NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
NUR 445 Med Surg 3 Exam 1: Palliative Care
Overview/End-of-Life Issues
I. Palliative Care
A. Specialized form of care that focuses on pain relief &
other symptoms/stress with a severe illness
B. Focuses on relief of suffering & maximizing quality of life
for patients with a serious illness
C. Given concurrently with curative treatment that meets
the patient’s goal - servies patients in all situations
(dialysis, ventilation, chronic/progressive conditions)
D. Shown to improve symptom management & pt/family
satisfaction, they received a better quality of life.
E. Provided in hospital, outpatient, community settings.
Also provided for patients under hospice care with a
projected prognosis of 6 months or less.
F. Provides continuity of care.
G. Hospice Care
1. Focuses on the care of a patient with a terminal
illness who has less than 6 months to live
2. Who can receive hospice?
a) Anyone, regardless of diagnosis, with a
prognosis of 6 months or less who has decided
not to pursue curative treatment (exceptions
may be made for time-limited palliative
treatment such as radiation or artificial
nutrition; also, Affordable Care Act [ACA]
pediatric patients are not required to forgo
curative treatment)
3. What are the levels of care under hospice?
a) Routine home care
b) Continuous home care
c) Inpatient respite care
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
,NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
d) General Inpatient Care
4. How is Hospice provided?
a) In the home by a team of nurses, health aides,
social workers, and others
b) In an inpatient hospice unit with 24-hour
nursing and other caregivers
c) In a nursing home with intermittent visits
provided by the home hospice team
5. Who can contact hospice?
a) The patient, the family, the attending
provider, or any member of the team can
contact hospice; the hospice will contact the
patient’s primary care provider to sign orders
for hospice.
6. When should hospice be contacted?
a) When the patient does not want to pursue
curative therapy; when life expectancy is 6
months or less
7. How long can a patient receive hospice care?
a) As long as the provider certifies the patient is
terminally ill with a life expectancy of 6
months or less if the disease runs its expected
course
8. What services are provided?
a) Intermittent nursing; home health aide; social
work; pastoral care; physical therapy;
nutrition services; provider visits; volunteers;
bereavement services; medical equipment;
medications to manage symptoms;
short-term acute inpatient care, including
respite care, counseling, and pain and
symptom management
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
,NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
(1)
Death/Dying Medications: opioids
(pain, sedation, Respiratory, zofran -
nausea, anticholinergic (death rattle),
haldol/benzos - delirium
9. How is it paid for?
a) Medicare A, Medical Assistance, and most
major health insurance plans provide hospice
coverage.
10. What is not covered?
a) Treatment for the terminal illness that is not
for symptom relief; care given by another
provider that was not arranged for by the
hospice; care from another provider that
duplicates the care hospice is required to
provide
II. Domains of Palliative Care
A. Domain 1: Structure & Process of Care
1. Addresses the plan of care provided by nurses &
providers with advanced PC training.
2. Plan should incorporate the patient’s goals,
preferences, and values while recognizing that they
can eventually change.
3. Patients and families should be educated about
hospice care when death may occur within the year.
The topic should be reintroduced as the patient
declines.
4. The healthcare team should assess and improve, as
necessary, patient and family knowledge about the
disease course, prognosis, and benefits and
risks/burdens of diagnostic evaluation and
treatments.
B. Domain 2: Physical Aspects of Care
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
, NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
1. Address the need to assess, treat, & document
symptoms such as pain, dyspnea, constipation, &
nausea using standardized scales to evaluate the
effectiveness of the interventions.
2. Patient outcomes should be documented, and f/u
with providers for continuing orders to provide
effective symptom management.
C. Domain 3: Psychological/Psychiatric Aspects of Care
1. PC plan should assess & document the presence of
anxiety, depression, & delirium using available
standardized scales (Memorial Symptom
Assessment Scale, Edmonton Symptom
Assessment Scale).
2. Patient/Family should be assisted with their
emotional/psychological reactions to functional
impairment & loss
3. Should be connected with coping resources such as
grief & bereavment services.
D. Domain 4: Social Aspecs of Care, Including Advanced
Care Planning
1. Address the need to facilitate regularly scheduled
patient and family conferences with the
interprofessional team to discuss the goals of care,
prognosis, & advanced care planning & to offer
support.
2. It includes assessment of patient and family social
networks; cultural, legal, and financial concerns;
caregiver availability; and coping skills, as well as
access to medications and equipment.
