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15.Advanced directivesa.Living willb.Allows you to document your medical wishes at end of life carec.Legal documentd.If no person appointed goes in this orderi.Guardianii.Spouseiii.Adult childiv.Parentv.Adult sibling
16.Do not resuscitate orders17. Hospice18.Physiologic and psychological changes at end of life and associated nursing care – LOOK AT CHARTS a.Goalsi.Provide support during dying processii.Improve quality of patients remaining lifeiii.Help ensure dignified deathiv.Provide emotional support to family v.Physical care meansvi.Skillful communicationb.Nursing Implementation: Psychosociali.Some things cannot be changed or fixedii.We cannot change the inevitability of death. iii.We cannot erase the anguish that is felt when someone is dying or has died. iv.We all must face the fact that we will die. v.No matter how hard we try, the perfect words or gestures to relieve a patient or family’s distress rarely exist. vi.It is most often enough to be compassionately with the person19.Care of family, communicationa.SPIKES = A Six-step Protocol for Delivering Bad Newsi.Settingup the interview1.Privacy2.Involve significant others3.Sit down4.Make connection with patient/family5.Manage time constraints and interruptionsii.Assessing the patients perception1.Use open-ended questionsiii.Obtaining the patients Invitation1.Determine whether the patient wants specific details or a more generalized overviewiv.Giving knowledgeand information to the patient1.Provide warning2.Avoid using medical terms3.Don’t be overly blunt4.Provide info in small chunks and assess understand periodically5.Don’t say “there’s nothing else we can do…”v.Addressing the patient’s Emotions and Empathetic1.These may include silence, disbelief, crying, denial, anger2.4 steps to empathetic response
vi.Strategyand Summary1.Ask if patient is ready to discuss treatment option2.Allow patient to express fears and conernsDiabetes (15)