CHP-SW flashcards

33 cards. Read the term and the definition here. The deck at the top of this page is optional.

Hospice prognosis criterion

A prognosis of six months or less if the terminal illness runs its normal course, combined with election of palliative rather than curative treatment for that diagnosis.

Hospice vs palliative care

Palliative care can start at diagnosis and continue with curative treatment; hospice requires a six-month prognosis and focuses on comfort for the terminal diagnosis.

Four levels of hospice care

Routine home care, continuous home care for crisis, general inpatient care for uncontrolled symptoms, and respite care of up to five consecutive days per benefit period.

Hospice interdisciplinary team

Core members are the physician, registered nurse, social worker, chaplain or counselor, and trained volunteers, who together develop and review the plan of care.

Total pain concept

Cicely Saunders described pain as physical, psychological, social, and spiritual; unrelieved suffering in any domain can present as refractory physical pain.

Bereavement support requirement

Hospice must have a bereavement plan before death, make at least one contact after death, and offer follow-up support for up to thirteen months.

POLST or MOLST

A portable medical order signed by a clinician that records treatment preferences for seriously ill patients and travels across care settings.

Opioid equianalgesic conversion

Oral morphine 30 mg approximates oral oxycodone 20 mg and IV morphine 10 mg; reduce the calculated dose by 25 to 50 percent for incomplete cross-tolerance.

Naloxone reversal principle

Titrate small doses to restore respiratory rate without fully reversing analgesia, and monitor for re-sedation because opioid half-life may exceed naloxone's duration.

Terminal secretions management

Anticholinergics and repositioning are used for audible secretions near death; explain to families that this is expected and generally not distressing to the patient.

Delirium at end of life

Often reversible; screen for urinary retention, constipation, dehydration, infection, and medications before labeling it terminal agitation or treating with sedatives.

Grief versus depression

Grief comes in waves, is triggered by reminders, and preserves self-esteem; depression is persistent, pervasive, and includes worthlessness, guilt, and anhedonia.

Complicated grief indicators

Persistent yearning, functional impairment beyond twelve months in adults, identity disruption, and avoidance suggest prolonged grief and warrant specialized referral.

SPIKES framework

A six-step protocol for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or Summary, with empathic responses throughout.

NURSE framework

A response to emotion: Name the emotion, Understand it, Respect it, Support the patient, and Explore what lies beneath it.

Ask-Tell-Ask

Elicit what the patient already understands before giving information, then check understanding again, reducing mismatch about prognosis and goals.

Substituted judgment standard

Surrogates decide as the patient would have decided based on known values; best interests applies when the patient's wishes are unknown.

Capacity assessment principle

Capacity is decision-specific; a patient may lack capacity for complex surgery but retain capacity to choose a surrogate or refuse a treatment.

FICA spiritual assessment

A brief spiritual history covering Faith, Importance, Community, and Address in care, which the social worker can complete and refer onward.

Worden grief tasks

Accept the reality of loss, process the pain, adjust to a world without the deceased, and relocate the relationship while moving forward.

Kubler-Ross stages

Denial, anger, bargaining, depression, and acceptance describe common reactions to dying, not a required sequence every patient follows.

Hospice benefit periods

Two ninety-day periods followed by unlimited sixty-day periods, each requiring recertification, with a face-to-face encounter before the third and later periods.

Hospice revocation right

A patient may revoke hospice at any time; live discharge requires a written plan, medication reconciliation, and coordination with community providers.

Continuous home care criterion

Crisis care in the home requiring at least eight of twenty-four hours of nursing or aide services to manage acute symptoms and avoid hospitalization.

Respite care limit

Up to five consecutive days per benefit period, provided to relieve family caregivers, typically in a Medicare-approved facility.

Hospice aide scope

Personal care only, delivered under a registered nurse-supervised plan of care; the social worker coordinates but does not supervise clinical care.

Withholding vs withdrawing

Most ethical frameworks treat withholding and withdrawing burdensome treatment as morally equivalent when benefits are outweighed and consent is obtained.

Double effect principle

An action with a good intended effect and a foreseeable bad effect may be permissible if the bad effect is not the means to the good and is proportionate.

Palliative sedation

Refractory symptom management using sedatives with informed consent and interdisciplinary agreement; the intent is relief, not ending life.

Signs of imminent death

Mottling, cool extremities, decreased urine output, Cheyne-Stokes respirations, terminal secretions, and decreased consciousness in the final hours to days.

Caregiver burnout signs

Exhaustion, resentment, withdrawal, declining personal health, and neglect risk; interventions include respite care, support groups, and education.

Confidentiality limits

Imminent harm to self or others, suspected abuse or neglect of a child or vulnerable adult, and court order override confidentiality and require reporting.

Pediatric palliative care principle

Care can combine curative and comfort treatment, with parents as surrogate decision-makers and long-term bereavement support for siblings and parents.