1. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Unit 9 Oncology Do Case Studies from Critical Thinking Book Before Class!Do Case Studies from Critical Thinking Book Before Class! 1st CS on pg:495 Adenocarcinoma 2nd CS on pg:509 Breast Cancer 3rd CS on pg:525 Small Cell Lung CA PART 2 REQUIRED READINGS: SMELTZER-Chap. 16,17, & 48

2. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins End-of-Life Care An essential part of nursing practice and patient care. Care of the dying should include a comprehensive approach that addresses: –Respecting the patient’s goals, preferences, and choices. –Attending to the medical, emotional, social, and spiritual needs. –Using the strengths of interdisciplinary resources. –Acknowledging and addressing caregiver concerns. –Building mechanisms and systems of support.

3. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Legislative Issues DNR orders Advance directives –Living will –Proxy directive –Durable power of attorney Assisted suicide legislation

4. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Palliative Care Comprehensive care for patients whose disease is not responsive to cure. Care also extends to the patient's family.

5. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Palliative Care and Hospice Palliative care emphasizes management of psychological, social, and spiritual problems as well as control of pain and other physical symptoms. The goal is to improve quality of life. This is a comfort-focused approach to care that may be used with cure-focused treatment. Hospice is associated with palliative care delivered at the home or in special hospice facilities to patients who are approaching the end of life.

6. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Hospice Care Concept of care in which the end of life is viewed as a developmental stage. Founder of hospice care: Dr. Cicely Saunders (England)

7. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Hospice is associated with palliative care that is delivered at home or in special facilities to patients who are approaching the end of life.

8. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles of Hospice Care Death must be accepted. The patient’s total care is best managed by an interdisciplinary team whose members communicate regularly. Pain and other symptoms must be managed. The patient and the family should be viewed as a single unit of care. Home care of the dying is necessary. Bereavement care must be provided to family members. Research and education should be ongoing.

9. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would not be considered to be an eligibility criterion for hospice? a.Informed choice of palliative care b.Progressive illness c.Acute illness d.Life expectancy of 4 months

10. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Barriers to Improving End-of-Life Care Cure is the focus of the health care establishment. Financial criteria and reimbursement issues Cultural and social issues Discomfort with addressing the issues of death, both on the part of the patient and family, and of health care providers. Psychological and coping responses to death and dying (such as denial)

11. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Reflect on your own experiences and values concerning illness and death. Deliver and interpret technical information without hiding behind medical terminology. Realize the best time for the patient to talk may be the least convenient for you. Be fully present during all communications. Allow the patient and the family to set the agenda regarding the depth of the conversation.

12. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Resist the impulse to fill “empty space.” Allow the patient/family sufficient time to reflect and respond. Prompt gently. Avoid distractions. Avoid the impulse to give advice. Avoid canned responses. Ask questions. Assess understanding, both your own and the patient's

13. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Responding with Sensitivity Responding to difficult questions Discussing at the time the issue is addressed by the patient. Make time. Using of open-ended statements or questions. Seeking clarification. Providing realistic reassurance. Dealing with grief processes. Assessing patient preferences, and spiritual and cultural practices.

14. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Spiritual Care Spirituality includes religion but is not synonymous with religion. Spiritual assessment mnemonic: SPIRIT Addressing spirituality is an important component of the care of the dying patient. Maintaining hope

15. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Physiologic Responses The patient's goal should direct care management. Symptoms: –Pain –Dyspneas See Chart 17-9 –Nausea –Weakness –Anxiety

16. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Approaching Death Refusal of food and fluids Urinary output decreases Weakness and sleep Confusion and restlessness Impaired vision and hearing Secretions in throat Breathing pattern Incontinence Decreased temperature control

17. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Grief and Mourning The grief process Nursing diagnosis: Anticipatory grief Interventions Support expression of feelings. Assess social support. Assess coping skills. Assess for signs of complicated grief and mourning, and offer professional referral.

18. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question All of the following are signs of approaching death except: a.Apnea b.Increased sleep c.Increased urinary output d.Restlessness