Death Flashcards
How can you increase quality of life for a frail patient (medical perspective)?
Decrease treatment burden, increase care + support
Maximise benefit from existing treatments
Stop treatments with limited benefit
Reduce medications with high risk of adverse effects
Consider non-pharmacological alternatives
Optimise number of appointments to decrease burden (as few as possible, multiple on same day)
Use individualised care plans
List some common symptoms of dying that are not medically managed
Profound weakness Gaunt appearance Drowsiness Disorientation Diminished oral intake Poor concentration Skin colour changes Temperature changes at extremities Patient must have condition that would mean it is not surprising that the patient is dying (eg. end stage heart failure, metastatic cancer, can include old age)
List some common symptoms of dying that are medically managed
Pain Breathlessness Agitation Secretions Vomiting Fitting/seizures Bleeds Urinary incontinence/retention
What are some problems with end of life drugs?
Sedation
Respiratory depression
‘Drying’
Confusion/amnesia
What are the 3 key principles of symptom control in a dying patient?
Anticipation of problems - add drugs to ‘as required’ on drug chart for symptoms we know will occur, even if not present yet
Non-oral route
Stop medication not helping symptoms
What 3 things are important for any remaining drug on a dying patient’s drug list?
Each drug left on chart should be justified
Each drug left should not cause side-effects
Each drug left should be easy for patient to manage
What is the death rattle?
common noisy, rattly, wet breathing noise
probably normal secretions that a dying patient is too weak to clear
upper airway
can sound like drowning
especially distressing to patient and family when combined with Cheynes-Stokes breathing
Position, suction, drugs (use syringe driver)
What is a syringe driver and why are they used?
device for delivering steady infusion (continuous sub-cutaneous infusions (CSCI))
keeps constant plasma concentration of drugs
non-oral route preferred in dying patients (too weak to swallow)
fewer repeated injections/discomfort
can control multiple symptoms by using a combination of drugs
What is a MCCD and what are it’s key features?
Medical Certificate as to the Cause of Death
Enables family to register death
Provides info on how/why patient died
Informs research into health effects of exposure to a wide range of risk factors
Direct cause on line 1a + work back with factors/conditions that led to that
What are the principles of palliative care?
pain + symptom relief
life + dying = normal process
neither hastens nor postpones death
holistic care (physical, psychological + spiritual)
support system to allow patient to live as actively as possible
support system for family
uses team to approach patient’s needs
What are the physical signs that a death has occurred?
no spontaneous movements no respiratory effort no heart sounds no palpable pulses absence of reflexes no response to pain stimuli pupils fixed + dilated retinal vessels show coagulation
What are the benefits of a hospice?
provides pain control provides care needs/dignity caters for drug administration needs relief for carers decreased emotional stress for children/relatives patient's wishes
