Notes

Sensory Organ Deficits:
Age related macular degeneration (ARMD)-cant read much, have to get intense eye magnifications
glaucoma: no symptoms, don't know they have it until they get screened
sensorinural hearing loss: inner ear affects it, has to do with the hair cells and neural stimulus stuff. The hair cells have been damaged or the optic nerve couldve been damaged. conductive is anything that interrupts the mechanical conduction of sound up to it hitting the eardrum, ear wax is a common problem. Noise induced: affects conduction of noise in the inner ear, older adults, under the sensorineural hearing loss umbrella.
Changes in hearing: people are reluctant to go to audio testing, most hearing loss cant be changed but can be improved with hearing aids, it really impacts communication (cant hear high pitch sounds like women or kids or cell phone ringing) and they cant really tell who is saying what vs what is background. By 85 half the population has hearing loss, its more common in men.
Alterations in smell and taste: can affect safety and quality of life
sensory overload: could happen in ICUs, theres alot going on. sensory deprivation: could be in nursing homes, esp if person is paralyzed, had a stroke, is cognitive impaired.
ototoxicity: pushing Lasix too quickly, using too much aspirin or for too long
Assessment: figure out whats changing in their functional status

Loss, Death, and Grief
loss can be more than death, death is the ultimate loss. grief is different that loss. someone that has a loss may not have much grief or someone that is grieving a lot may not seem to have a huge loss. grief is whatever the person says it is. Actual loss can encompass many things, including a social scandal, etc. Perceived loss is just as bad as actual loss to the person.
Complicated grief: exaggerated grief is when the loss is so severe that they just cannot cope or function. delayed grief is when it is processed later on. Masked grief is when person doesn't process that a loss has happened. Disenfranchised grief is when its not socially acceptable like if a mistress griefing a man but cant show it in front of the wife.
The dying process: may see increased jaundice, swelling, lowered ability to complete ADLs, changes in organ failure, youll see a drop in urine output. Double effect: youre giving a medication for a given purpose, and you know that it has unfortunate side effects but you give it anyway. Sometimes cath is the right thing because person has no control over urine. Will have low vitals, so you stop checking it and only do it if the family asks. If person is on comfort care dont have them on cardiac monitor. Mottling of the skin goes hand in hand with CV, body will shunt blood to vital organs. In resp youll see SOB, will sound wet, cant cough, will Cheyne-Stokes breathing. Even after a patient dies the patient may still exhale.
Nurses Role at end of life: advocacy for patient, talk with them, learn and respect patient's wishes. Never give a time limit for their death. use opoids for air hunger. Hospice is a service, not necessarily a place.
After death has occurred: best thing is just being present. Validating a persons life is important. Ask people to share stories. Listen to the patient more than saying "she's in a better place" provide comfort to the family. Next notify the provider so they can pronounce the time of death. The time the MD says death is, is the time that gets put on the certificate. Next contact donor services so they can see if they can use anything or ask the family for anything.
Post-Mortem Care: clean the body first, oral care, bath, if there will be an autopsy leave all the tubes and drains, but side rails down, turn off monitors.
End of life Decision Making: DNAR(do not attempt resuscitation), POA (power of attorney), living will (what tubes, things they want done). All medicare/medicaid facilities must ask about advanced directives upon admission.