Cardio quiz 1

• Advance Directives


  Designates an agent, surrogate, or proxy to make healthcare decisions on the patient's behalf based on the patient's wishes
• Living Will


  A written document that directs treatment in accordance with a patient's wishes in the event of a terminal illness or condition
• Hospice


  • Controlling or alleviating the patient's symptoms
  • Allowing the patient and caregiver to be involved in the decisions regarding the plan of care
  • Encouraging the patient and caregiver to live life to the fullest
  • Providing continuous support to maintain patient and family confidence
  • Educating and supporting the primary caregiver in the home setting that the patient chooses
• Hospice team members


  • Medical Director
  • Nurse Coordinator
  • Social Worker
  • Spiritual Coordinator
  • Volunteer Coordinator
  • Bereavement Coordinator
  • Hospice Pharmacist
  • Primary Health Care Provider
  • Primary Nurse
  • Primary Spiritual Leader
  • Hospice Volunteer
  • Hospice Aide
• Medical Director


  • Mediates between the hospice team and attending medical provider
  • Provides consultation relative to the medical aspect of care
• Nurse Coordinator


  • Manages the patient's care
  • Explains the service, admits the patients, assigns the primary team
• Social Worker


  • Evaluates the patient's psychosocial needs
  • Serves as resource for potential community services
  • Assist with counseling in grief issues
• Spiritual Coordinator


  • Serves as liaison between the patient and the spiritual community
  • Coordinates spiritual support
• Volunteer Coordinator


  • Recruits and trains the volunteers
  • Coordinates assignments of volunteers
• Bereavement Coordinator


  • Assesses and supports the bereaved survivor
  • Facilitates support groups
• Hospice Pharmacist


  • Provides drug consultation
• Primary Health Care Provider


  • Responsible for the medical aspect of symptom control for the patient
• Primary Nurse


  • Serves as liaison for patient and caregiver, healthcare provider, and interdisciplinary team
  • Evaluates patient's response to treatment
  • Educates the patient and family in disease process and care
  • Assesses symptom management
  • Provides emotional support to patient and caregiver
• Primary Spiritual Leader


  • Supports patient and caregiver in coping with fears and uncertainty about spiritual issues
• Hospice Volunteer


  • Provides companionship for patient and caregiver
  • Available for short period of respite care
• Hospice Aide


  • Administers personal care and assistance with bathing
  • Therapeutic communication
• Stages of grief


  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Nursing support for patient/family communication and involvement in care planning


  • The thanatologic philosophy dictates that the family members are free to choose if and when they wish to be with the patient who is dying. DO NOT raise a barrier because of "visitation hours"
  • Allow young children to visit a dying patient when the patient is able to communicate
  • Be willing to listen to family members' complaints about a patient's care and their feelings about the patient
  • Help family members learn to interact with the dying patient
  • Allow family members to help with as much or as little patient care as they desire
  • When the family becomes fatigued with care activities, relieve them from their duties so they can get the rest and support they need. Refer them to resources for meals and lodging
  • Support the act of shared grieving among patient and family. Provide privacy when preferred. DO NOT discourage open expression of grief between patient and family
  • As the time of death approaches, assist family members to stay in communication with the dying patient through short visits, caring silence, touch, and telling the patient of their love for him or her
  • After death, assist the family with decision making, such as selection of a mortician, transportation of family members, and collection of the patient's belongings
• Physical Care


  • Provide thorough skin care, including daily baths, lubrication of skin, and dry clean bed linens to reduce irritants
  • Provide oral care as least Q2-4H
  • Use soft toothbrushes or foam swabs for frequent mouth care
  • Apply a light film of water-soluble lubricant of lip balm to lips and tongue
  • Eye care removes crusts from eyelid margins
  • Artificial tears reduce corneal drying
• EOL-specific symptoms - Physical Pain


  • Frowning
  • Grimacing
  • Appetite changes
  • Poor sleep
  • Fearful expression
  • Teeth grinding
  • Fidgeting
  • Groaning or moaning
  • Crying
  • Sighing
  • Heavy breathing
  • Decreasing activity
  • Change in gait
  • A loss of function
• EOL-specific symptoms - Emotional Pain


  • Forgetfulness
  • Poor concentration
  • Dull senses
  • Lethargy
  • Boredom
  • Low productivity
  • Negative attitude
  • Anxiety
  • Mood swings
  • Anger
  • Bad dreams
  • Irritability
  • Crying spells
  • Nervous laughter
  • Dependency on others
• EOL-specific symptoms - Nonverbal Indicators


  • Tense body language
  • Restlessness
  • Strained facial expressions
  • Sad facial expressions
  • Tearfulness
  • Increased resistance with movement
  • Increased breathing
  • Shortness of breath
  • Withdrawing from family and activities
  • Decreased communication
  • Weight gain because of inactivity
  • Rubbing affected areas
• Air hunger - pharm and non-pharm interventions


  1. Treat or control underlying cause

  2. Maximize patient's oxygenation

  3. Position patient upright

  4. Provide supplemental oxygen

  5. Maintain patent airway

  6. Reduce anxiety and fear

  7. Administer medications such as bronchodilators, inhaled steroids, or narcotics to suppress cough and ease breathing and apprehension
• Anorexia / cachexia


  • Serve smaller portions and bland foods, which may be more palatable
  • Allow home-cooked meals, which may be preferred by patient and gives the family a chance to participate
• Signs of imminent death


  • The arms and legs of the body sometimes become cool to the touch, and the underside of the body sometimes becomes darker
  • The patient may spend more and more time sleeping during the day and at times is difficult to arouse
  • The patient may become increasingly confused about time, place, and identity of close and familiar people
  • Incontinence of urine and bowel movements often happens when death os imminent. Sometimes there is a significant decrease in urine output
  • Oral secretions sometimes become more profuse and collect in the back of the throat. This produces the sound often referred to as the "death rattle"
  • Clarity of hearing and vision decrease slightly
  • Restlessness, pulling at the bed linen, and having visions of people or things that do not exist sometimes occur
  • The patient's need for food and drink decreases
  • Breathing patterns change to an irregular pace; there are sometimes 10-30 second periods of no breathing (apnea)
  • Changes in vital signs occur, with decreased blood pressure and elevated pulse
• Troponin levels


  0-0.4 is normal range, 0.4 and over is abnormal (cardiac damage)
• Warfarin


  Monitors PT/INR, Therapeutic range for INR around 2 (Coumadin)
• Nitro


  Vasodilator, relaxes vessels and blows up a balloon inside
• PT INR normal ranges


  Around 2-2 coumadin
• Angina


  Chest pain, not getting the proper function of the heart
• MI


  Damage to heart
• CPR


  30:2 adults, 15:2 children, hands on the sternum
• Ventricle adequacy


  • Check pulses to see rate & rhythm
• Check if intact, no bleeding, awake, normal urine output, skin warm and dry
• Echocardiogram


  Ultrasound of the heart to see the flow
• EKG


  Electrical image of the heart
• Signs/Symptoms of heart failure


  • Edema
  • SOB
  • BP decrease
  • Heart rate increase
  • Temperature decrease
• Administer diuretics


  To increase urine output
• Nocturnal dyspnea


  Trouble breathing at night, sleep in a recliner
• Modifications for CAD


  • Weight loss
  • No smoking
  • No drinking
  • Increased exercise & water intake
  • Change to a healthier diet