Flashcards in Palliative Care Deck (30):
What are the three truths about dying?
1. we dont really mind death
2. our biggest loss is emotional
3. our biggest hope is spiritual
Why are we afraid of death?
- in the last 100 years we have quarintiened death
-people are now taken to a hospital and a sheet placed over them when they die and then to make sure they are gone they are cremated
Why is death good?
- when people get old they lose all function and cannot live by themselves and thus are misserable
What are the ECOG ratings?
0 = fully active
1 = restricted in physically strenuous activity
2 = self care but only for 50% of day
3 = limited self care for less then 50% of the day
4 = completely disabled
5 = dead
What happens in the last week of life?
- weakness and fatigue
- lack of appetite
- lack of interest in surroundings
- restlessness and confusion
What happens in the last hours of life?
- all die of circulatory failure
- brain, kidney, liver and skin
- the end is more distressing for the family than the patient
- abscence of life
What is medical death?
- absent pupil reflex
- no pulse, respiration
- no brain activity
What are the considerations of the person?
Define palliative care
- to cure sometimes, to relieve often, to comfort always
- easing the severity of pain associated with disease or illness without removing the cause
What are some factos associated with pallliatice care?
- affirms life and treats dying as a normal proccess
- neither hastens nor postpones death
- provides relief from pain and other distressing symptoms
What does palliative care integrate?
- physical, psychological, social, emotional and spiritual aspects of care with coordinated assessment and management of each person' needs
What are the generalised effects of cancer?
- weight loss
- increasing pain
What are the specific effects of cancer?
- metabilc e.g. raised calcium
- mass effects
- fungating wound
What are the effects of morphine?
- drawsiness and impaired concentration
- nausea and vomitting
What is temporal effects?
- patient feels fine now but later on feeling severly worse
What are other factors to consider in palliative patient care?
- bucket list
- advanced directives
- financial planning
- special events
- funeral planning
What is the role of RT in palliative care?
- make you feel better but RT can make you feel worse first
- need to think about patient shouldn't just treat for the sake of treating
What are the aspects to decide if RT is used for palliative patient?
- will RT help
- prognosis (if patient is going to die tomorrow then dont treat)
- patient factors
- alternatives (e.g. is a stent possible instead of 10 days of RT)
- dose fractionation
What are some indications of SC compression?
- pain increasing
- bladder and bowel dysfunction
What is the RT role in SC compression?
- 1 to 10 days
- 80:20 rule
- side effects: nausea and fatigue
What happens in an emergency SC compression?
- rapid onset of symptoms leading to irreversible paralyss
- early intervention allows for preservation of neruological function in up to 80% of people
- reduces pain
What is the managmenet of an emergency SC compression?
- emergency RT to 30Gy in 10 fractions
- pain management
What are the challenges in treating CNS?
- pain, confusion, immobility, neurological, other cancer effects (steroids, morphine)
- drug effects, depression, cycle of loss, anger, fear
- faith or lack of faith, miracles
- mask, timing of treatment, family, conflicitng interests, swelling from steriods
What are the beam arrangment options for spine RT?
- ant and post
- 2 post oblique, 1 lat, 1 ant oblique and 1 ant
What are the common side effects from RT and how are they treated?
- nausea: zofran
- diarhhoae: gastro-stop
- burning: skin lotion
- muscositis: opioids
- hair loss: none
- fatigue: none
- oesophagitus: mylanta
How do we manage palliative patients?
- allow space
- understand journey: changes will occur
- faimly members are also experiencing loss so may be part of care process
What are the emotions realted to dying?
- loss and grief
What are the three factors that make up the "whole person"