NUR2790 – Nursing III
Exam 1 Study Guide
Cultural Considerations
• Native American
o Serious illness is not always discussed to avoid negative thoughts
o No eye contact
o May sing, wail, or shriek around dying family member
o Soul doesn’t leave the body for up to 36 hours
• Black American
o Usually independent; depends on family
o Home remedies may be used
o Bad luck to die in the home
o Professionals prepare the body
• Chinese American
o Eldest male is in charge of decision making
o No eye contact
o Family takes care of patient
o Herbs, Chinese medicine, and acupuncture may be used
o Spirit is lost if death occurs in the hospital
o Family prepares the body
• Japanese American
o Eldest male is decision maker; DNR is a family decision
o Herbal medicine, prayer, and offerings may be used
o Death at home is preferred
• Hispanic
o Spokesperson is older daughter/son; important decisions are discussed
with entire family
o Family and even extended family takes care of dying patient
o Spirit is lost if death occurs in the hospital
o Family takes care of body
Anticipatory grieving
• The intellectual and emotional responses and behaviors by which individuals
work through the process or modifying self-concept based on the perception
of potential loss.
Hospice requirements for a prescription
• Specific dose in milligrams with corresponding volume in milliliters
• Concentration to be dispensed
The “final surprising rally”
• Temporarily more alert and responsive before death
, • Good time to turn off the monitors
Signs and Symptoms of Pending Death
• Cold extremities, may become mottled or discolored
• Increased sleeping
o Do not force them to stay away and talk to them normally
• Decreased metabolism
o Do not force Pt to eat
o Offer small sips of liquid when alert and use moist swabs to keep
mouth moist
• Incontinence
o Keep them clean and use disposable undergarments if needed
• Congestion and gurgling
o Position on side for increased secretions
o Use medications to decrease production
• Irregular breathing or periods of apnea
o Raise the head of the bed
o Position to the side
• Disorientation
o Reorient the patient
o Introduce yourself every time
o Speak softly and clearly
• Restlessness
o Use music or aromatherapy
o Reduced the number of people in the room
o Dim lights and minimum noise
Five Wishes
• The person I want to make care decisions when I cannot?
• The kind of medical treatment I want or don’t want?
• How comfortable I want to be?
• How I want people to treat me?
• What I want my loved ones to know?
ABCDE Model
• Ask about pain
• Believe what the patient and family reports of pain/relief
• Choose pain control appropriate for patient/family
• Deliver interventions in a timely fashion
• Empower patients and their families
Adjunctive medications
• Antidepressants
• Corticosteroids
• Anticonvulsants
Exam 1 Study Guide
Cultural Considerations
• Native American
o Serious illness is not always discussed to avoid negative thoughts
o No eye contact
o May sing, wail, or shriek around dying family member
o Soul doesn’t leave the body for up to 36 hours
• Black American
o Usually independent; depends on family
o Home remedies may be used
o Bad luck to die in the home
o Professionals prepare the body
• Chinese American
o Eldest male is in charge of decision making
o No eye contact
o Family takes care of patient
o Herbs, Chinese medicine, and acupuncture may be used
o Spirit is lost if death occurs in the hospital
o Family prepares the body
• Japanese American
o Eldest male is decision maker; DNR is a family decision
o Herbal medicine, prayer, and offerings may be used
o Death at home is preferred
• Hispanic
o Spokesperson is older daughter/son; important decisions are discussed
with entire family
o Family and even extended family takes care of dying patient
o Spirit is lost if death occurs in the hospital
o Family takes care of body
Anticipatory grieving
• The intellectual and emotional responses and behaviors by which individuals
work through the process or modifying self-concept based on the perception
of potential loss.
Hospice requirements for a prescription
• Specific dose in milligrams with corresponding volume in milliliters
• Concentration to be dispensed
The “final surprising rally”
• Temporarily more alert and responsive before death
, • Good time to turn off the monitors
Signs and Symptoms of Pending Death
• Cold extremities, may become mottled or discolored
• Increased sleeping
o Do not force them to stay away and talk to them normally
• Decreased metabolism
o Do not force Pt to eat
o Offer small sips of liquid when alert and use moist swabs to keep
mouth moist
• Incontinence
o Keep them clean and use disposable undergarments if needed
• Congestion and gurgling
o Position on side for increased secretions
o Use medications to decrease production
• Irregular breathing or periods of apnea
o Raise the head of the bed
o Position to the side
• Disorientation
o Reorient the patient
o Introduce yourself every time
o Speak softly and clearly
• Restlessness
o Use music or aromatherapy
o Reduced the number of people in the room
o Dim lights and minimum noise
Five Wishes
• The person I want to make care decisions when I cannot?
• The kind of medical treatment I want or don’t want?
• How comfortable I want to be?
• How I want people to treat me?
• What I want my loved ones to know?
ABCDE Model
• Ask about pain
• Believe what the patient and family reports of pain/relief
• Choose pain control appropriate for patient/family
• Deliver interventions in a timely fashion
• Empower patients and their families
Adjunctive medications
• Antidepressants
• Corticosteroids
• Anticonvulsants
