learn 1 /7 Study using Learn
Index of Independence in Activities of Daily Living
Choose an answer
1 Katz assessment 2 Pluses assessment
3 Pulses assessment 4 FICA Spiritual Assessment
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Terms in this set (85)
When should dialysis be discontinued? when burdens outweigh benefits and/or when dialysis is no
longer prolonging life or only prolonging death
Most Common Symptoms in Final Dyspnea
Days/Weeks of Life Pain
Noisy breathing/respiratory congestion
Other Symptoms to be Aware of Near the Delirium
End of Life Myoclonus
Use of Opioids in the Final Days/Hours Dosing of opioids given during last hours based on
appropriate assessment and reassessment.
Dose may be decreased or increased
Consider other routes:
ØOral
ØRectal
ØSubcutaneous
, National Comprehensive Cancer Network Titrate to comfort
(NCCN): Guidelines for Treating Pain Weeks Recognize and treat toxicities
to Days Before Death Analgesia vs. reduced LOC
Use equianalgesic dose conversions
Consult
Consider sedation for refractory pain
Symptoms of Imminent Death Decreased urine output
Cold and mottled extremities
Vital sign and breathing changes
Delirium / confusion
Restlessness
The Pause brief acknowledgment of the patient's humanity just after
death has been declared
Barriers to Communication Fear of mortality
Lack of experience
Avoidance of emotion
Insensitive
Sense of guilt
Desire to maintain hope
Fearing of not knowing answers to questions
Disagreement with patient and/or family decisions
Lack of understanding culture and/or goals of care
Role relationships
Personal grief issues
Ethical dilemmas
Remember the Caregiver: Their Needs What else is going on?
Assessment Requires the Right Questions What is it like at home?
Is the care you are providing interfering with your work?
Financial needs?
Who holds the insurance?
What is most important/meaningful to you?
Fears/worries?
What do you hope for your family?
What kinds of needs do you have?
Support systems?
Verbal and Non-Verbal Communication Includes body language, eye contact, gestures, tone of voice
80% of communication is nonverbal
Attentive Listening Set the right atmosphere
Does the patient need/want to talk?
Encourage them to talk
Be silent
Share your feelings
Avoid misunderstandings
Don't change the subject
Take your time in giving advice
Encourage reminiscing
Create legacies
Articulating Empathy: NURSE Naming
Understanding
Respecting
Supporting
Exploring