Week 4: Palliative and end of life care

Question 1

Models of Palliative Care

Answer 1

community based support: home, RAC, general practices
hospital based support: inpatient, outpatient services, emergency departments

Question 2

National Palliative Care Strategy

Answer 2

people affected by a life-limiting illnesses, including carers and families, may benefit from the varied support available through palliative care. Helping people to live as well as possible for as long as possible is ultimately what palliative care is seeking to achieve.

Question 3

palliative care standards

Answer 3

assessment of needs,
develop the care plan
caring for carers,
providing care,
transitions within services,
grief support
service to culture
quality improvement
staff qualification and training

Question 4

standard 1 criteria

Answer 4

needs assessment carried out by qualified interdisciplinary staff
person’s needs are regularly reassessed
documented in the person’s clinical record

Question 5

standard 2 criteria

Answer 5

Care planning is based on assessment process and reflects a person-centred, holistic approach
up to date information appropriate to meet their needs
substitute decision maker if a person does not have the capacity

Question 6

standard 3 criteria

Answer 6

works with the family and carers to understand their needs and desired level of involvement in care
There are systems in place to ensure that the person’s nominated family and carers are supported to
participate
The family and carers are provided with information about the signs and symptoms of approaching death
and the steps to take following death

Question 7

standard 4 criteria

Answer 7

Care is delivered promptly, in accordance with the changing needs
uses the best evidence to inform clinical practice.
Where care cannot be delivered in accordance with the goals and preferences of the person, this is discussed

Question 8

standard 5 criteria

Answer 8

Care is integrated across the person’s experience to ensure seamless transitions within and
between services:
Care plans demonstrate appropriate actions for handover
Referrals from the specialist palliative care service are made to appropriate specialists or services that are able to meet needs
Services assist local community-based service providers to help home based palliative care

Question 9

standard 6 criteria

Answer 9

risk assessment process begins on intake to the palliative care service and continues throughout the service’s involvement with the person and beyond.

Referrals to bereavement, specialist mental health and/or counselling professionals are made when
clinically indicated.

provides education about loss, grief and bereavement to staff, volunteers and other community providers.

Question 10

Principles of symptom management

Answer 10

 Evaluation
 Explanation
 Discussion
 Individualised treatment
 Monitoring
 Dose escalation

Question 11

common symptoms

Answer 11

Dyspneoa (reassure, reposition, oxygen)
Nausea and vomiting (anti nausea, small fluid & food, vomit bag in place)
Dehydration (rehydrate, keep mouth moist, offer icy poles)

Question 12

Xerostomia is?

Answer 12

Dry, painful mouth
Caused by radiotherapy to head and neck
Some medications like tricyclic anti-depressants, antihistamines and anti-cholenergics

Can you think of 2 ways to help manage this?
1. Small frequent sips
2. General mouth care; water; sprays; oral balance; lip balm

Question 13

last day of life toolkit?

Answer 13

1. Recognition and Management Planning (standardise prescribing guideline, 5 symptoms management flowchart)
2. Medication Management
3. Transfer to Die at Home Plan (back up plan if tough for carer at home, med cert cause of death)

Question 14

Anticipatory medicines

Answer 14

are injectable or sublingual medications prescribed to a person with a life-limiting illness. These medications are prescribed and dispensed in preparation for a time when a person needs them to manage symptoms

Question 15

After death occurs

Answer 15

notify your palliative care service or can directly contact the funeral director of your choice. Nurse from the service will visit to support your carer, family, friend or support person.
Doctor can fill out the Medical Certificate of Cause of Death as long as they know your medical history within 48 hours of death. The doctor will also notify the Registrar of Births, Deaths and Marriages.

Question 16

Nursing responsibilities and management

Answer 16

Be present and accepting; hear the patient & family.
Support the right to grieve.
Acknowledge that there is no one right way to grieve.
Provide assurance of normality; do not offer false reassurance.
Consider how information is delivered & received.
Check understanding consult and refer.