Question

nursing diagnosis, interventions , rationales

Dying pt

Physiologic needs, personal hygiene, movement , elimination, respiratory 9it should based on )

Answer 1

#. Desired Outcomes for End of Life :-

Needs and preferences met---> Control of symptoms of distress---> Meaningful interactions with family--> A peaceful death

#. Physiological Signs of Approaching Death :-

May have coping problems, fear, anxiety, impeding doom, knowledge deficit,

Withdrawl, Vision like experiences, letting go, saying goodbye

1. Nursing Interventions - Pain

Pain is the most distressing symptom for the dying. Pain from cancer, osteoarthritis, spasms, stiff joints secondary to immobility. Depending on the brand oral meds can be given rectally. Morphine sulfate elixir—sublingually, via buccal mucosa, or rectally.

PAIN IS THE PRIORITY

Fentanyl citrate---is an opiod that's safer for renal failure pts cuz it lacks metabolites

Massage---enhances dignity and helps pt find inner peace. Pts with cancer use light and avoid deep issue massage.

Music therapy—Therapeutic touch—Reiki, Aromatherapy-lavender capsicum, bergamot chamomile rose ginger rosemary lemongrass and camphor. Some increase N&V

2. Nursing Intervention - Weakness

Curologic function may impair the ability to swallow (dysphagia). Anorexia is normal, giving food or fluids can lead to discomfort. Dehydration does not cause stress releases natural endophines for a sense of well being. S>E> dry lips and mouth. Apply ointment to soften lips. Collaborate about drugs, never crush sustained release cap, never use IM, use least invasive such as oral, buccal mucosa transdermal, or rectal. SQ Or IV used only last resort combined with ne

3. Nursing Intervention - Breathlessness / Dyspnea

Major cause of suffering at EOL- Assess,

Opiods morphine sulfate --they work by altering the perception of air hunger, reducing anxiety and associated oxygen consumption, reducing pulmonary congestion by dilating pulmonary blood vessels.

Oxygen—2-6 l, nasal cannula at most 90% preferred

Brochodilators- PROVENTIL, ATROVENT, via dose inhaler or neubilizer, for brochspasm,

Corticosteroids Deltasone, Winpred for brochospasm and inflammatory problems within and outside the lung. Superior vena cava and lymphangitis

Antibiotics---resp infection

4. Nursing Intervention - Death Rattle

secretions built up and is loud and wet. Position on side, small towel under head, Anticholinergics atropine ophthalmic solution 1% q 4hrs or Levsin every 6hrs dry up secretions oral. Scopolamine may be given trans or SQ to reduce production. No suctioning in bronchi or oropharynx.

Benzodiazephines are commonly given when the morphine does not fully control the persons dyspnea ATIVAN---orally sublingually, or IV q4hrs

Circulating cool air, applying wet clothes, positioning the pt with hob up either in a hospital bed or a reclining chair to increase chest expansion, encouraging imagery and deep breathing.................maybe foley

5. Nursing Intervention - N/V

Aids, breast, and gynecologic cancers more frequently,

Causes: uremia increased serum urea nitrogen, hypercalcemia, ICP, bowel obstruction

Fleet, mileral oil, disimpaction, Compazie, Stemil, Decadron, Deronil, Dexasone, Reglan, Maxeran. Remove odor and keep room temp good, Aromatherapy—pepperment and rosewood for N and Chamomile camphor fennel lavender peppermint and rose for V

6. Nursing Intervention - Restlessness / Agitation

Assessing for pain, constipation, or other cause. Hypoactive and agitated delirium treated with meds. HAldol 1st line or Ativan. Do not give more than one type of drug

7. Nursing Intervention - Seizures

Valium, ativan drug choices, for home use recatl diazepam gel or sublingual lorazepam oral solution 2mg/ml...2nd choice Phenobarbital may be given IV or IM

8. Psychosocial Management Interventions

Offer physical and emotional support by "being with" the patient, Respect cultural, be realistic, encourage reminiscence, promote spirituality, foster hope, avoid explanations of the loss, communicate with the patient, provide referrals to bereavement specialists, teach about the physical signs of death, ensure that the pt is receiving palliative care with an emphasis on symptom