Care of the dying patient Flashcards
What are the 4 main stages of end of life?
Living with a life-limiting condition
Period of decline and indications of decline
Last days or hours
Actively dying
What is involved in living with a life-limiting condition?
- Start anticipatory care planning
- Are prescribed drugs still needed
- Is the patient or family aware of focus on palliative care
- Consider resuscitation status
- Power of attorney in place
What is involved in period of decline?
- Decreasing activity, mobility and function
- Increasing need for support
- Choice of no further active treatment
- Review ACP
- Request just in case medication
- Increasing symptoms of complications and adverse effects
What is involved in last days of hours?
- Unneccessary medications stopped
- Family supported and updated
- Wishes accounted for
What is the LASTBreath mnemonic for active dying?
- L - Lethargy - Weak, bed-bound, increasingly sleepy
- A - Altered mental state - Confused, restless, agitated
- S - Skin changes - Pale, blue, mottled, cold
- T - Tablets - Tablets and oral intake diminished or stopped
- Breath - Breathing changes - Rattly, rapid, intermittent
What are some signs of a patient entering the dying process?
- Progressive weakness and reducing performance status
- Progressive fatigue, sleepiness or unconsciousness
- Loss of interest in food or fluid
- Changes in breathing patterns
What are some treatable conditions that can mimic dying?
- Opioid toxicity
- Sepsis
- Hypercalcaemia
- Hypoglycaemia
- Uraemia/AKI
What are the 4 key principles of caring for a dying patient?
- Communication with patient and family
- Decisions made by MDT
- Recognise and address physical, psychological, social and spiritual needs
- Consider wellbeing of relatives or carers
What is the REDMAP framework for communication with dying patient and family?
- R - Ready - Can we talk about your care?
- E - Expect - What do you know / Want to ask?
- D - Diagnosis - What we know / don’t know
- M - Matters - What matters to you?
- A - Action - This can help / This will not help
- P - Plan - Let’s plan good care for you and your family
What documentation is required from a dying patient?
DNACPR
ReSPECT form
What are the 3 categories of prioritising comfort and dignity?
Stop
Start
Don’t forget
What is involved in the stop process of prioritising comfort and dignity
Stop:
- Unnecessary medications
- Routine observations
- Remove unused cannulas
What is involved in the start process of prioritising comfort and dignity
Start:
- Anticipatory medications (Symptom control)
What is involved in the don’t forget process of prioritising comfort and dignity
Don’t forget:
- Plan for essential oral medications (Convert to alternate form)
- Urinary retention as a cause of agitation (Catheter)
- Appropriate environment and equipment
- Holistic and spiritual support to family members
