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Elderly YR3 > Palliative care and Death Certification > Flashcards

Palliative care and Death Certification Flashcards

1
Q

What should be done, where possible, with regards to end of life care?

A
  • Advanced decision making re wishes of care inc resucitation and treatment options
  • Discuss this with pt and family
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2
Q

When is palliative care important?

A
  • When curative care is not possible and care needs to switch to more hollistic approach
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3
Q

What tool was previously used in terms of end of life care which has now been scrutinised?

A
  • Liverpool care pathway - care should now be individualised for each patient and concentrate and focus on theri needs
  • Individualised care plans should be completed
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4
Q

Eating and drinking at EOL

A
  • Still able to enjoy food and drink if they are conscious and safe to swallow
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5
Q

Priority for EOL

A
  • Dignity
  • Comfort
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6
Q

What are advanced directives?

A
  • State how patients wish to managed at end of life if they are unable to communicate it themsleves
  • These must be seen and reviewed
  • Patients are able to refuse treatment but not request
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7
Q

When can end of life/dying phase be recognised - at what stage of disease?

A
  • Bed bound
  • Semi-comatose
  • Only able to take sips of fluid
  • Unable to take medicine orally
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8
Q

Symptoms of people facing EOL

A
  • Pain
  • N+V
  • Dyspnoea
  • Agitation
  • Confusion
  • Constipation
  • Anorexia
  • Terminal secretions
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9
Q

What type of care should continue and be stopped at EOL?

A
  • Personal care continue
  • Observations if no longer appropriate - stop
  • Regular mouth care prescribed and given
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10
Q

What staff can support at EOL care?

A
  • Macmillan nurses
  • Palliative care team
  • Hospices and community hospital beds are available for pts with ongoing treatment or support - majority can be cared for at home
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11
Q

Who does death certification?

A
  • Medical doctor
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12
Q

What is involved in certification process?

A
  • Checking pupils are fixed and dilated
  • No response to pain
  • No breath or heart sounds after 1 minute of auscultation
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13
Q

What happens after death is certified?

A
  • Patient transferred to mortuary and bereavement services
  • A doctor who has cared for the patient within the last 14 days completes the death certificate and cremation paperwork
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14
Q

How does the death certificate state cause of death?

A

1a - Cause of death
1b - Condition leading to cause of death
1c - Additional condition leading to 1b
2 - any contributing factors/conditions

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15
Q

Example of death certificate cause of death layout

A

1a - Type 2 respiratory failure
1b - Congestive cardiac failure
1c - Myocardial infarction
2 - ischaemic heart disease, Hypertension, Diabetes mellitus

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16
Q

How is cremation paperwork completed?

A
  • 2 independent doctors
  • One must have cared for the patient
  • Part 1 is completed by doctor who knows pt
  • Part 2 is completed by independent doctor, 2 years post registration seeking confirmation of cause of death from variety of sources
17
Q

What must be removed before cremation?

A
  • Body pacemakers
  • Radioactive implants
18
Q

What to be aware of re beliefs post death?

A

Some religions require burial within 24hrs

19
Q

When should death be reported to coroner?

A

When a doctor knows or has reasonable cause to suspect the death:
* Occurred as a result of poisoning, use of controlled drug, medicinal product or toxic chemical
* Occured as a result of trauma, violence or phsyical injury, whether inflicted intentionally or otherwise
* is related to any treatment or procedure of a medical or simular nature
* occurred as a result of self harm (inc failure to preserve their own life) whether intentional or otherwise
* injury or disease received during or attributed to course of persons work
* occured as result of a notifiable accident, poisoning or disease
* result of neglect or failure by another person
* was otherwise unnatural

20
Q

When else should coroner be informed?

A
  • Death occurred in custody of state detention (inc DoLS)
  • No attending practitioner attended the deceased at any time in the 14 days prior to death or no attending practitioner is available withina reasonale period to prepare an MCCD
  • Identity of deceased is unknown
21
Q

What is the role of coroner?

A
  • Determine who died
  • Where they died
  • How they died
  • They do not comment on care but have powers to insist on further local investigation
  • Can decide to hold an inquest to ascertain answers to the questions above
22
Q

When is Amber care used in hospital?

A

If think have maybe weeks/months to live
Unsure if will survive this admission

23
Q

Dr role in palliative care

A
  • Identify those who need it
  • Evaluate pt
  • Anticipate problems and minimise progressive problems
  • Manage distressing symptoms
  • Educate family and pt on prognosis
  • Clarify treatment goals
24
Q

3 triggers to think about that can suggest rapid decline in organ function and potential need for palliation

A
  • Suprise - would I be suprised if patient died in a few months, weeks, days
  • Decline - deterioration, increased requirements for treatment eg O2
  • Specific clinical indications depending on condition
25
Q

Palliative care emergencies

A
  • Spinal cord compression
  • SVCO
  • Hypercalcaemia - occurs in bone mets
  • Seizures - bone mets, abnormal sodium
  • Neutropenic sepsis - chemotherapy, less than 500 neuts and sepsis
  • Severe haemorrhage - clotting deranged
26
Q

What does AMBER care involve?

A
  • Assessment
  • Management
  • Best practive
  • Engage with family and pt
  • Review, reversibility limited? outcome uncertain?
27
Q

Things to consider when someone is on AMBER care

A
  • Patient preferences - place of preferred care etc
  • TEP/DNACPR
  • Remove unecessary medications
28
Q

Daily review of AMBER care patients involves

A

ACT
* Still suitable for amber?
* Any medical changes
* Talked to pt and family today?

29
Q

When is AMBER care stopped?

A
  • Recovery from acute illness
  • Dying person care plan instead
  • Likely dying
  • Transfer to another place where they are not familiar with AMBER care
  • Discharged
30
Q
A

Elderly YR3 (14 decks)

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