1.10 - Palliative Care Flashcards
Define palliative care.
The active, total care of the patient whose disease is not responsive to curative treatment.
Control of pain, of other symptoms, and of social, psychological and spiritual problems is paramount.
What is end of life care?
The care for patients who are likely to die within the next 12 months.
Barriers to recognising deterioration in patients.
- unclear diagnosis
- complex and difficult
- lack of confidence
- fear
- destroy hope
- difficult questions
Trajectories of decline at end of life.
- cancer (short decline)
- organ failure (intermediate with acute episodes)
- frailty or dementia trajectory (gradual dwindling)
Screening tool example for patients approaching end of life.
SPICT - identifies people at risk of deteriorating and dying.
General indicators of decline.
- unplanned hospital admissions
- poor performance status
- dependent on others for care
- carer requiring support
- significant weight loss
- persistent symptoms despite optimal treatment
- decision to reduce, stop or not have treatment
ECOG performance status.
Factors that indicate that dying is immenent.
- bed-bound
- drowsiness
- difficulty taking oral medications
- reduced food and fluid intake
- increased symptom burden
Five priorities for care of the dying person (LACDP).
- Possibility of death is recognised and communicated.
- Sensitive communication between staff and the dying person.
- Dying person is involved in decisions about the treatment and care, to the extent the dying person wants.
- Needs of the families and others is identified as important, and met as far as possible.
- Individual care plan (ie. food, drink, symptom control, psychological support, social support, spiritual support).
Recognising the dying phase.
- shallow breathing
- use of accessory muscles of respiration
- respiratory secretions
- temperature changes
- decreased level of consciousness
- agitation / restlessness
- decreased urine output / incontinence
- difficulty swallowing
Common symptoms in the dying.
- pain
- N+V
- breathlessness
- restlessness and agitation
- respiratory secretions
Anticipatory medications for end-of life care.
- morphine 2.5-5mg SC PRN
- levomepromazine 2.5-5mg SC PRN
- midazolam 2.5-5mg SC PRN
- glycopyronium 200-400mcg SC PRN
Indication of anticipatory morphine.
- pain
- breathlessness
Indication of anticipatory levomepromazine.
- N+V
- restlessness and agitation
Indication of anticipatory glycopyronium.
- respiratory secretions
Indication of anticipatory midazolam.
- restlessness and agitation
Can dying patients eat and drink?
The patient should be supported to eat and drink as long as they wish to do so; discuss the risks of aspiration.
What is the gold standard framework?
A charity providing practical recommendations of end-of-life care, specific to:
- primary care
- care homes
- acute and community hospitals
- hospice support
- retirement villages
- prisons
- cross boundary care
Considerations for care after death.
- death verified
- death certificate
- ensure carers / family can have time alone
- offer to contact funeral director or minister of religion
- offer bereavement support
- inform community nursing team or palliative care team
- organise collection of equipment and medications
- inform relevant health providers / health services
Stages of grief.
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Normal grief reaction symptoms.
- tightness in throat / chest
- lack of energy
- crying
- sleep disturbance
- dreams of deceased
- avoiding reminders
- disbelief
- confusion
- anxiety
- fear
- relief
- loneliness
Effect of bereavement on surviving family members.
- poor health outcomes
- depression
- alcohol and drug dependency
- mortality doubles in the 12 months after death
Priorities at end of life.
- place of death
- avoid prolonged dying
- symptom control
- time to say goodbye
- arrange important affairs
- dignity and privacy
- spiritual and emotional support
- ensure wishes are respected
