ONC 17,18,19

(obj 17) On death and dying
-1st stage is ______: upon hearing the diagnosis, the patient reacts with a shocked, "No, not me." This is a healthy staged and permits the patient and family to develop other defenses.
-Next comes _____: "Why me?", "Why my child?" Blame, directed against the doctor, nurses and God is often part of this stage. This outcry should be accepted, unjudged.
-The third stage is _____: "Yes me, but-" "If you'll just give me five years, God, I'll...." = temporary truce.
-The fourth stage is ______: Now ther person says, "Yes, me" with the courage to admit that it is happening
-Finally comes_____: A time of facing death calmly. This is often a difficutl time for the family, since the patient tends to withdraw, to be silent.

(Obj 17) Signs and symptoms approaching death-psycho/spiritual
______ _____ awareness: special knowledge about, and sometimes a control over the process of dying.

(Obj 17) Signs and symptoms approaching death-psycho/spiritual- not all these characteristics will appear at the same time and some may never appear
-Patient's belief that he/she is in the presence of someone (that is, or is not?) alive.: can occur hours, days, or weeks before actual death. May report recognizing significant people from his/her life and/or religious figures.

(Obj 17) Signs and symptoms approaching death-psycho/spiritual
-Patient's belief that he/she is preparing for _____ or change: may try to communicate with loved ones that he/she is preparing for death. The patient may try to share info with symbolic language to indicate preparation for a journey or change soon to happen. (looking for tickets or passport)

(Obj 17) Signs and symptoms approaching death-psycho/spiritual
-Patient's belief that he/she is seeing a different ____: the patient may see a place not visible ot any one else. The description may be brief and not very specific. Respond "I'm so pleased. I can see it makes you happy. Can you tell me more?"
-Knowing when ___ will occur: The patient may know specifically the day or hour when he/she will die.

(Obj 17) Signs and symptoms approaching death-psycho/spiritual- KEY signs to watch for:
-_____-eyed look
-appearance of ____ through you
-______ or secretiveness
-______ smiles
-gestures such as ____, reaching towards, or waving
-efforts to pick at the _____ or get out of bed for on reason
-_____ or distress at your inability to comprehend what the patient is trying to say.

(Obj 17) Signs and symptoms approaching death-psycho/spiritual
-Respond to anything your don't understand with gentle _____.
-Pose questions in ______ terms.
-Don't ____ or challenge what the patient is saying.
-The patient may use images from life ____ such as work or hobbies.
-Be ___ about having trouble understanding.
-Don't ____, let the patient control the convo.
- If you don't know what to say, don't say ______.

(Obj 17) Signs and symptoms approaching death
1. Pt. will have greatly decreased need for ____ or ____ because the body will naturally beging to conserve energy.
2. The patient will gradually spend more and more time ____.
3. Pt. may become increasingly ___ about time, place, and identity.
4.The pt. may become _____, pull at bed linens, and/or have visions of people or things which do not exist.
5.Clarity of _____ and _____ decrease.
6._____ and _____ output decreases as death approaches.
7.______ of urine and bowel movements is often not a problem until death becomes imminent.
8. ______ secretions may become profuse and collect in the back of the throat.
9. The patient's ______ pattern will become irregular with periods of no-breathing
10. The pt.'s arms and legs become ____ to the touch.

(objective 18)
______ _____:
-does not require a physician's signature/approval.
-Under the specified circumstances, hydration and nutrition supplied by "tube" can be withdrawn.
-There is never an option for the withholding of pain medication.
-Under the specified circumstances, a patient can be taken off a ventilator.
-A person can change what their __ __ says at any time.
-_______ _______: it would generally be a matter of days, weeks or even months before the circumstances and decision making of an __ __ would come into play. Those circumstances occur when one or more physicians determine that the person's condition holds "no reasonable hope" of recovery.

(obj 18) _____ _____ of ____ for medical decisions:
-When a person fills out and AD, it is recommended that they explain their choices to family members and friends. Even though an AD will stand alone, it is much less stress to the family if someone is chosen to be the __ __ __ who will interact with the physicians as the signee's spokesperson. The intention of the role of the __ __ __ is that they represent what the person wants, when that person is unable ot say what he/she wants themselves.

(Obj 18)
Role of PT and in AD's
-ask the patient if they already have an AD completed
-if the person does not already have an AD, the healthcare provider will briefly explain what an AD is about. If the person is interested in learning more, the provider will give the person a blank AD document for them to read. The patient is free to complete the AD or not.

(obj 19)
_____ pain: <6 months duration; etiology known; increased vitals; dilated pupils; sweating; focus; reports pain; crying, moans, restless; grimace.

(obj 19)
_____ pain: > 3 months duration; etiology may not be known; normal vitals; normal pupils; dry skin; distraction; no report; quiet, sleep, rests; blank or normal facial expression.

(obj 19)
1. iatarogenic ____/_____: psychological dependence to an opiod analgesic caused by the physician prescribing it. <1%.
2. ______: a decreased therapeutic effect resulting from the same dose. A higher opioid dosage is required to give the same therapeutic/analgesic effect.
3. ________ ______: if an opioid is abruptly reduced or discontinued it will cause physical withdrawal and symptoms.
4. ________ dependence: compulsive use of an opioid despite harm. The opioid is being used for effects other than pain relief.

(obj 19) Potential side effects of opiods
there are 7

(obj 19) Common opioid drugs
morphine
hyromorphone (dilaudid)

oxycodone (tylox, percocet)

meperidine (demerol)
hydrocodone (lortab)
codeine