WEEK 7: PALLIATIVE CARE Flashcards
1
Q
PHILOSOPHY OF PALLIATIVE CARE
A
- Philosophy→ dignity
- Ethically appropriate approach→ psychosocial, spiritual, physical and practical care
- Holistic care, valuing all of the past experiences and characteristics of a person, not seeing them solely through their diagnosis
2
Q
PALLIATIVE CARE
A
- An approach that involves 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 early identification and assessment and treatment of pain and other problems
- Provides relief from pain and other distressing symptoms
- Intends neither to hasten or postpone death
- Offers a support system to help patients live as actively as possible until death
- Offers a support system to help the family cope during the patient’s illness and in their own bereavement
- Will enhance quality of life and may also positively influence the course of illness
3
Q
KEY PRINCIPLES OF PALLIATIVE CARE
A
- NEVER true that nothing can be done
- The family and the patient are the unit of care
- Patients priorities are paramount
- The ‘death bed’ consultation is a set of missed opportunities
- Palliative care involves more than just terminal (end of life) care
- Communication
4
Q
PALLIATIVE CARE OUTCOMES
A
- Symptom control
- Reduced inpatient days
- Reduced cost of EOL care/ resource utilisation
- Increased likelihood to achieve preference for place of death
- Prolongation of life
- Reduced carer burden
- Clarity of goals of care and communication
5
Q
PALLIATIVE CARE MISCONCEPTIONS
A
- Only for end of life
- Only for cancer patients
- Automatic commencing of opiods
- Means all active interventions will be stopped
- Is euthanasia by stealth
6
Q
DIAGNOSING DYING
A
- The last hours or days of life
- Decreasing or fluctuating levels of consciousness
- Bedfast/ chairfast
- Experiencing difficulty taking nutrition and oral medication
- Delirium
- Pooled respiratory secretions
- Decreased urine output
- Peripheral vascular shutdown
7
Q
DIAGNOSING DYING: WEAKNESS/ FATIGUE
A
- Decreased ability to move
- Joint position fatigue
- Increased risk of pressure sores
- Increased need for care with activities of daily living, turning, movement, massage
8
Q
DIAGNOSING DYING: DECREASED APPETITE/ FOOD INTAKE
A
- Fears: ‘giving in’ → Starvation
Reminders;
- Food may be nauseating
- Anorexia may be protective
- Risk of aspiration
- Clenched teeth express desires/ control
- Help family find alternate ways to care
9
Q
DIAGNOSING DYING: DECREASING FLUID INTAKE
A
- Fears: Dehydration, thirst
- Support for family, caregivers
- Where assessed it can be managed simply
10
Q
DIAGNOSING DYING: DECREASING BLOOD PERFUSION
A
- Tachycardia, hypotension
- Peripheral cooling, cyanosis
- Mottling of skin
- Diminished urine output
11
Q
DIAGNOSING DYING: NEUROLOGICAL DYSFUNCTION
A
- Decreasing levels of consciousness
- Communication with the unconscious patient
- ‘Terminal’ delirium
- Changes in respiration
- Loss of ability to swallow/ sphincter control
12
Q
DIAGNOSING DYING: CHANGES IN RESPIRATION
A
Altered breathing patterns
- Diminished tidal volume
- Apnoea
- Cheyne- stokes respirations
- Use of accessory muscles
- Last reflex breaths
Terminal respirations
- Info and support for families
- Appropriate medication use
- Positioning
- Mouth care
13
Q
DIAGNOSING DYING: MEDICATIONS
A
- Often no longer able to swallow
- Commencement of a syringe driver if indicated for symptom management
- Conversions of medications (oral morphine to S/C morphine)
14
Q
BEREAVEMENT CARE
A
- Care of the bereaved is an important goal of palliative care
- Understanding of grief responses is therefore important
- Often it is most necessary to normalise feelings of grief
- Open up the space for storytelling
- Help the bereaved to identify persons and places of support
- Rituals and remembering
