pain management, end of life care, and ethical and legal issues

pain
unpleasant sensation experienced by all human beings
pain is both ___________ and __________
emotional
sensory
acute pain
short
identified injury source
affects functional health
often no long standing effects
chronic/persistent pain
prolonged pd. time
disease not well defined
affects functional health
affects psychological and emotional status
pain is?
subjective
visceral pain
organ pain
somatic pain
pain of muscles, joints, connective tissue, and bones
neuropathic pain
damage from the CNS and PNS
hyperalgesia
increased sensitivity to pain
normal changes of aging of pain
acute pain and persistent pain
pain assessment in cognitive impaired
verbal communication is challenging
undertreatment/ no treatment is common
6 pain indicators in older adults with dementia
facial expressions
body mvmts
vocalizations
interpersonal interactions
activity patterns
mental status change
pain scale for dementia
PAINAD
pain management in older adults
pain may be more difficult due to age related changes and decline of renin and hepatic functions

opioids, non opioid, adjuvant

unrelieved pain can result in
depression, anxiety, decreased socialization, sleep disturbance, impaired ambulation, increased health care cost
nurses role in end of life care
respect patients wishes
relieve suffering,
coordinate care,
preparation of the patient and family for death,
clarification and communication of goals, support decision making process
hospice
needs to be determined by two physicians, support in the last phase of life through medical care
myths of hospice
all care is the same
medicare only provides 6 months of coverage
hospice is giving up hope
you cant keep your own doctor
palliative care
an approach that involves the quality of life of patients and their families facing the problem associated with life threatening illness
dying process
lower extremities mottled
saliva secretions build up
cheyne strokes
skin: dusky/grey/cold/clammy
eye discoloration
postmortem care
remove tubes
change soiled linen
wash body
body on back
dentures
clean gown
respiratory assessment
support of the family
who announces death?
doctors and nurses but physician has to sign
ethical issues
Autonomy
making independent decisions
decision capability/incapability
beneficence/ nonmaleficence
do good/ no harm
confidentiality
right to privacy
HIPAA
justice
being fair
access to healthcare services
veracity
telling the truth
fidelity
keeping promises
durable power of attorney
someone to make healthcare decisions for you when no longer able
living will
written statement of patient desires
CMO
comfort care measures only
DNR- CC
do not resuscitate comfort care – only comfort care administered
DNR -CCA
do not resuscitate comfort care arrest – treat the patient fully until arrest
active euthanasia
administering
passive euthanasia
withholding
voluntary euthanasia
decision making capacity
non voluntary euthanasia
decision made by others
involuntary euthanasia
punishment