end of life and patients Flashcards
(55 cards)
define palliative care
improves the quality of life of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification impeccable assessment treatment of pain and other problems, physical, psychosocial and spiritual
what are the principles of end of life care
• Open lines of communication
• Anticipating care needs and encouraging discussion
• Effective multidisciplinary team input
• Symptom control – physical and psycho-spiritual
• Preparing for death - patient & family
• Providing support for relatives both before and after
death
early identification
what should be discussed in advanced care planning
Wishes / preferences / fears about care
• Feelings/ beliefs / values that may influence future
choices
• Who should be involved in decision making?
• Emergency interventions e.g. CPR
• Preferred place of care
• Religious / spiritual / other personal support
• May wish to make an Advance & Anticipatory care plan /
formalise wishes regarding care
types of formal wishes
advance statement
advance refusal
power of attorney
how do you asses the validity of advanced decisions
- Is it clearly applicable?
- When was it made?
- Did the patient have capacity when it was made?
- Was it an informed decision?
- Were there any undue influences when made?
- Has the decision been withdrawn?
- Are more recent actions / decisions inconsistent?
what is empathy
understanding another person’s feeling
what is sympathy
being affected, entering or sharing the feelings of another, compassion and commiseration
what 4 areas of care must always be maintained
must act in accordance with legislation
must not be unfair
must not deny access to services
must not cause patients distress
what 3 areas does the BMA support conscientious objection?
abortion (abortion act)
fertility treatment ( human fertilisation and embryology act )
withdrawl of life sustaining treatment
describe Janaway case
secretary refused to write abortion letters
describe eweida and others
british airways refused to let employee wear a cross
what limitations are placed on religious freedoms
prescribed by law and are necessary in a democratic society in the interests of public
safety, for the protection of public order, health or morals, or the protection of the rights and freedoms of others.
what are the 4 arguments against conscientious objection
inefficiency and inequality
inconsistency
commitments of a doctor
discrimination
what are some of the complications of iV drug admin
phlebitis infection thrombosis extravasation anaphylaxis overdose
what is red man syndrome
hypersensitivity to vancomycin
how does first order kinetics apply to drug elimination
the amount of drug eliminated per unit time is proportional to the conc of drug in the plasma
plasma conc will tend towards a plateau or equilibrium
input = output
Css
what is clearance
the volume of blood cleared of drug in a unit time
it is a CONSTANT
but amount of drug eliminated per unit time varies, hence graph slopes down
Css=
rate of drug administered (Ko) / Clearance
what determines the time taken to reach Css
elimination half life (t 1/2)
Css depends on the rate of drug in and the rate of clearance
what is the half life dependant on
volume of distribution and clearance
what is health promotion
the process of enabling people to increase control over and to improve their health
what are the methods of health promotion
provide information enhance motivation behavioural methods health behaviour maintainance and relapse prevention combined programmes CBT motivational interviewing gain vs loss training, reminding, reinforcing slimming clubs
what is an example of primary prevention
walking campaign HEBS
describe the stage model
pre contemplation contemplation preparation action maintenance relapse
