20 - Palliative Care Flashcards
What is the WHO definition of palliative care?
- Care that improves the quality of life of patients, and their families, that have life-threatening illnesses
- Prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.
What are some diseases other than cancer that may result in needing palliative care?
- Alzheimer’s
- COPD
- Dementia
- Frailty
- Heart Failure
- HIV
- CKD
- Mitochondrial disease
- Meningitis
What is advanced care planning?
A plan made between a healthcare professional and a patient to inform their future healthcare decisions based on the patient’s personal values, beliefs and wishes
Helps relieve family anxiety as decisions made by patient early in their disease whilst the patient still has capacity
Look at illness trajectory in this and can include ReSPECT
When are patients classified as ‘approaching the end of life’?
What is the way of defining frailty as a clinical syndrome?
- State of increased vulnerability as decreased physiological reserve!!
- People who are frail would have a sharp decline to a stressor due to this lack of reserve
What is the illness trajectory of the following?
- Cancer
- Organ failure
- Frailty
- Dementia
- Vascular dementia is step wise manner
How may you recognise that a patient is nearing the end of their life?
- Would you be surprised if this patient died in the next 12 months?
- Common symptoms of advanced illness (see image)
- Exacerbations may worsen/become more frequent and patient may not recover to their baseline after each episode
What are some things you need to explain to patients’ family when they are dying and how can you offer them advice to help their family member?
- Loss of appetite: explain it takes a lot of effort and they don’t need the food because they aren’t expending energy. Offer drink through straw, moisten mouth with damp sponge, apply lip balm if lips look dry
- Death Rattle/Cheynne Stokes: due to not being able to swallow or reabsorb secretions. Give a patient a fan or an open window. Change person’s position if breathing very rattly
- Person may be a lot sleepier: they have less energy to take part but can still hear you so communicate with them
- Person may be more agitated: may be hallucinating or may be constipated etc so try to comfort them and let them know that you are there
- Skin may go cold or change colour: this is normal part of the dying process
- Person may lose continence: clean them to keep them comfortable
What are some measures in place to help the death rattle?
- Lay patient on their side
- Oropharyngeal suction
- Anticholinergics like hyoscine butylbromide to dry up secretions
What is the definition of the following terms that are used in medical ethics:
- Beneficence
- Non-maleficence
- Autonomy
- Justice
What do the following terms mean when thinking about ethical issues relating to end of life care?
- Presumption in favour of prolonging life
- Presumption of capacity
Presumption in favour of prolonging life
Decisions concerning potentially life- prolonging treatment must not be motivated by a desire to bring about the patient’s death, and must start from a presumption in favour of prolonging life
Presumption of capacity
You must work on the presumption that every adult patient has the capacity to make decisions about their care and treatment
Doctors are bound to respect a refusal of treatment from a patient who has capacity and, if they have an objection to the refusal, they have a duty to find another doctor who will carry out the patient’s wishes.
What are some treatments that are debated as to whether to administer or not when patient’s are at the end of their life?
What is a ReSPECT form?
Recommended Summary Plan for Emergency Care and Treatment
- Individualised care for a patient if they are in a situation in the future where they cannot make decisions for themselves. Can decide what they want and don’t want!!*
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What do you need to do before carrying out the ReSPECT process?
- Capacity Assessment
- If lack capacity have a family member or legal proxy decide what the patient would have wanted!!!
What are some important questions to ask during the ReSPECT process?
- What do you understand about your medical condition?
- Do you need any further support?
- What is important to you?
- What concerns do you have?
- What treatments would you/wouldn’t you want?
ReSPECT is not legally binding, can be reviewed regularly!! It is not a DNACPR
How can you easily remember the difference between a transudative and an exudative pleural effusion?
Transudate: all the failures
Exudate: infection and cancer
What are two lists that you need to think about creating when planning the care for an end of life patient?
- Problem list (current conditions and how they are being managed and who in the MDT is responsible for this)
- Anticipated problems (what might you forsee that could cause the patient to deteriorate)
Why does heart failure lead to death?
- Ventricles gets so stretched that electrical activity cannot conduct as well so malignant arrythmias ,e.g VF, can start
- Often put in an ICD
