1.10 - Palliative Care Flashcards
Define palliative care.
The active, total care of the patient whose disease is not responsive to curative treatment.
Control of pain, of other symptoms, and of social, psychological and spiritual problems is paramount.
What is end of life care?
The care for patients who are likely to die within the next 12 months.
Barriers to recognising deterioration in patients.
- unclear diagnosis
- complex and difficult
- lack of confidence
- fear
- destroy hope
- difficult questions
Trajectories of decline at end of life.
- cancer (short decline)
- organ failure (intermediate with acute episodes)
- frailty or dementia trajectory (gradual dwindling)
Screening tool example for patients approaching end of life.
SPICT - identifies people at risk of deteriorating and dying.
General indicators of decline.
- unplanned hospital admissions
- poor performance status
- dependent on others for care
- carer requiring support
- significant weight loss
- persistent symptoms despite optimal treatment
- decision to reduce, stop or not have treatment
ECOG performance status.
Factors that indicate that dying is immenent.
- bed-bound
- drowsiness
- difficulty taking oral medications
- reduced food and fluid intake
- increased symptom burden
Five priorities for care of the dying person (LACDP).
- Possibility of death is recognised and communicated.
- Sensitive communication between staff and the dying person.
- Dying person is involved in decisions about the treatment and care, to the extent the dying person wants.
- Needs of the families and others is identified as important, and met as far as possible.
- Individual care plan (ie. food, drink, symptom control, psychological support, social support, spiritual support).
Recognising the dying phase.
- shallow breathing
- use of accessory muscles of respiration
- respiratory secretions
- temperature changes
- decreased level of consciousness
- agitation / restlessness
- decreased urine output / incontinence
- difficulty swallowing
Common symptoms in the dying.
- pain
- N+V
- breathlessness
- restlessness and agitation
- respiratory secretions
Anticipatory medications for end-of life care.
- morphine 2.5-5mg SC PRN
- levomepromazine 2.5-5mg SC PRN
- midazolam 2.5-5mg SC PRN
- glycopyronium 200-400mcg SC PRN
Indication of anticipatory morphine.
- pain
- breathlessness
Indication of anticipatory levomepromazine.
- N+V
- restlessness and agitation
Indication of anticipatory glycopyronium.
- respiratory secretions