3. Advanced Care Planning
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
NUR 445 Med Surg 3 Exam 1: Palliative Care
Overview/End-of-Life Issues
I. Palliative Care
A. Specialized form of care that focuses on pain relief &
other symptoms/stress with a severe illness
B. Focuses on relief of suffering & maximizing quality of life
for patients with a serious illness
C. Given concurrently with curative treatment that meets
the patient’s goal - servies patients in all situations
(dialysis, ventilation, chronic/progressive conditions)
D. Shown to improve symptom management & pt/family
satisfaction, they received a better quality of life.
E. Provided in hospital, outpatient, community settings.
Also provided for patients under hospice care with a
projected prognosis of 6 months or less.
F. Provides continuity of care.
G. Hospice Care
1. Focuses on the care of a patient with a terminal
illness who has less than 6 months to live
2. Who can receive hospice?
a) Anyone, regardless of diagnosis, with a
prognosis of 6 months or less who has decided
not to pursue curative treatment (exceptions
may be made for time-limited palliative
treatment such as radiation or artificial
nutrition; also, Affordable Care Act [ACA]
pediatric patients are not required to forgo
curative treatment)
3. What are the levels of care under hospice?
a) Routine home care
b) Continuous home care
c) Inpatient respite care
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
,NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
d) General Inpatient Care
4. How is Hospice provided?
a) In the home by a team of nurses, health aides,
social workers, and others
b) In an inpatient hospice unit with 24-hour
nursing and other caregivers
c) In a nursing home with intermittent visits
provided by the home hospice team
5. Who can contact hospice?
a) The patient, the family, the attending
provider, or any member of the team can
contact hospice; the hospice will contact the
patient’s primary care provider to sign orders
for hospice.
6. When should hospice be contacted?
a) When the patient does not want to pursue
curative therapy; when life expectancy is 6
months or less
7. How long can a patient receive hospice care?
a) As long as the provider certifies the patient is
terminally ill with a life expectancy of 6
months or less if the disease runs its expected
course
8. What services are provided?
a) Intermittent nursing; home health aide; social
work; pastoral care; physical therapy;
nutrition services; provider visits; volunteers;
bereavement services; medical equipment;
medications to manage symptoms;
short-term acute inpatient care, including
respite care, counseling, and pain and
symptom management
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
,NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
(1)
Death/Dying Medications: opioids
(pain, sedation, Respiratory, zofran -
nausea, anticholinergic (death rattle),
haldol/benzos - delirium
9. How is it paid for?
a) Medicare A, Medical Assistance, and most
major health insurance plans provide hospice
coverage.
10. What is not covered?
a) Treatment for the terminal illness that is not
for symptom relief; care given by another
provider that was not arranged for by the
hospice; care from another provider that
duplicates the care hospice is required to
provide
II. Domains of Palliative Care
A. Domain 1: Structure & Process of Care
1. Addresses the plan of care provided by nurses &
providers with advanced PC training.
2. Plan should incorporate the patient’s goals,
preferences, and values while recognizing that they
can eventually change.
3. Patients and families should be educated about
hospice care when death may occur within the year.
The topic should be reintroduced as the patient
declines.
4. The healthcare team should assess and improve, as
necessary, patient and family knowledge about the
disease course, prognosis, and benefits and
risks/burdens of diagnostic evaluation and
treatments.
B. Domain 2: Physical Aspects of Care
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
, NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
1. Address the need to assess, treat, & document
symptoms such as pain, dyspnea, constipation, &
nausea using standardized scales to evaluate the
effectiveness of the interventions.
2. Patient outcomes should be documented, and f/u
with providers for continuing orders to provide
effective symptom management.
C. Domain 3: Psychological/Psychiatric Aspects of Care
1. PC plan should assess & document the presence of
anxiety, depression, & delirium using available
standardized scales (Memorial Symptom
Assessment Scale, Edmonton Symptom
Assessment Scale).
2. Patient/Family should be assisted with their
emotional/psychological reactions to functional
impairment & loss
3. Should be connected with coping resources such as
grief & bereavment services.
D. Domain 4: Social Aspecs of Care, Including Advanced
Care Planning
1. Address the need to facilitate regularly scheduled
patient and family conferences with the
interprofessional team to discuss the goals of care,
prognosis, & advanced care planning & to offer
support.
2. It includes assessment of patient and family social
networks; cultural, legal, and financial concerns;
caregiver availability; and coping skills, as well as
access to medications and equipment.
3. Advanced Care Planning
NUR 445 Med Surg 3 Exam 1: Palliative Care Overview/End-of-Life Issues
