Ageing and end of life care Flashcards
Define what is meant by palliative care
It is an approach that improves 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 means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
What are the general principles which would then consider a death as a ‘good death’?
- Freedom from pain / distress
- Peaceful
- Loved ones nearby
What are the scottish guidance principles on end of life care (EOLC)?
- Informative, timely and sensitive communication is essential
- Significant decisions about a person’s care, including diagnosing dying, are made on the basis of MDT discussion
- Each individual person’s physical, psychological, social, and spiritual needs are recognised and addressed as far as possible
- Consideration is given to thewellbeing of relatives or carers attending the person.
What are the 10 key elements for care of someone who is dying ?
- Recognition that the patient is dying
- Communication with the patient (where possible) and always with family and loved ones
- Spiritual care
- .Anticipatory prescribing for symptoms of pain, respiratory tract secretions, agitation, nausea and vomiting, dyspnoea
- Review of clinical interventions should be in the patient’s best interests
- Hydration review, including the need for commencement or cessation
- Nutritional review, including commencement or cessation
- Full discussion of the care plan with the patient and relative or carer
- Regular reassessment of the patient
- Dignified and respectful care after death
What should you do before diagnosing someone as dying ?
Ensure there is no reverisble factors and seek a senior opinion
What are some of the potential signs that someone is dying ?
- Worsening weakness and performance status
- Worsening physiological status with no reversibility
- Struggling to manage oral medicines
- Losing interest in food and fluid
- Sleeping more, eventual unconsciousness
Describe the WHO analgesic ladder
- Non-opiods e.g. aspirin, paractamol or NSAID
- Weak opiod e.g. codeine
- Strong opiod e.g. morphine
Describe how you would commence treatment with morphine
Initially (titration phase):
- Give oromorph 4hrly (qds) ==> 6 x’s in one day
- Also give breakthrough oromorph PRN
After 24hrs:
- Total the morphine dose given in 24hrs and divide by 2, giving the MST (long acting) 12hrly doses needed 2x’s daily
- Also presribe breakthrough oromorph at doseage of 1/6th of total daily dose required for breakthrough pain PRN
- Also prescribe laxative e.g. senna, laxido
- Also prescribe an antiemetic if required e,g, metoclopramide (not this one in parkisons)
What are some of the common side effects of morphine ?
- Constipation
- Nausea
- Drowsiness
- Resp depression
Often oral route is not possible in pallative care so what delivery device is used when oral route not possible ?
Continuous subcutaneous infusion using a syringe driver
Describe how a synringe driver works
- SC access gained with butterfly needle with connector tubing
- Upto 3 medicines can be infused together in a syringe driver and the infused over 24hrs
What needs to be done when coverting from oral (PO) to S/C morphine ?
Dose given needs to be changed as S/C 2x’s as potent so dose given needs to be divided by 2
What are some of the other drugs commonly given in palliative care and why?
- Pain/SOB ==> morphine
- Distress ==> midazolam (it is a benzo i.e. sedative)
- Nausea/agitation ==> Levomepromazine (antipsychotic)
- Resp secretions (often ratteling noise when dying) ==> Buscopam reduces this
What is often give to palliative care patients for symptom control in home if needed
Just incase boxes
