Pallia by Mm.

Gabule (1/4/17)
END OF LIFE NURSING PRACTICE:
INTEGRATING PALLIATIVE CARE
S/SX of Impending Death
1. Decreased food & fluids
- never force food/fluids
- use glycerin swabs to keep
mouth & lips moist
2. Increased sleeping & withdrawal
- sit w/ the person
- hold his/her hand gently
- speak softly & naturally
3. Incontinence
- reposition & change pads
frequently
4. Breathing pattern change &
congestion
- try elevating the persons head
by raising head of bed or use of
pillows
5. Changes in temperature & skin
color
- keep person warm if they
appear cold but dont use
electric blankets
6. Restlessness & disorientation
- hold persons hand or gently
massage the forehead
At the time of death, call a supportive
person to be with you before making
other calls.
NURSING INTERVENTION BEFORE
& DURING DEATH
Outcome:
demonstrate freedom to express
feelings, needs, fears, concerns
identify & use effective coping
strategies
accept need for help as appropriate
& use available resources
Implementing:
develop trusting nurse-patient
relationship

explain patient condition &

treatment
teaching self-care & promoting selfesteem
teaching family members to assist
in care

Meeting the needs of dying patients:

physiologic needs
psychological needs
spiritual needs
Providing post-mortem care:
caring for patients body
caring for family
discharging specific legal
responsibilities
care of other patients
Evaluation:
Care is effective if dignified
death & family members resolve
their grief after a suitable time of
mourning & resume meaningful life
roles & activities

MS by Sir Nalzaro (1/5/2017)

DEGENERATIVE DISORDERS
Parkinsons disease
-

progressive neuro disorder

resulting from degeneration of
basal ganglia in the cerebrum;
men > women
degenerative change are found
in substantia nigra (which
produces dopamine)

Etiology:
a.
b.
c.
d.

viral
chemical toxicity
cerebrovascular disease
effects of drugs such as major
tranquilizers & reserpine

Pathophysiology:
Depletion of dopamine diminishes
normal NM inhibiting mechanisms
neurologic deficit
Clinical Manifestations:
1. tremor early sign
2. bradykinesia, akinesia,
dyskinesia
3. cogwheel rigidity
4. fatigue & muscle weakness
5. masklike facial expression
6. oily skin
Nursing Mgmt:

a. meds antiparkinson,
anticholinergic, antihistamine
agents
a1. Antiparkinsonian (LEVODOPA)
inc. striatal dopaminergic activity;
act on neurotransmitter pathways
other than dopaminergic pathway
a2. Anticholinergic (BIPERIDEN &
BENZTROPINE MESYLATE)
controls tremor & rigidity
a3. Antiviral (AMANTADINE
HYDROCHLORIDE)
b. provide semisolid diet
c. maintain adequate airway
d. maximize functional abilities
Other: dopamine agonists, MAOI,
cathecol-O-methyltransferase inhibitor,
antidepressant
focus on physical & psychological
deficit
observe mood, cognition,
organization, & general well-being
Surgical Mgmt:
Thalamotomy & Pallidotomy effective in
relieving many symptoms
Thalamotomy stereotactic electrical
stimulation destroys part of ventrolateral
position of thalamus to reduce tension
Deep brain stimulation electrode is
placed in thalamus & connected to pulse
generator implanted in subcutaneous
subclavicular or abdominal patch
Note:

if unresponsive to
pharmacotherapy,
ELECTROCONVULSIVE THERAPY is
indicated
use SEDATIVES with sleep related
problems
dont force into situation which
they feel ashamed of their
appearance

instruct to speak slowly, clearly &

to pause & take a deep breath
relaxation therapy

Abnormal collection
of glutamine in

Interfere
biochemical

(George) Huntingtons disease (1972)

-

onset 35-45 yo
chronic, progressive hereditary
disease of neuro system
resulting in involuntary
choreiform movment &
dementia; d/t degeneration of
basal ganglia progressing to
cerebral cortex
transmitted as an autosomal
dominant genetic disorder:
chromosome #4

Pathophysiology:

Chromosome #4
contains

Premature death of
cells in basal
ganglia, cortex
cerebellum
Neurotransmitter
imbalance
Dec. in

Inc. in ACTH

Inc. in

Clinical Manifestations:
1) Chorea/Choreiform movement
abnormal involuntary twitching
2) Constant writhing, twisting,
uncontrollable movement involving
entire body
3) Chewing & swallowing is difficult;
results to exhaustion
4) Slurred speech
5) Cognitive function is affected
6) Impaired memory
7) Hallucinations & delusions