階段 6 — 評估結果。回顧日班軌跡,並回答關於症狀緩解、升級及死亡後照護的三個問題。 | MyMerci
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階段 6 — 評估結果。回顧日班軌跡,並回答關於症狀緩解、升級及死亡後照護的三個問題。

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TimeData
0700 — Initial assessmentRR 28 and labored with intermittent Cheyne-Stokes breathing; BP 96/58; mottled knees; arousable only to firm voice; coughing and pocketing a sip; grimacing and reaching into the air; pooled upper-airway secretions audible. Family asks whether he is suffering.RR 28 且費力,伴隨間歇性陳施氏呼吸;BP 96/58;膝蓋花斑;僅對大聲呼喚有反應;咳嗽且一口水含在口中;面部扭曲並向空中伸手;可聽見上呼吸道分泌物積聚。家屬詢問他是否在受苦。
0720 — Goal-concordant careThe nurse explains the changes, positions Mr. K with the head elevated and supported side-lying, provides mouth and lip care, continues oxygen for comfort, and administers prescribed subcutaneous morphine for observed dyspnea. The secretion medication is used only for its documented target and response is monitored.護理師解釋變化,將 K 先生頭部抬高並側臥支撐,提供口腔和嘴唇護理,持續供氧以維持舒適,並依醫囑皮下注射嗎啡以緩解觀察到的呼吸困難。分泌物藥物僅用於其記錄的目標,並監測反應。
0800 — ReassessmentBreathing remains irregular but is less labored; brow and jaw are relaxed; restless reaching has stopped; secretions are softer. Mottling and reduced responsiveness continue. The wife accurately explains that the care is relieving distress rather than reversing the dying process.呼吸仍不規則但費力減輕;眉頭和下巴放鬆;躁動伸手停止;分泌物聲音變小。花斑和反應力下降持續。妻子準確解釋照護是在緩解痛苦,而非逆轉瀕死過程。
1430 — Death with family presentBreathing gradually slows and stops. Required notification and pronouncement procedures begin. The nurse checks medical-examiner, donation, facility, and family requirements before device removal or postmortem care.呼吸逐漸減慢並停止。開始必要的通知和宣告死亡程序。護理師在移除裝置或進行死後照護前,檢查法醫、捐贈、機構及家屬要求。

Q1. Which evaluation best describes the response by 0800?哪項評估最能描述 0800 時的反應?

Q2. Which finding would require prompt hospice-prescriber or specialist reassessment?哪項發現需要立即由安寧照護開立處方者或專科醫師重新評估?

Q3. Which action cluster is appropriate after death?死亡後哪組行動是適當的?

解析
結果解讀
呼吸費力減少、臉部肌肉放鬆、躁動伸手動作消失,以及家屬理解,支持有效的症狀緩解和符合目標的照護。持續的花斑和反應力下降反映潛在的瀕死過程,本身並不代表舒適計畫失敗。若在醫囑介入後持續出現痛苦,則需要立即由安寧照護開立處方者或專科醫師重新評估。

死亡後
遵循法律和機構要求進行通知和宣告死亡,判斷法醫或捐贈程序是否需要保留管路,尊重文化和宗教偏好,保管遺物,記錄,並將家屬連結至安寧哀傷服務。Medicare 安寧哀傷諮詢可在死亡後持續最多一年,而非 13 個月。
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