End of life manifestations:
•Metabolism is decreased.
•Body slows down until all function ends
•Respiration generally ceases first.
⚬Respirations may be rapid or slow, shallow, irregular.
•Heart stops beating within a few minutes.
⚬Increased heart rate (initially)
⚬Later slowing and weakening of pulse
⚬Irregular rhythm (dysrhythmias)
⚬Decreased blood pressure
⚬Delayed absorption of IM or SQ drugs
•decreased sensation to pain/touch
•hearing is last to go
•eyes sunk/glazed (blink absent/blurry vision)
opatient appears to stare
•decreased taste/smell
•Mottling on hands, feet, arms, and legs
•Cold, clammy skin
⚬The skin cools first on lower, then upper extremities and finally the torso unless a fever is present.
•Cyanosis of nose, nail beds, knees
•“Waxlike” skin when very near death
•Slowing of GI tract (possible cessation of function)
•Accumulation of gas
•Distention and nausea
•Loss of sphincter control
•Bowel movement may occur before imminent death or at the time of death.
•Decreased Urine output noted
•Kidney Function diminishes
•Gradual loss of ability to move
•Trouble holding body posture and alignment
•Loss of facial muscle tone
•Sagging of jaw
•Difficulty speaking
•Loss of gag reflex
•Swallowing can become more difficult
Difference between hospice and palliative:
Palliative care: can get a cure
Hospice: no cure, end of life care, comfort focused
What happens when a pt wants to be DNR?
Notify the provider so the doctor can change the code status and explain risks and benefits
What happens if a family member says pt is DNR but she left papers at home and will be back in 10 minutes and pt starts coding?
Pt is full code until POLST is filled out
How does spiritual care affect pt and family?
Spiritual distress
Kubler Ross stages of grief:
Bargaining: Struggling to find meaning, Reaching out to others, Telling one’s story
Denial: Avoidance, Confusion, Elation, Shock, Fear
Anger: frustration, irritation, anxiety
Depression: overwhelmed, hopeless, flight, hostility
Acceptance: moving on, exploring new options
Factors that impair wound healing (3):
Peripheral vascular disease (d/t lack of circulation), malnutrition, DM, albumin/pre-albumin (needed for tissue repair)
When a vaccine is introduced into the body, what does the body produce?
Antibodies
Priority for s/p transplant:
Urine output, rejection, infection
Pt education for transplant medications:
-cannot miss a dose
-LIFELONG treatment
Immunoglobulin responsible for allergic reaction?
IgE
What happens if a patient complains of itchiness and develops a rash after a bee sting?
Administer EPI, not Benadryl!
What to do if pt develops SJS after antibiotics? (Bow tie question)
Stevens-Johnson syndrome (SJS) is a disorder that causes painful blisters and lesions on the skin and mucous membranes and can cause severe eye problems.
DC and stop infusion immediately!
Skin protection teaching:
-SPF 50
-protective clothing
-go out early in the morning before sunlight (avoid 10am-2pm)
Risk factors for melanoma:
Melanoma: the most serious type of skin cancer. Melanoma occurs when the pigment-producing cells that give color to the skin become cancerous (melanocytes)
RF: outdoor work, tanning booths, light/fair skin tone
TPN complications:
-Re-feeding syndrome (hypophosphatemia, fluid & electrolyte imbalance, fluid retention)
-metabolic problems (hyper/hypoglycemia, HLD, mineral deficiencies)
-mechanical problems (dislodgment, phlebitis, thrombosis of great vein)
TPN safety/nursing interventions:
-Have Dextrose 10% at bedside just in case next bag unavailable
-blood glucose every 4 to 6 hours
-monitor electrolytes, kidney function
-HOB elevated
Enteral feeding indications:
Functioning GI tract!
Malnutrition manifestations:
-Mild to emaciation (extreme thinness, absence of body fat and muscle wasting resulting from malnutrition)
•Skin, nails, hair
•Mouth and tongue
•CNS
•Fatigue
•Increased susceptibility to infection
•Anemia
-edema
Diet: high protein, high fat, high calories
Vision changes r/t aging:
Lens become less flexible, becomes cloudy, causing glaucoma & cataracts. HIGH RISK FOR FALLS
At risk for hearing problems:
-teenager/party person at the club (loud noises)
-ototoxic meds (antibiotics & lasix)
What determines level of care for burn pt?
-type of burn (airway always priority)
-rule of 9
-if mass casualty and pt is 90% burn, they aren’t priority. Pain management only
Rule of 9:
Head: 4.5%
Chest area: 18%
Arms: 4.5%
Perineal: 1%
Legs: 9%
Smoke inhalation priority:
100% oxygen via non rebreather. Smoke inhalation usually d/t carbon monoxide poisoning.
