disease and palliative Flashcards
End of life care
Also known as comfort care or terminal care.
End of life care focuses
End of life care focuses
important factors to patients
and their families at the end of life
Pain and symptom management. Preparation for the end of life. Relationships between patients, families and health care workers. Achieving a sense of completion.
End of life care communicate
Experienced palliative carers need to have
some idea when patients are going to die so
that they can communicate this to the patient
(if possible) and the family/ caregivers.
Signs that people are entering the last stage of
life are:
profound weakness, diminished intake
of food or fluids, drowsiness, disorientation,
bed-bound, unable to co-operate with carers.
Australian modified Karnofsky rating scale 100— 90— 80— 70— 60—
100—Normal with no complaints or evidence of disease 90—Able to carry on normal activity, but with minor signs or symptoms of illness present 80—Normal activity but requiring effort. Signs and symptoms of disease more prominent 70—Able to care for self, but unable to carry on normal activity or to do active work 60—Able to care for most needs, but requires occasional assistance
Australian modified Karnofsky rating scale 50— 40— 30— 20— 10— 0—
50—Considerable assistance and frequent
medical care required; some self-care
possible
40—In bed more than 50% of the time
30—Almost completely bedfast
20—Totally bedfast and requiring extensive
nursing care by professionals and/or family
10—Comatose or barely rousable
0—Death
More signs and symptoms of
impending death
Decreased bladder and bowel activity.
Incontinence of these functions as muscles relax.
Disorientation and restlessness.
Elevated temperature but cold and clammy skin due to
shutdown of brainstem.
A bluish tinge or cyanosis to the fingers and toes.
Lowered blood pressure.
Noisy/ irregular breathing. “Moaning” may occur but is only
the result of breathing through relaxed vocal cords.
Cheyne Stokes respiration.
4 themes good death
Life completion
Treatment preferences
Dignity
Family
What is a “good death”?
A death free from pain, symptoms and suffering.
The sense of a life well lived.
A sense of control and independence: of being
able to prepare for death and make choices.
Clear decision making.
A sense of community.
A sense of completion.
Contributing to others.
Affirmation of the whole person
Clear decision making end of life
treatment preferences were unclear and
patients felt disregarded, family members confused,
and providers felt out of control and feared that they
were not providing good care.
Decisions that had not previously been discussed usually
had to be made during a crisis, when emotional
reserves were already low
Patients feel empowered by being involved in their
treatment plans.
Preparation for death
Patients sometimes like to know what will happen when
they die.
Some like to make a will and arrange their funeral: songs,
letters, DVDs.
Family members like to know what the physical and
psychosocial symptoms of death may be.
Patients, carers and caregivers emphasise the importance
of spirituality and meaningfulness at the end of life.
A feeling of completion end of life
Resolving conflicts, saying good-bye, spending time
with family and friends.
They may need to transfer legal responsibilities.
Closure of social responsibilities: may include
expressions of regret, gratitude, forgiveness.
Reconciliation.
Saying goodbye.
Life review: telling “one’s stories”.
Self acknowledgement and forgiveness.
Acceptance
Contributing to the wellbeing of
others end of life
Terminal patients find it important to know that
they mean something to others.
Their contribution could be in the form of a
bequest, a gift or knowledge.
Many family members tell nurses : “ my
husband/ wife asked us to give this to you”.
They may agree to participate in a clinical trial.
Affirmation of the whole
person
The patient likes to be seen as a unique and
whole person.
They especially appreciate empathetic nurses.
They like to be seen as a person, not a disease.
