FOPC3 - End of life care Flashcards Preview

FOPC > FOPC3 - End of life care > Flashcards

Flashcards in FOPC3 - End of life care Deck (21)
Loading flashcards...
1
Q

What is the most common cause of death?

A

IHD and cancer
Accidents in young
Suicide in males aged 15-34

2
Q

What does palliative care focus on?

A

Management. of conditions until terminal phase reached
Quality of life
MDT approach
Most from primary care with palliative specialist support

3
Q

What are the. 4 step guidelines for identifying palliative care patients?

A

Ask
General clinical indicators
Two or more disease related indicators
Ask patient and family for supportive care needs

4
Q

What is the Palliative Performance Scale based on?

A
Activity
Evidence of disease 
Self-care 
Intake
Conscious level 
Ambulation
5
Q

What is palliative care according to WHO?

A

Relief from pain and other distressing symptoms
Affirms life and regards dying as normal process
Doesn’t hasten or postpone death
Integrates psychological and spiritual aspects
Offers support for patient and family
Team approach

6
Q

Who are part of the palliative care team?

A
GP
District nurse
Pharmacist 
Receptionist 
Care manager 
Palliative specialist 
Religious support e.g Chaplain 
3rd sector: MacMillan, CLAN, Marie Curie
7
Q

What is considered a “good death” in the Western World?

A
Pain free
Open acknowledgement 
At home with family 
'Aware death' - resolve conflicts and unfinished business
According to personal preference
See death as personal growth
8
Q

What is SPICT?

A

Supportive and Palliative Care Indicator Tool - identifies those at risk of deteriorating health and dying

Looks for two or more general indicators of deteriorating health and look for clinical indicators of one or more advance conditions.

9
Q

What are signs of late stage heart disease where supportive and palliative care should take place?

A
NYHA Class III/IV HF
SBP<100
HR >100
eGFR<30
2 or more acute episodes needing I therapy in past 6 months 
SOB/chest pain on minimal exertion
10
Q

What is the function of the palliative performance scale?

A

Assess and monitor change in condition

11
Q

Draw the disease trajectory graph.

A

12
Q

What is the Gold Standards Framework?

A

Offers tools to provide palliative care at home

13
Q

What is important when breaking bad news?

A
Listen 
Set the scene
Find out what patient knows and how much they want to know
Use common language
Review and summarise
Allow opportunity for Qs
Agree follow-up and support
14
Q

What does successful ageing depend on?

A

Individual and socio-cultural factors

15
Q

What are the 5 stages of grief?

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
16
Q

What is the difference for family members between sudden and expected loss?

A

Sudden = more difficult to adjust to

17
Q

What is the DS1500 form?

A

Used for benefit claims for last 6-12 months of life (jump list for housing, access to benefits etc)

18
Q

What medications should be prescribed in terminal phase?

A

For:

  1. Pain (opioids e.g morphine, fentanyl patches, NSAIDs)
  2. Agitation (benzodiazepines e.g midazolam)
  3. Respiratory secretions (anticholinergic drugs e.g hyoscine butyl bromide)
  4. Nausea (Anti-emetic e.g haloperidol, cyclizine, metoclopramide, levomepromazine)
  5. Breathlessness (positioning, fan, cool environment, oxygen, benzodiazepines, opioids)

*Administer via subcutaneous bolus or continuous subcutaneous infusion over 24hrs or via syringe pump.

19
Q

What comfort measures are taken in last days of life?

A

Review meds
Reduce medical intervention to a minimal
Symptom control drugs
Regular oral care
Skin care
Bladder and bowel care
Always consider possible sources of stress other than pain

20
Q

What is required for good care of the dying patient?

A
Recognition 
Care objectives
Resuscitation status clarification 
Good communication 
Consider place of care
Multiprofessional care
Drugs
21
Q

How do you recognise a patient is dying?

A
Daily continuous deterioration 
Profound weakness and drowsiness
Difficulty taking things by mouth 
Poor concentration 
Disorientation 
Reduce peripheral perfusion with changes in skin colour and temperature
Breathing pattern may change 
PPS is 10%