A good death Flashcards
What are some of the challenges we might face when we can’t cure a patient?
- Trained to look for drugs/cures to prolong life and delay death
- Want to preserve hope in the patient and their family which may promote the use of ineffective treatments
- May make the transition to end of life care much more difficult
- Difficult to come to terms with personally, need to be appropriately detached but also completely compassionate
What are the main principles of palliative care?
- Accurate assessment of need in the physical, psychological, social and spiritual domains
- Comfortable, not curative
- Multi-disciplinary approach
- Patient-centred care
- Accurate record keeping
How is nausea and vomiting (as an end-of-life symptom) managed?
Several potential causes - anxiety, medication, GI obstruction, constipation
Identify cause and choose appropriate anti-emetic and effective route of administration
Non-pharma: avoiding strong smells, eating small portions.
Consider hydration status of the patient.
How is dyspnoea (as an end-of-life symptom) managed?
Common advanced cancer, COPD, heart failure and pulmonary fibrosis.
Treat reversible causes (infections, anaemia, arrhythmia), giving opioids, corticosteroids, benzodiazepines (to relieve any anxiety). Give oxygen therapy and nebulisers if needed.
Non- pharma: using a fan, breathing exercises, anxiety management techniques and activity management
How is constipation (as an end-of-life symptom) managed?
Could be due to use of opioids, effects of disease, reduced appetite or dehydration.
Treat with stimulant laxatives (Senna) or osmotic laxatives (Macrogol). If unsuccessful consider rectal treatments such as suppositories or enemas.
Non-pharma: good fluid intake, review of diet, regular exercise.
How is anxiety/depression/agitation (as an end-of-life symptom) managed?
Natural feelings
Socially isolated and those with poorly managed symptoms are particularly vulnerable.
Agitation and confusion could be caused by opioid toxicity, constipation or uncontrolled pain.
Treatment: anxiety (Lorazepam or Diazepam), depression (SSRI), agitation/confusion (sedation or Haloperidol).
Non-pharma: involved in decision making, relaxation therapies, repeated reorientation with clock/calendar and key family members.
How is pain (as an end-of-life symptom) managed?
Caused by the illness itself or side-effects of medication
Mild pain (paracetamol/ibuprofen), moderate pain (codeine) or severe pain (Strong opioid such as morphine/oxycodone).
Morphine can be given as immediate release or modified release.
Syringe pumps used to administer medication in palliative care patients who can’t take oral medication
Non-pharma: acupuncture, occupational health, physio
How is fatigue/weakness (as an end-of-life symptom) managed?
Severity and effects may change during the course of the disease
Detrimental to quality of life as well as cognitive ability in decision-making.
Non-pharma: activity diary, energy conservation plan, physical activity and exercise, sleep pattern advice, anxiety management and relaxation therapy
How are excessive respiratory secretions (as an end-of-life symptom) managed?
Common in the last days of life
Fluids accumulate in airways causing gurgling and rattling (no pain)
Conservative management: Re-positioning the patient so that the upper body is elevated, encouraging drainage of fluid as well as suction of fluid.
Atropine can help reduce saliva and other body secretions
How is dehydration/loss of appetite (as end-of-life symptoms) managed?
Common in advanced life limiting illness
Dysphagia is common in illnesses that effect brain and muscles such as motor neuron disease and MS.
Soft diet, thickened fluids, extra oral support, and artificial nutrition, offering smaller meals, planning meals, encouraging social eating.
Speech and language therapist referral.
Mouth care near the end is important - sponge sticks, ice chips, water soluble lubricant
What is palliative care?
Holistic way of providing comfort to patients who are suffering from end of life illnesses and also for their families. It’s generally associated with cancer patients but can be for a number of conditions including organ failure as well as the elderly frail/dementia.
Keeping patients free from symptoms and as pain free as possible.
What is the Gold Standard Framework (GSF) for palliative care?
5 main goals including ensuring symptom control, allowing patients to die in their preferred place of care as well as educating staff and increasing confidence and competency. The 3 main key processes are identifying the needs, accessing the needs, symptoms, preferences and any other important issues with the patient as well as planning.
What is the Liverpool care pathway?
Initially created for generalist staff on hospital wards but then extended to GP and care homes.
Tends to be used in the last few hours/day of life.
Covers the physical, psychological, social and spiritual aspects of care.
Which healthcare professionals are involved in palliative care?
GP: key contact for the patient and their families, have the ability to provide and refer to arrange specialist care.
District nurses: provide medical care at home and have key up to date information to provide palliative needs. Important for delivery of equipment and counselling.
Specialist social workers trained for end-of-life help
Hospice: support for family and carers in end of life and bereavement.
Families: keep them well informed and involved, support through the bereavement stage.
What are some of the challenges associated with palliative care in the community?
Lack of 24-hour care such as night nurses
Struggles to be able to access equipment.
Lack of bereavement and carer support.
Specialist palliative care services and respite services are limited.
Inequalities across end of life care.
Communication difficulties between different members of the community palliative care team.
Provisions in the UK for palliative care tends to favour cancer treatment.
