End of Life Flashcards
(17 cards)
What is palliation ?
active total care of patients whose disease is not responsive to curative treatment
- control of pain, and other symptoms
What is the goal of palliative care ?
to achieve the best quality of life for pt’s and families
- prevent or treat symptoms of disease, or treat the disease as early as possib;e
- prevent or treat the psychologic, social and spiritual problems related to the disease or treatment
- help patients with chronic conditions live more comfortably
What is disease trajectory ?
can be viewed from 3 different perspectives
- short period of evident decline
- sudden death from complications or acute exacerbation
- long-term limitations
What are the goals of paradigm shift ?
- maintain optimal health and quality of life for those with multiple chronic conditions
- introduce palliative care earlier into the management of chronic diseases
What is the plan of care based on ?
- 1st on the patient and families realistic expectations and goals
- 2nd the team’s assessment, recommendations, and support
What are some interventions for dyspnea ?
- pursed lip breathing
- fans, open windows
- positioning & relaxation
- supplemental O2
- opioids
- diuretics
- bronchodilators
What are some interventions for anorexia and cachexia (wasting syndrome) ?
- avoid restrictions
- select appealing foods
- appetite stimulants
- anti-emetics
- artificial nutrition can prolong suffering and cause complications
How do you break bad news ?
SPIKES
- get the physical SETTING right
- finding out how much the patient and family PERCEIVE
- finding out how much the patient wants to know/allow them to INVITE the info
- sharing medical KNOWLEDGE
- responding to the patient and family’s EMOTIONS
- planning and SUMMARIZING
What is some post-mortem care ?
- close pt’s eyes
- replace dentures
- wash the body as needed
- remove IV’s, tubes, and dressings
- straighten body/support head with pillows
What are some signs of moment of death ?
- absence of respirations and pulse
- fixed and dilated pupils, eyes may remain open
- release of urine and stool
- waxen color as blood settles to dependent areas of body
- lack of reflexes
- absence of brain waves on EEG
What does dying look like ?
- wet, slow, shallow, or loud breathing, apnea
- urinary changes: little or no output, incontinence
- increased pain
- moaning
- restlessness, agitation
- cool extremities
- sweating, mottled skin
What is anxiety ?
a subjective feeling of apprehension, tension, insecurity, and uneasiness, usually without a known cause
What is delirium ?
a state of mind characterized by restlessness, illusions, and incoherence of thought and speech
What are some interventions for anxiety/delirium/agitation/confusion ?
- tx based on underlying cause
- decreased LOC and agitation are expected but can be distressing to family
- can use neuroleptics, tranquilizers, or antiolytics
- hearing is last sense to fade, don’t engage in conversation as if the patient is not present (this can increase pt agitation)
What are some interventions for intestinal obstruction ?
- NG tube
- surgery
- symptom management: relieve/prevent constipation, small meals with reduced roughage, served when pt requests
What are interventions for constipation ?
- stool softeners and stimulus
- MOM
- lactulose
- dulcolax syrup
- fleets
What are some interventions for N/V ?
- assess and tx cause
- liquid and soft foods, small meals, avoid noxious smells
- anti-emetics (compazine)
- motility (reglan)
- ABHR (ativan, benadryl, haldol, and reglan)
