Palliative care Flashcards
(24 cards)
Define palliative care:
An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by treatment of pain and other physical, psychosocial and spiritual problems.
Model of care for palliative patients:
- Primary palliative care (primary care): provide learning and development opportunities for primary and secondary care providers
- Consultation - liaison (intermediate care): provide consultation and advice to primary and secondary care providers
- Shared care (intermediate care): with primary and secondary providers
- Direct care (complex care): in the community and in designated beds
Potential symptoms to deal with:
- Pain
- Xerostomia (dry mouth)
- Anorexia/cachexia
- Nausea/vomiting
- Dehydration
- restlessness
- confusion
- dyspnoea
- fatigue
- constipation
- diarrhoea
- pruritus
Types of pain:
- Somatic
- Visceral pain
- Neuropathic
Somatic pain
- Superficial: skin, mucous membranes
- hot, sharp, stinging, well localised
- eg. malignant ulcers, mucositis
- Deep: connective tissues, lymph nodes, organ capsules
- dull, ache, throbbing, well localised, incident & referred pain
- eg. bony metastases, liver capsule pain
Visceral pain
- organs, deep tumours, deep lymph nodes
- dull, deep, cramping pain, poorly localised, referred pain
- eg. deep abdominal/mediastinal masses
Neuropathic pain
- shooting, stabbing or burning
- caused by damage to or dysfunction of the nervous system
eg. allodynia, hyperalgesia, hyperpathia
Syringe drivers
- Constantly applies analgesia over 24hrs
Causes of nausea & vomiting:
- The disease itself
- medication
- chemo/radiotherapy
- constipation
- chemical imbalance
- hormonal imbalance
- anxiety and fear
- mechanical obstruction
- *must be treated because it will affect appetite
Fatigue: causes & management
- related to lack of sleep, low O2, poor diet, depression, chemo/radiotherapy, infection, disease
- management: energy conservation, management of sleep disturbance, treatment of underlying cause, rest periods
Dyspnoea/breathlessness: causes & management
- causes: lung disease, asthma, emphysema, chest infection, pressure from other body organs, anaemia, anxiety
- management: comprehensive assessment, symptomatic relief, energy conservation, drugs, trials of oxygen
Constipation:
- patient on opioids require aperients
- faecal impaction can be life-threatening
- can lead to nausea & vomiting, agitation
Pruritus
- itching is a form of pain and needs to be treated with the same concern
- can be caused by severe liver or renal disease or failure
- goal of care: reduce symptoms, protect skin
Pruritus
- itching is a form of pain and needs to be treated with the same concern
- can be caused by severe liver or renal disease or failure
- goal of care: reduce symptoms, protect skin
Dehydration:
- Symptoms: headache, nausea, vomiting, cramps, dry mouth, cracking of oral mucosa and inflammation
- often iatrogenic (medically created) due to medications (eg. morphine, anti-depressants, anti-nausea
- Management:
- rehydration often causes more problems than it cures
- small, frequent sips to satisfy thirst
- icy-poles/ice chips
- keep mouth clean and moist
Characteristics of a good assessment:
- acknowledges patient goals of care
- assess whole person and family unit
- standardised tools can support practice and provide information
- is proactive
- facilitates collaboration
Goals of care:
- maintaining and improving function
- staying in control
- relief of suffering
- living well
- quality of life
- pain and symptom management
- relieving burden for family members
- strengthening relationships
- preferences for location of care/death
- life closure/dying well
Assess needs for support/referral:
- 24/7 support
- home support, equipment or supplies
- psychosocial care for person/family
- spiritual care
- disease management
- preparing for dying
- bereavement process
Characteristics of end-stage care:
- sleepiness and difficulty waking (semi-conscious)
- difficulty swallowing or not wanting to eat/drink
- incontinence
- restless movements
- changes in breathing - noisy
- temperature changes
- cold feet, hands, legs, arms
- confusion and disorientation
- complete loss of consciousness
Markers of the dying phase:
- patient withdrawing
- refusing tablets, food, drink, basic care
- decreased oral intake
- decreased circulation, tachycardia, mottling
- changes in breathing patterns with respiratory congestion or apnoea
- changes in level of consciousness
- confusion, agitation, delirium
- changes in perception
Define bereavement
the loss of a significant person and also the period of adjustment for the bereaved after the loss
Define grief
The normal response to the loss of someone or something precious
Define mourning
the social expression of grief after a death, associated with rituals and behaviours within the appropriate religious and cultural context
Who can verify and certify death?
Medical practitioners, nurses, midwives and paramedics can verify death.
Only medical practitioners can certify death.
